Pes cavus. This is also known as claw foot. In pes cavus, your foot has a very high arch which does not flatten when you put weight on your foot. It happens because of an imbalance in the muscles of the foot. It can run in families. Sometimes pes cavus can happen out of the blue but most people with pes cavus also have a neurological problem such as cerebral palsy, spina bifida, muscular dystrophy or polio. Pes cavus can mean that extra stress is placed on the ball of the foot, which can lead to metatarsalgia. Morton's neuroma has other specific symptoms and is explained further in the separate leaflet. Previous surgery to the foot. For example, previous surgery for bunions. The Institute of Chiropodists and Podiatrists Hammertoe deformity
The doctor may also ask for other tests and procedures to help in the diagnosis and in determining the proper treatment. Persistent stress can lead to chronic irritation and inflammation of the bone covering and adjacent tissues, such as ligaments and tendons. Blood tests. These can check for diabetes, arthritis and gout. Hammer toe or claw toe deformity. With a claw toe you have an abnormal position of all three of the joints in the toe. The joint with the metatarsal bone is bent upwards, the middle joint in the toe is bent downwards and the end joint in the toe may also be bent downwards. The toe resembles a claw. With a hammer toe, your toe is permanently bent at its middle joint so that it looks like a hammer. There are a number of conditions that can cause these toe deformities. These can include poorly fitted shoes, injury to the toes, bunions and rheumatoid arthritis. Hammer and claw toe can also occur in someone with pes cavus. They can also run in families. These toe deformities can mean that extra stress is placed on the ball of the foot, which can lead to metatarsalgia. Most often, the pain comes on over a period of several months, rather than suddenly.
Bone scan of your foot. Your doctor may suggest this if they suspect a stress fracture of one of your metatarsal bones. There are also many muscles, tendons and ligaments within your foot. The bones, ligaments and tendons within your foot form the foot arches. These arches are called the longitudinal and transverse arches. It is your foot arches that allow your foot to hold up the weight of your body. Nerves also provide sensation to the skin of your foot. Metatarsalgia causes pain in the ball of your foot that can be made worse by standing, walking or running. Some people describe the pain as feeling like they are walking on pebbles. Others describe more of a general aching pain. The pain can occur in one or both feet. In some people the pain is felt under one or two metatarsal heads; in others it is felt under all of them. Some of the causes of metatarsalgia cannot be prevented - for example, metatarsalgia due to pes cavus. However, there are some things that may help to prevent some of the other causes. These include: If you develop metatarsalgia, you'll feel a burning, stabbing, or aching pain at the "head" of the bone, just beneath the toes. It usually affects the second toe, and often the third or fourth. "People complain that it feels like there's a stone in their shoe," says Dr. Cianca. It's worse when you stand, walk, or run, and better when you take a load off (especially if you're at all overweight). It's an equal-opportunity injury, affecting the flat-footed, the high-arched, and all soles in between. Symptoms can occur suddenly: after running barefoot on the beach, walking on a hard tile floor, or sprinting on pavement in worn-out shoes. But it usually builds over a few months. Overuse. For example, in runners and athletes, which can cause some mild inflammation in the metatarsal heads and nearby joints. Other sports such as tennis or sports that involve jumping may also put extra stress on the metatarsal heads and lead to inflammation and pain. Wearing high-heeled shoes. This can put extra stress on the metatarsal heads. Footwear that is poorly fitted or too tight may also be a cause. Resting with your feet elevated where possible. A condition known as Morton's neuroma (interdigital neuroma) produces symptoms of metatarsalgia due to irritation and inflammation of a nerve at the site of pain. People with Morton's neuroma may experience toe numbness in addition to pain in the forefoot. If you develop metatarsalgia, give your feet a break. Reduce your mileage, run on softer surfaces, or temporarily switch to a low-impact activity. Treat acute symptoms with ice during the first 24 hours and take anti-inflammatories as needed. See your doctor or a podiatrist if your symptoms don't improve in 10 days. You may need a callus shaved, a different insert or metatarsal pad, or orthotics. "Metatarsalgia can lead to joint swelling, bone bruising, chronic stiffness, and lost range of motion," warns Dr. Cianca. "So it's best to start treatment sooner than later." Losing weight if you are overweight. Can metatarsalgia be prevented? Metatarsalgia is the name given to pain in the front part of your foot under the heads of your metatarsal bones (the ball of your foot). Metatarsalgia can be caused by a number of different conditions affecting the foot. You may need some investigations to find the cause of your metatarsalgia. Treatment will depend on the underlying cause. Simple measures such as changes to your footwear, rest and losing weight can sometimes help.
What are the symptoms of metatarsalgia?
Improving your own support system doesn't hurt, either. Strengthening the bottom of the foot prevents it from flattening excessively, which protects the metatarsals from impact. Strengthening the "plantar sling" muscles, which run on either side of the calf, helps control overpronation, one of the most common causes of metatarsalgia. (See below for exercises that accomplish both.) Metatarsal pads and orthotic inserts for your shoes may help to relieve pain in your foot by reducing the pressure placed on the heads of your metatarsal bones.
