Pain on bottom of foot under toes

What Is Metatarsalgia?

Metatarsalgia is a common overuse injury. The term describes pain and inflammation in the ball of your foot. It’s often thought of as a symptom of other conditions, rather than as a specific disease.

Metatarsalgia Symptoms

The main symptom of metatarsalgia is pain at the end of one or more of the metatarsal bones. Those are the bones in the ball of your foot, closest to your toes. 

• The pain can be sharp, a dull ache, or a burning feeling.

• You may feel like you’re stepping on a pebble.

• The pain is typically worse  when you walk or run.

• You may feel tingling or numbness in your toes. 

• Athletes who take part in high-impact activities and also have an inflammatory condition like bursitis often have more widespread pain in the ball and middle of the foot. 

Most often, the pain comes on over a period of several months, rather than suddenly.

Metatarsalgia Causes

The pain of metatarsalgia comes from too much pressure on one spot in your foot. It often results from the pounding your feet take during high-impact sports. Or you may have something unusual about your bones or muscles that affects the way pressure is distributed on your feet, such as: 

• A short first metatarsal bone or a long second metatarsal bone 

• Prominent metatarsal heads

• Tight toe extensors (muscles)

• Weak toe flexors (muscles)

• Hammertoe deformity

• Hypermobile first foot bone

• Tight Achilles tendon

Other things that can cause metatarsalgia include:

• Excessive pronation (side-to-side movement of the foot when walking or running)

• Shoes that don’t fit well  

• Being overweight

• Stress fractures in your toes or metatarsals

• Bunions 

• Torn ligaments in your feet

A condition known as Morton's neuroma (interdigital neuroma) also causes metatarsalgia-like symptoms. Extra tissue builds up around a nerve, usually between your third and fourth toes. The irritated, inflamed nerve causes pain.  Morton's neuroma can also cause toe numbness in addition to pain in your forefoot.

Metatarsalgia Risk Factors

In the U.S., forefoot injuries, including metatarsalgia, are common in athletes who participate in high-impact sports. Activities that involve running or jumping are most often to blame. While track and field runners are most at risk, other athletes, including tennis, football, baseball, and soccer players, often get forefoot injuries.

Other factors that raise your odds of metatarsal pain include:

• Having a high arch

• Wearing high heels

• Certain illnesses that cause joint inflammation, like osteoarthritis, rheumatoid arthritis and gout

• Age. The fat pad that cushions the ball of your foot gets thinner over time

Metatarsalgia Diagnosis

X-rays may help your doctor rule out other causes of forefoot pain. A bone scan can pinpoint places of inflammation.

Ultrasound can help identify conditions such as bursitis or Morton’s neuroma that cause pain in the metatarsal area.

The doctor may also ask for an MRI to look for causes of pain in your metatarsal and midfoot regions. These can include traumatic disorders, circulatory conditions, arthritis, neuroarthropathies, and conditions that cause biomechanical imbalance.

The doctor may also do other tests and procedures to help make a diagnosis and figure out the proper treatment.

Metatarsalgia Treatment

There are several options when it comes to treating metatarsalgia.

Medical Treatment

To relieve metatarsalgia pain, the doctor may have you:

• Stay off your feet. Avoid high impact activities for a while and prop up your injured foot when you can.

• Ice the injured foot. Try rolling it over a frozen water bottle.

• Use a pressure bandage.

• Wear cushioned pads, arch supports or other orthotics in your shoes.

• Do gentle stretching and strengthening exercises.

If you have a callus on the bottom of your foot where you feel pain, the doctor may scrape it down to take off some pressure.

You may need surgery to fix problems with your bones or release a pinched nerve. 

Medication 

Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, Nuprin) or naproxen (Aleve, Naprosyn), can relieve pain in the short term.

If a pinched nerve is the cause of your pain, the doctor may try a nerve block in combination with long-acting steroids. 

Recovery 

Once the pain is gone, you can increase stretching and strengthening exercises and gradually get back to normal activity.  Try a low-impact type of exercise at first, like swimming.

Metatarsalgia Complications

Metatarsalgia can lead to other problems if you don’t treat it. You’re likely to change the way you walk to take pressure off the painful spot on your foot. That can cause pain elsewhere in your foot or in your other foot, and all the way to your lower back or hips. You can even develop a hammertoe.

Metatarsalgia Outlook

Most people recover from metatarsalgia with treatment. But you need to understand what caused it in your case and take steps to keep it from coming back.

Metatarsalgia Re-injury Prevention

Taking good care of your feet can help you avoid another bout with metatarsalgia.

• Get shoes that fit correctly. If you run a lot, get new shoes often. 

• Don’t wear high heels.

• Use pads, arch supports or other orthotics your doctor recommends.

• Keep calluses from building up. You can soak your feet and gently rub the area with a pumice stone.

• Get to a healthy weight.

• Increase the amount and intensity of athletic activity gradually.

• Always stretch and warm up before you exercise.