Symptoms and causes

Symptoms

Symptoms of metatarsalgia can 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

When to see a doctor

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

Causes

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

  • Intense training or activity. Distance runners are at risk of metatarsalgia, primarily because the front of the foot absorbs significant force when a person runs. But anyone who participates in a high-impact sport is at risk, especially if your shoes fit poorly or are worn.
  • 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. A downward-curling toe (hammertoe) and swollen, painful bumps at the base of your big toes (bunions) can cause 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 might reduce or eliminate symptoms.
  • 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 the problem.
  • 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.

Risk factors

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

  • Participate in high-impact sports that involve running and jumping
  • Wear high heels, shoes that don't fit properly or shoes with spikes, such as cleats
  • Are overweight or obese
  • Have other foot problems, including hammertoe and calluses on the bottom of your feet
  • Have inflammatory arthritis, such as rheumatoid arthritis or gout

Complications

Left untreated, metatarsalgia might lead to pain in other parts of the same or opposite foot and pain elsewhere in the body, such as the low back or hip, due to limping (altered gait) from foot pain.

Nov. 04, 2016
References
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  2. Metatarsalgia. The American College of Foot & Ankle Orthopedics & Medicine. http://www.acfaom.org/information-for-patients/common-conditions/metatarsalgia. Accessed Aug. 23, 2016.
  3. Espinosa N, et al. Metatarsalgia. Journal of the American Academy of Orthopaedic Surgeons. 2010;18:474.
  4. Metatarsalgia (forefoot pain). American Orthopaedic Foot & Ankle Society. http://www.aofas.org/footcaremd/conditions/ailments-of-the-smaller-toes/Pages/Metatarsalgia.aspx. Accessed Aug. 23, 2016.
  5. Imboden JB, et al. Approach to the patient with foot & ankle pain. In: Current Diagnosis & Treatment: Rheumatology. 3rd ed. New York, NY: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com. Accessed Aug. 24, 2016.