Metatarsalgia is defined as pain in the ball of the foot. There are several conditions which can cause pain in the ball of the foot. They include inflammation of the joint (metatarsophalangeal joint- MTP), instability of the MTP joint, toe deformities, Morton’s neuromas, and boney deformities creating pressure and calluses.
Often increased pressure is caused by an abnormally long second, third and/or forth metatarsal bone. Normally the big toe and first metatarsal carry the majority of the weight of the body when walking, but if the other metatarsal are longer they have increased pressure (see picture). This pressure causes calluses to occur on the bottom of the foot and, if the calluses become very thick, they can intensify the pain.
Another common cause of metatarsalgia is called idiopathic second MTP synovitis and instability (a sore swollen knuckle). This is caused by excess pressure on the joint creating irritation and inflammation in the joint. This condition can occur in runners due to repetitive injury or by a traumatic event. Persistent swelling and pressure will cause the ligaments to stretch, causing the joint to subluxate and eventually dislocate the toe.
Regardless of the cause of the metatarsalgia, the condition is made worse if you are barefoot, wear high heels, or shoes without support and soft innersoles. In turn the pain of metatarsalgia can be relieved by wearing shoes with low heels, a rigid outer sole, and soft inner soles. Using metatarsal pads or orthotics can also relieve the pain. If calluses are present a pumice stone can be used to remove the callus (or have a medical professional shave the callus). If you have diabetes, poor circulation or a lack of feeling in your feet, talk to your doctor before attempting any self-treatment.
If changes in shoe wear and padding do not improve your pain, then one of several surgical procedures may relieve the pain. Surgical procedures include metatarsal osteotomies (bone shortening procedures) and corrective procedures of the toes to relieve the pressure on the ball of the foot. Most surgical procedures for metatarsalgia are done on an outpatient basis under regional block, and the patients are able to walk immediately after surgery on the surgical foot with protected weight bearing (walk using a cam walker boot or post-operative shoe).