Metatarsalgia is a general term that refers to pain in the foot (typically around the ball of the foot).
It’s common in runners, track and field athletes, and for those who participate in high impact related sports (such as basketball and soccer). It’s also commonly associated with overuse syndrome.
Metatarsalgia is pain and irritation at the end of the metatarsal joints near the toes. Potential causes for the pain include: a stress fracture; gout; osteoarthritis; hammertoes; calluses; and pain in the joint from swelling and irritation. It can also be from neuromas, in which nerves tend to bundle and become irritated between the metatarsal heads.
How to Self-Treat Metatarsalgia
Metatarsalgia typically begins as a mild discomfort which grows steadily and quickly to the point that a person may struggle to walk, stand, or run. The key to treatment and management of this condition is to intervene quickly and to identify the actual cause or causes that led to the pain and irritation. Learn the potential causative factors for metatarsalgia and how to self-treat this condition so you don’t lose too much time with your training.
- Excessive foot pronation. Your feet tend to roll inward as you stand, walk, and/or run.
- Either excessively high arches or overly flat feet.
- Spending long periods of time standing or walking (overuse).
- High impact activities and sports.
- Spending long periods of time on hard surfaces, such as concrete.
- Your shoes don’t fit well or the shoe is worn out. Typically due to shoes being too narrow or wearing high heels.
- You have transitioned too quickly from a more built up running shoe into a minimalistic style.
- Poor ankle mobility, particularly excessive tightness in the Achilles tendon or calf muscles.
- Poor foot muscle strength, particularly the foot intrinsic muscles which help to support the arch of the foot.
- Prominent metatarsal heads.
- Having a hammertoe deformity.
Metatarsalgia is a condition that can start off as a minor annoyance. It can quickly progress into a painful irritation, and then suddenly sideline you for weeks. Take the pain seriously, and begin treatment right away. Whenever possible, begin the rehabilitation upon injury or the onset of pain. The goal is to restore normal range of motion (ROM) while reducing pain, irritation, and swelling. Restoring strength and function as soon as possible is also critical. Depending on the amount of pain and swelling, begin with RICE (Rest, Ice, Compression, and Elevation).
- Rest. Initially, limit any activities that are causing pain. As the pain subsides, you can slowly taper up the use while taking care to avoid pain.
- Ice. Apply ice to the painful area–typically the sooner, the better. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel pack style. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.
- Compression. If swelling is present, utilize a simple ACE wrap around the foot and ankle to help with the swelling and pain. Start at the toes, and work up the leg. Take care to not apply the ACE wrap too tightly. Depending on the cause of the injury, over squeezing the foot can be irritating.
- Elevation. Use pillows to position the foot above the level of your heart to help reduce swelling. This would be an excellent time to apply ice, too.
After you have initiated RICE and the pain and swelling have decreased, address any risk factors noted above (if possible). Please refer to Metatarsalgia Rehabilitation Exercises.pdf for detailed descriptions and photos on how to address other causative factors including: poor tissue mobility in the feet; tightness in the Achilles tendon; weakness in the foot intrinsic muscles; and balance deficits.
How to Self-Treat Metatarsalgia:
- Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) can lead to excessive strain on the tissues on the bottom of the foot including the plantar fascia. I recommend initiating a complete ankle/foot strengthening protocol. Please refer to Ankle Resistance Exercises.pdf.
- Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as weakness in the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which ultimately can lead to metatarsalgia. Improving your balance can help to reduce the risk of metatarsalgia and is an important part of the rehabilitation process. For more ideas on how to improve your balance, please refer to Improving Balance by Using a Water Noodle. As your pain level improves, I recommend that you perform these balance exercises without shoes on.
- Add a metatarsal pad. Using metatarsal pads can help to provide pain relief (particularly, in the early phases of treatment). Some people don’t have much padding over the metatarsal area. This is particularly true as you age. Shoes with adequate cushion around the ball of the foot (or the area where the metatarsal heads are located near the base of the toes) can make all the difference. Visit your local running store to purchase a quality metatarsal pad. If unavailable, you can usually find one at a specialty shoe store or you may need to call a local podiatrist for recommendations.
- Add an orthotic. Semi-rigid corrective devices worn in supportive shoes have been shown to be an effective treatment for metatarsalgia. If the metatarsal pad is helpful, but it doesn’t fully address the pain, you may consider orthotics. If you have flat feet or an excessively high arch, you may need a specially fitted orthotic that also includes a metatarsal pad. Supportive shoes worn alone, with or without soft corrective devices, may not provide adequate pain relief. Most orthotics requiring a metatarsal pad are custom made by either a podiatrist or a physical therapist that specializes in orthotics.
- Did you progress too quickly into a minimalistic shoe? The standard built up shoe offers more foot support and padding than most minimalistic style shoes. If you attempt a quick progression, you may be at risk of developing metatarsal pain. Unless you are a child or teenager, expect a safe transition to take at least three months. Don’t transition during a period of intense training. A slow transition will allow your body to adequately adapt to the new stresses. I highly recommend waiting until the off season as progressing slowly is always a better choice. Taper back your running and implement my recommended strengthening exercises and balancing activities prior to a slow transition.
I recommend following this protocol for two to three weeks. While you’re self-treating your metatarsalgia, you’ll likely need to modify your exercise or running program. This would be an excellent time to focus on cross training activities.
If you’re not experiencing significant relief upon progressing into your exercise program, please consult a medical professional. I recommend a physical therapist that specializes in feet or who works with athletes for the treatment of metatarsalgia. The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. You may also consider consulting with a podiatrist.
For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.