Metatarsalgia & Forefoot Pain
Pain in the ball of your foot can make walking, standing, running and everyday activities uncomfortable. You may notice aching, burning, sharp or bruising-type pain underneath the forefoot, particularly around the metatarsal bones.
Metatarsalgia is not a diagnosis as such. It is a general term used to describe pain in the forefoot, in the region of the metatarsal bones. There can be a number of different reasons for this pain, so identifying the underlying cause is an important part of deciding how best to manage it.
At MK Orthotics in Milton Keynes, we can assess your foot and lower-limb mechanics to help establish what may be contributing to your symptoms.
What is metatarsalgia?
The metatarsals are the five long bones in the middle of your foot, between your toes and the bones towards the back of your foot.
The term metatarsalgia is commonly used when pain is experienced around the heads of these bones, particularly underneath the ball of the foot.
It is a description of where you are experiencing pain rather than a specific condition. This means that two people with metatarsalgia may have very different underlying problems.
A more detailed assessment may therefore be needed to determine the cause of your symptoms.
What does metatarsalgia feel like?
Symptoms can vary depending on the underlying cause, but may include:
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Pain underneath the ball of the foot
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Aching or burning in the forefoot
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Sharp or shooting pain
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Pain that becomes worse when walking or running
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Discomfort when standing for prolonged periods
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Tenderness around one or more metatarsal heads
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A feeling that there is a pebble or small stone inside your shoe
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Pain that improves when you rest or take weight off your foot
The location and nature of your pain can provide useful information, but further assessment may be needed to determine exactly what is causing it.
What can cause metatarsalgia?
There are several possible causes of forefoot pain. These can include:
Morton’s Neuroma
Morton’s neuroma can cause burning, tingling, numbness or shooting pain in the ball of the foot and into the toes. It most commonly affects the space between the third and fourth toes.
Capsulitis
Capsulitis is inflammation or irritation of the capsule surrounding a joint. In the forefoot, this can affect the joints where the toes meet the metatarsal bones and may cause pain underneath the ball of the foot.
Plantar Plate Tear
The plantar plate is a strong structure underneath the joints at the base of the toes. Injury or damage to the plantar plate can cause pain underneath the forefoot and may sometimes be associated with changes in the position of a toe.
Freiberg’s Disease or Infarction
Freiberg’s disease is a condition affecting the blood supply and bone of a metatarsal head. It most commonly affects the second metatarsal and can cause forefoot pain and stiffness.
Fracture or Stress Injury
A fracture or stress injury affecting one of the metatarsal bones can cause localised pain and tenderness. If a fracture or other significant injury is suspected, appropriate medical assessment and imaging may be required.
Corns and Calluses
Areas of thickened skin can develop where there is repeated pressure or friction. A painful corn or callus underneath the forefoot may therefore be associated with the way pressure is being distributed through the foot.
There are also other possible causes of forefoot pain, so persistent or unexplained symptoms should be assessed rather than assuming that they are simply metatarsalgia.
Foot mechanics and forefoot pain
The way your foot moves and absorbs load can influence how pressure is distributed through the forefoot.
Factors such as foot shape, joint movement, muscle strength, footwear and your walking or running pattern may all be relevant.
For some people, the way the foot functions during walking or running may contribute to increased loading through a particular area of the forefoot. For others, the underlying problem may be more localised to a joint, bone, nerve or soft tissue structure.
This is why an assessment needs to consider more than just the area that hurts.
Could orthotics help?
Orthotics are not automatically required for metatarsalgia, and they are not appropriate for every cause of forefoot pain.
Where foot mechanics and pressure distribution appear to be contributing to your symptoms, an orthotic may sometimes form part of a treatment plan.
Depending on the findings of your assessment, an orthotic may be designed to help redistribute pressure away from a painful area of the forefoot or alter the way load is transferred through the foot.
This might include an appropriate metatarsal pad or other modification, depending on the individual problem.
The aim is not simply to put an arch support underneath the foot. The design of any orthotic needs to be based on your individual foot shape, movement, symptoms, footwear and activity.
If another cause of your pain is identified, a different treatment approach may be more appropriate.
Footwear and metatarsalgia
Your footwear can have an important influence on forefoot symptoms.
Shoes that are narrow around the toes may increase pressure around the forefoot, while footwear with adequate space for the toes can allow them to spread more naturally.
Depending on your symptoms, it may be worth considering:
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Shoes with sufficient width around the toes
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A comfortable toe box that does not compress the forefoot
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Avoiding footwear that increases pressure over a painful area
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Appropriate cushioning where this is helpful
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Footwear that is suitable for your activity
The most suitable footwear will depend on the cause of your symptoms and your individual needs.
How we assess forefoot pain
At MK Orthotics, your assessment begins with a detailed discussion about your symptoms and how they affect your everyday activities.
We may consider:
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Where exactly you feel your pain
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When your symptoms started
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What makes the pain better or worse
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Your footwear
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Your usual activities and exercise
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Previous injuries or treatment
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The movement of your feet and lower-limb joints
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Your foot posture and structure
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How your feet behave when standing and walking
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Your walking or running pattern where appropriate
A dynamic assessment and video gait analysis may be used where appropriate to look more closely at how your feet and lower limbs move.
The initial consultation is approximately 90 minutes, allowing time for a thorough assessment and discussion of the findings.
What happens after the assessment?
Once your assessment has been completed, the findings will be discussed with you and an appropriate management plan considered.
This may include footwear advice, exercises or other treatment approaches. If an orthotic is considered appropriate, we can discuss the options with you and explain how it may be intended to help with your particular symptoms.
If your symptoms suggest that further medical investigation is needed, you may also be advised to discuss this with your GP or another appropriate healthcare professional.
When should forefoot pain be assessed?
Consider arranging an assessment if:
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Your forefoot pain has persisted or keeps returning
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Pain is affecting your walking or everyday activities
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You are experiencing recurrent pain when running or exercising
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You have developed a painful area underneath the ball of your foot
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You have burning, tingling or numbness in your toes
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You feel as though there is a pebble or lump inside your shoe
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You have tried changing your footwear but symptoms continue
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You have previously been given orthotics that have not helped
Sudden or significant pain following an injury, marked swelling, inability to bear weight or other concerning symptoms may require medical assessment rather than an orthotic assessment alone.
Related conditions
You may also find these pages useful:
Metatarsalgia and orthotics in Milton Keynes
If you are experiencing pain in the ball of your foot, a detailed assessment can help identify what may be contributing to your symptoms.
At MK Orthotics in Blakelands, Milton Keynes, we assess the foot and lower limb as a whole rather than assuming that every case of forefoot pain requires an orthotic.
If an orthotic is appropriate, we can discuss how it may be used as part of your individual treatment plan.
Book an assessment with MK Orthotics in Milton Keynes to discuss your forefoot pain.