In metatarsalgia (met-uh-tahr-SAL-juh) the ball of your foot becomes painful and inflamed.

You may experience metatarsalgia if you participate in activities that involve running and jumping. Or, you may develop metatarsalgia by wearing ill-fitting shoes. There are other causes as well.

Although generally not serious, metatarsalgia can sideline you. Fortunately, at-home treatments, such as ice and rest, often can relieve metatarsalgia symptoms. Proper footwear with shock-absorbing insoles or arch supports may be all you need to prevent or minimize future problems with metatarsalgia.

Symptoms of metatarsalgia may include:

  • Sharp, aching or burning pain in the ball of your foot — the part of the sole just behind your toes
  • Pain that worsens when you stand, run, flex your feet or walk — especially barefoot on a hard surface — and improves when you rest
  • Sharp or shooting pain, numbness, or tingling in your toes
  • A feeling of having a pebble in your shoe

Sometimes symptoms develop suddenly — especially if you've recently increased the time or intensity of your high-impact exercise, such as running — but problems usually develop over time.

When to see a doctor

Not all foot problems need medical care. Sometimes your feet simply ache after a long day of standing or a punishing workout. But it's best not to ignore any foot pain that lasts more than a few days. Talk to your doctor if you experience a burning pain in the ball of your foot that doesn't improve after changing your shoes and modifying your activities.

Sometimes a single factor can lead to metatarsalgia. More often, several factors are involved, including:

  • Intense training or activity. Runners are at risk of metatarsalgia, primarily because the front of your foot absorbs significant force when you run. But anyone who participates in a high-impact sport is also at risk, especially if your shoes fit poorly or are worn out.
  • Certain foot shapes. A high arch can put extra pressure on the metatarsals. So can having a second toe that's longer than the big toe, which causes more weight than normal to be shifted to the second metatarsal head.
  • Foot deformities. Wearing too-small shoes or high heels can cause your foot to be misshapen. Hammertoe, when one of your toes curls downward, and bunions, swollen, painful bumps at the base of your big toes, can result in metatarsalgia.
  • Excess weight. Because most of your body weight transfers to your forefoot when you move, extra pounds mean more pressure on your metatarsals. Losing weight may reduce or eliminate symptoms of metatarsalgia.
  • Poorly fitting shoes. High heels, which transfer extra weight to the front of your foot, are a common cause of metatarsalgia in women. Shoes with a narrow toe box or athletic shoes that lack support and padding also can contribute to metatarsal problems.
  • Stress fractures. Small breaks in the metatarsals or toe bones can be painful and change the way you put weight on your foot.
  • Morton's neuroma. This noncancerous growth of fibrous tissue around a nerve usually occurs between the third and fourth metatarsal heads. It causes symptoms that are similar to metatarsalgia and can also contribute to metatarsal stress.

    Morton's neuroma frequently results from wearing high heels or too-tight shoes that put pressure on your toes. It can also develop after high-impact activities such as jogging and aerobics.

Almost anyone can develop metatarsalgia, but you're at higher risk if you:

  • Participate in high-impact sports. Metatarsalgia is more likely to occur if you're a runner or you participate in sports that involve running or jumping, such as soccer, tennis, baseball, football or basketball. Swimming and cycling, which don't put pressure on your forefoot, aren't likely to cause metatarsalgia.
  • Wear high heels or shoes that don't fit properly. High heels transfer extra weight onto the front of your foot, and shoes that are too tight can compress your toes. Wearing athletic shoes that aren't well padded or that aren't appropriate for a particular sport — for example, playing basketball in tennis shoes — also can put you at risk of metatarsalgia.
  • Are overweight. Extra pounds put more pressure on your metatarsals.
  • Have other foot problems. Certain foot shapes — such as high arches, a long second toe or unusually long metatarsals — can contribute to metatarsalgia. So can conditions such as hammertoe, arthritis and gout. These conditions can cause pain and inflammation that change the way you walk and the distribution of weight in your feet.
  • Having rheumatoid arthritis or gout. These inflammatory arthritis diseases make your feet more vulnerable to metatarsalgia.

