Forefoot Disorders – Metatarsalgia

Ms Roxanne Agius, our resident podiatrist at Remedies Ta’ Xbiex, gives us an overview on foot pain (Metatarsalgia). In this article Ms Agius highlights symptoms, treatment options and ways to prevent the occurrence of this painful condition.


      The word ‘Metatarsalgia’ is an umbrella term used to describe dorsal or plantar and deep or superficial pain in the area of the metatarsal bones, the ball of the foot. Therefore, this is a symptom that is associated with various forefoot conditions.

Metatarsalgia problems develop when something changes in the way the foot mechanically works thus affecting how weight is distributed. This can put excess pressure and tension on the metatarsal bones, leading to inflammation and pain.

Metatarsalgia occurs due to pathological changes in any forefoot tissue (bones, ligaments, tendons, joint, fascia, skin and vascular and neurological) either local or referred pain from proximal sites. Obesity, pregnancy or occupational factors are contributing elements to acquire metatartsalgia due to weight bearing forces acting upon the forefoot (part of the sole, just behind the toes). Moreover, ill-fitting footwear could alter foot function that might result in metatarsalgia. Therefore, too short, too narrow, high heeled shoes, over-sized shoes, thin soled or worn out footwear; contribute to the development of metatarsalgia. Systemic diseases and old age also contribute to forefoot pain as the foot is predisposed to atrophy or distal displacement of the plantar fat pad.

Occasionally, a single factor can lead to metatarsalgia. Such as:

  • Intense training: athletes, runners, are at risk of acquiring metatarsalgia, due to the high amount of force being absorbed by the ball of the foot when running. However, any individuals who participate in high impact sports are also at risk, especially if ill-fitting footwear is worn.
  • Foot types: high arched feet, put a lot of pressure on the forefoot. Also, having a second toe longer than the first, this causes more weight than normal to be shifted to the second metatarsal head.
  • Hammertoe: a condition where a toe, usually the second digit, curls downwards, due to damage in the toe joint. This occurs due to high heels or inappropriate footwear.
  • Bunion: seen more in women than in men. Could be inherited or occurs due to ill-fitting shoes or high heels. A bunion is a bony deformity of the joint at the base of the big toe, this weakens the digit and thus outs extra pressure on the ball of the foot.
  • Excess weight: most of the body weight is transferred to the forefoot, thus extra weight results in extra pressure on the metatarsal bones.
  • Stress fracture: small breaks in the metatarsal bones or in toe bones, resulting in pain and can change the way one applies weight on the foot.

Symptoms of metatarsalgia include:

  • Sharp, aching and burning sensation on forefoot area.
  • Painful, second, third or fourth toes.
  • Pain that gets worse when the individual stand up, walks or runs and reduces when s/he is resting.
  • Numbness or tingling in the toes.

The above symptoms may develop suddenly especially if there was a recent increase in physical activity mainly high impact sports. However, there are circumstances when the symptoms develop gradually.

If left untreated, complications may arise. Metatarsalgia may lead to referred pain; pain in other area of the foot or on the opposite foot or pain in other areas of the body, lower back or hip. This occurs because of altered gait, limping from foot pain.

Management for metatarsalgia:

The first line of treatment should be the conservative route. This aims to relieve the pain through rest to protect the foot from further injury. Any sporting activities which are strenuous on the foot should be stopped for a while and resort to low impact exercises such as swimming. A topical NSAID could be applied to the forefoot to reduce the inflammation and pain. Wearing appropriate footwear is recommended. And also shock absorbing insoles will aid in reducing the pressure and pain from the forefoot.


Preventing metatarsalgia condition is by wearing the right footwear. Avoid wearing high heels and footwear that does not have a wide toe box. Shoes footwear with a rocker bottom sole sow eight would be evenly distributed. Orthotic management should be considered to help prevent metatarsalgia pain as well as when metatarsalgia is present. Moreover, maintaining a healthy body weight is key to preventing from obtaining such a condition. If a person is recovering from an injury refrain from starting strenuous activity too soon or train through the pain as one would be risking to develop more severe problems that limits the activity even longer.

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