Tabassum Ali, DC, CCSP, CCCN
Metatarsalgia is commonly found in the running community or in women who wear high-heeled shoes. Metatarsalgia is classically described as pain felt at the front of the foot on the plantar surface between the third and fourth metatarsals with:
Exacerbation by walking barefoot, especially on a hard floor
Exacerbation with flexing the foot
Feels like there is a pebble in your shoe when walking
This pain can be attributed to compression from tight shoes, subluxation of the metatarsal heads, foot deformities, excessive weight bearing, or other compressive forces placed on the foot in a repetitive motion such as running or jumping or standing for long periods of time. When palpating the foot, you may also inspect for calluses or corns around the second metatarsal head and or a high or dropped arch of the foot.
Metatarsalgia is often differentially diagnosed with Morton’s Neuroma and Sesamoiditis, because of similar symptoms. With Morton’s Neuroma the pain will be shifted over just a little to the second and third metatarsals, and sometimes a small mass can be palpated where the nerve has been entrapped. Sesamoiditis will present with pain on the plantar surface near the bottom of the great toe due to direct trauma of the flexor hallucis brevis muscle.
Treatment of metatarsalgia can vary depending on how chronic the condition is. In rare cases surgery to realign the metatarsal bones may be an option. If you're considering foot surgery, discuss the benefits and risks with your doctor. Conservative treatment is preferred, especially for people who are actively involved with high impact sports and exercising, resting the feet temporarily will alleviate the pain and stress put on the foot. Ice can help with the pain as well for about 20 minutes. Some sources recommend an insole to provide cushion to the foot, I would not suggest an orthotic or an insole without first consulting with an orthopedist because the foot is already under compression and does not need any extra compression. The most effective form of treatment would be to address the scar tissue that has built up over time from overuse and adjust any subluxations of the metatarsals. Once you are able to walk without pain and the scar tissue has healed, the next phase of treatment would be to keep stretching the muscles of the plantar fascia in the foot and to strengthen them to prevent future injury.
Warm up of the muscles is important and can be done with simple arch stretching and continued on with the strengthening program. Exercises to strengthen the muscles associated with metatarsalgia will include laying a resistance band flat on the ground and scrunching it up with the foot flat on the ground, and simple inversion and eversion with a resistance bands. Approximately 6-8 weeks of treatment will be needed to decrease the pain and strengthen the muscles.
In summary, to address metatarsalgia:
Address the scar tissue in primary involved muscle, and any associated muscle
Adjust any subluxaxtions in the foot, ankle, and knee
Strengthen and train the tibialis posterior to prevent future injury (sport specific functional training)
For more information about this condition and other sports related injuries check our website at www.lonestarsportandspine.com
Davis, Faith. "Abstract." National Center for Biotechnology Information. U.S. National Library of Medicine, 30 June 2012. Web. 26 Mar. 2013. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390214/>.
Stoxen, James. "Morton’s Neuroma – Self Help Tips, Treatment and Prevention From The Barefoot Running Doctor at Team Doctors." Web log post. Team Doctor's Blog. N.p., 24 Dec. 2012. Web. 26 Mar. 2013. <http://teamdoctorsblog.com/2012/12/24/mortons-neuroma-self-help-tips-treatment-and-prevention-from-the-barefoot-running-doctor-at-team-doctors/>.