Left untreated, metatarsalgia may lead to:

  • Pain in other parts of the same or opposite foot
  • Pain elsewhere in the body, such as the low back or hip, due to limping (altered gait) from foot pain

You'll probably first see your family doctor or general practitioner. However, he or she may refer you to a bone specialist (orthopedist) or a foot specialist (podiatrist).

Here's some information to help you get ready for your appointment and to know what to expect from your doctor.

What you can do

Before your appointment:

  • Make a list of your symptoms, including any that may seem unrelated to your foot pain.
  • Write down questions to ask your doctor.

For metatarsalgia, some basic questions you might ask your doctor include:

  • What's causing my symptoms?
  • Do I need tests?
  • Is my condition likely temporary or chronic?
  • What treatment do you recommend?
  • What are the alternatives to the primary approach you're suggesting?
  • How long will it be before I start feeling better?
  • Are there activity restrictions that I need to follow?
  • Are there brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions as well, including:

  • When did your symptoms begin?
  • What type of shoes do you wear?
  • What activities do you do?
  • Does your daily routine involve a lot of walking or standing?
  • Do you often go barefoot? On what types of surfaces?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

While you're waiting to see your doctor, rest your foot as much as possible and wear properly fitting shoes. If your pain is severe, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or aspirin may help ease your discomfort.

Various foot problems can cause symptoms similar to those of metatarsalgia. To help pinpoint the source of your pain, your doctor will examine your foot and ask about your lifestyle and activity level. You may need an X-ray to identify or rule out a stress fracture or other foot problems.

Conservative measures usually relieve the pain of metatarsalgia.

Surgical or other procedures

In rare cases, when conservative measures don't relieve your pain and your metatarsalgia is complicated by foot conditions such as hammertoe, surgery to realign the metatarsal bones may be an option. Discuss the benefits and risks of foot surgery with your doctor.

To help ease your metatarsalgia pain, try these tips:

  • Rest. Protect your foot from further injury by not stressing it. Elevate your foot after standing or walking to allow it to recover. You might need to avoid your favorite sport for a while, but you can stay fit with low-impact exercises, such as swimming or cycling.
  • Ice the affected area. Apply ice packs to the affected area for about 20 minutes at a time several times a day. To protect your skin, wrap the ice packs in a thin towel.
  • Take an over-the-counter pain reliever. Try ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve) or aspirin to reduce pain and inflammation.
  • Wear proper shoes. Your doctor may recommend a shoe that's especially suited for your foot type, your stride and your particular sport.
  • Try shock-absorbing insoles. These off-the-shelf shoe inserts — often made of cork, plastic, rubber or a gel-like substance — fit inside your shoes to help cushion shock.
  • Use metatarsal pads. These off-the-shelf pads are placed in your shoes just ahead of the metatarsal bone to help deflect stress away from the painful area.
  • Consider arch supports. If insoles don't help, your doctor may recommend arch supports to minimize stress on the metatarsal bones and improve foot function. Off-the-shelf arch supports come in various sizes and can be fitted immediately. More-durable arch supports can be custom-made from a foam mold or plaster cast of your foot.

    Rigid arch supports are made of a firm material such as plastic or carbon fiber. They're designed to control motion in two major foot joints below your ankles. Semirigid arch supports are made of softer materials such as leather and cork reinforced by silicone. Arch supports designed to treat metatarsalgia may include metatarsal pads, too.

When you're serious about sports, your metatarsals may take a beating. But that doesn't mean you have to live with pain and injuries. To help protect your feet:

  • Choose the right shoes. Wearing high heels or too-small shoes can set the stage for a host of foot problems, including metatarsalgia. The same is true of shoes that don't provide enough support and cushioning. Look for shoes with a wide toe box and a rocker sole, which redistribute weight on the bottom of your foot.
  • Consider cushioned insoles or arch supports. These products can help prevent the pain of metatarsalgia — as well as relieve the pain when it develops.
  • Maintain a healthy weight. Keeping your weight within a healthy range can take a load off your feet.

If you're recovering from an injury, don't try to resume strenuous activity too soon. If you're not completely healed — or you train through the pain — you may develop more severe problems that limit your activity even longer.

May 14, 2014