Metatarsalgia: causes, symptoms and treatment

Photo of feet with pain (metatarsalgia)

The term metatarsalgia refers to pain in the metatarsals which in the majority of cases is caused in the region of the ball of the foot by excessive loading on one or more of the metatarsal heads. Metatarsalgia is more commonly found in women and is usually associated with trauma of a biomechanical nature caused by an altered loading of the forefoot on the ground.

There is also so-called non-biomechanical metatarsalgia that originates from illnesses affecting the entire body (e.g. rheumatoid arthritis, systemic lupus erythematosus, diabetes, etc…), local diseases (e.g. Septic arthritis) or conditions that affect the nerves of the foot (e.g. Morton’s neuroma).

Metatarsalgia: what are the symptoms?

In most patients there is a plantar hyperkeratosis under the central metatarsals.

As time progresses and if shoes are worn that have a rigid sole, with a heel, that are narrow or if no socks are worn, the pain develops during deambulation in the areas of hyperkeratosis.

In acute stages the pain can make walking intolerable and in some cases the individual may take on an irregular standing position in an attempt to avoid the painful areas.

Treatment of Metatarsalgia

In mild cases of metatarsalgia a conservative approach may be adopted using footwear with a soft sole and/or a personalised silicone protective orthosis, able to give relief to the painful metatarsal heads.

In serious cases such a solution cannot be offered to the patient. It becomes necessary to resort to percutaneous surgical treatment that cures the metatarsalgia by means of carrying out small osteotomies (the bone is cut to shorten, lengthen or modify its alignment) to retract and lift the painful heads.