There are many causes of foot pain, but when most people talk about foot pain they are describing symptoms that cause pain under the ball of the foot. When foot pain occurs under the ball of the foot, the medical term is metatarsalgia. Metatarsalgia occurs often in association with deformities of the foot, although it may also occur without an obvious structural abnormality.
Causes of Foot Pain
Metatarsalgia occurs in the region between the arch and the toes. The medical term for foot pain, metatarsalgia, comes from the name of the bones that are in this part of the foot: the metatarsals. The metatarsals are long bones at the base of each toe. Sometimes pressure on the ends of the metatarsal bones causes symptoms in the ball of the foot. There are many other causes of foot pain in other parts of the foot. Some other areas of the foot that can be sources of pain include:
- Toe pain and bunions
- Arch pain
- Heel pain (underneath the heel)
- Posterior heel pain (behind the heel)
Metatarsalgia can be caused by increased pressure on the metatarsal heads. The cause of increased pressure in this part of the foot can be either due to deformities of the foot, or from pressure from sources outside the foot, such as footwear. Structural issues usually have to do with the metatarsal bone, and the most common variation in people with foot pain is a long second metatarsal. Other variations include abnormal joint alignment (increased extension) of the joint of the metatarsal with the toe (called the metacarpophalangeal joint). There are a number of conditions that can cause enlargement of the metatarsal head, also commonly associated with foot pain. These conditions include different types of arthritis, osteonecrosis, neuromas, tumors, or infections. Lastly, traumatic injuries, including fractures and ligament tears, can cause this type of foot pain. Tests used to make a diagnosis of metatarsalgia usually include x-rays, often obtained while standing to assess the foot anatomy while supporting the weight of the body. MRI tests can also be helpful, especially when the structure of the foot is found to be normal.
Treatment of Foot Pain
Treatment of foot pain often consists of anti-inflammatory medications, footwear modifications, and inserts for your shoes. When buying footwear, look for shoes with a wide toebox, good support, and avoid high heels. Simple inserts can help with many types of foot pain. Metatarsal pads are best for the treatment of metatarsalgia. These pads help to take pressure off the ball of the foot. If some simple steps do not alleviate your symptoms, you should see your doctor to ensure you are receiving adequate treatment. Conditions that cause inflammation of the forefoot may also benefit from a cortisone injection. Cortisone is a powerful anti-inflammatory medication, and the injection allows a high concentration of this medication to be delivered directly to the area of the problem. In some rare situations, patients don’t find relief with shoe modifications, and may require a surgical procedure. The usual surgical procedure is called a metatarsal osteotomy to correct the abnormality of the metatarsal bone. An osteotomy is a surgical procedure to deliberately fracture a bone to change the length and/or alignment of the bone. This can alter the forces of weight bearing in the forefoot to relieve the symptoms of foot pain.
Espinosa N, et al. “Metatarsalgia” J Am Acad Orthop Surg August 2010 ; 18:474-485.