The following factors can contribute to excessive localized pressure over the forefoot: Anchor an exercise band tied in a loop to a desk leg. Place the arch of your right foot in the loop. Working against resistance, pull the band away from your center 10 times. Replace your right foot with your left, and pull toward your center. Turn around, face the opposite direction, and repeat: left foot pulls away, right foot pulls in. Progress to 30 reps per side. Hypermobile first foot bone Excessive pronation (side-to-side movement of the foot when walking or running) Ultrasound can help identify conditions such as bursitis or Morton neuroma that can be causing pain in the metatarsal region of the foot. The primary symptom of metatarsalgia is pain at the end of one or more of the metatarsal bones. The pain is typically aggravated when walking or running. Athletes who participate in high-impact activities and may also have an inflammatory condition such as bursitis often have diffuse forefoot and midfoot pain. Tight toe extensors (muscles) A bone scan can pinpoint places of inflammation. Simple painkillers such as paracetamol and non-steroidal anti-inflammatory drugs may help to relieve pain. Although generally not serious, metatarsalgia can sideline you. Fortunately, conservative treatments, such as ice and rest, can often relieve metatarsalgia symptoms. And proper footwear, along with shock-absorbing insoles or arch supports, may be all you need to prevent or minimize future problems with metatarsalgia. Metatarsalgia usually comes on gradually over some weeks rather than suddenly. The affected area of your foot may also feel tender when you (or your doctor) presses on it. What is the treatment for metatarsalgia? Any or all of the above musculoskeletal problems may contribute to forefoot trauma in athletes. Diabetes. This can cause damage to the nerves in the feet and can be a cause of metatarsalgia. Please refer to the separate leaflets on diabetes for more details. X-ray of your foot. This can show a problem with the bones or joints in your foot. Wearing shoes that are well fitted, low-heeled and have a wide toe area.
The foot can be injured during sports activities. As with many other overuse injuries, the condition may be the result of an alteration in normal biomechanics that has caused an abnormal weight distribution. Metatarsalgia is a condition marked by pain and inflammation in the ball of your foot.
Metatarsalgia is a common overuse injury. The term describes pain and inflammation in the ball of the foot. It is often thought of as a symptom of other conditions, rather than as a specific disease.
Preventing metatarsalgia is often as simple as wearing the right shoes. If you have a flat or neutral foot, look for a shoe with a wide toebox and a dome-shaped metatarsal pad, which protects the metatarsals from pounding. Runners with high arches may benefit from a shock-absorbing insole that provides a platform for the foot and extra cushioning that deflects pressure from the bones. Visit a running specialty store for help outfitting your foot.
Simple measures can help to relieve the symptoms of metatarsalgia. These include:
Stress fracture of a metatarsal. A stress fracture is a type of incomplete fracture in a bone. Stress fractures tend to occur as a result of overuse and are known as overuse injuries. A metatarsal stress fracture is a stress fracture in one of the metatarsal bones in the foot. See separate leaflet called 'Metatarsal Fractures' for more detail, including metatarsal stress fractures.
Athletes who take part in high-impact sports involving running or jumping are at high risk of forefoot injury. While track and field runners are exposed to the highest level of traumatic forces to the forefoot, many other athletes, including tennis, football, baseball, and soccer players, often have forefoot injuries.
Your feet have to bear the weight of your whole body. There are many bones in each foot. They can briefly be divided into the tarsal bones, the metatarsal bones and the phalanges. The tarsal bones are the larger bones that form the back section of your foot, with the calcaneum being the largest. There are five metatarsal bones and these are given names from the first to the fifth. The first metatarsal bone is the largest and is the bone that joins to your big toe. Each toe has three phalanges, except the big toe which only has two. This means that there are three joints in the toes (two joints in the big toe).
If you have metatarsalgia, your doctor will usually try to establish the cause for the pain. They may be able to identify the cause just by listening to you, asking you questions and examining your foot. However, they may also suggest one or more of the following investigations:
If you have diabetes, good control of your diabetes may reduce your chance of developing foot problems.
A short first metatarsal bone often seen in people with a Morton toe; the normal forefoot balance is disturbed, resulting in the shift of an increased amount of weight to the second metatarsal.
A blister is a bubble of skin filled with clear fluid, ranging from pinpoint size to more than an inch in diameter. They are different than pustules, which contain thicker, yellow-white material. Depending on the cause, blistering may be accompanied by pain, redness, or itching.
The British Orthopaedic Foot and Ankle Society X-rays may be helpful in excluding other causes of forefoot pain.
Weak toe flexors (muscles) Having a stiff ankle or Achilles tendon (the tendon at the heel). This can affect the way that pressure is distributed across the foot and may lead to extra stress on the metatarsal heads. Being overweight. This can put extra stress on the feet in general. Other tests. Occasionally more detailed tests, such as an MRI scan of your foot, are needed.
If you're experiencing a burning, stabbing, or aching pain in your foot, just beneath the toes—it could be metatarsalgia Ensuring that you wear good, properly fitted footwear when running or doing sports with high impact on the feet. Arthritis or gout. This can cause inflammation of the joints in the ball of the foot or of the big toe and can be a cause of metatarsalgia. See separate leaflet called 'Gout' and those on arthritis for more detail. The doctor may also ask for an MRI to help detect and diagnose many causes of pain in the metatarsal and midfoot regions. These can include traumatic disorders, circulatory conditions, arthritis, neuroarthropathies, and conditions that result in biomechanical imbalance. Ill-fitting footwear Metatarsalgia is a general name given to pain in the front part of your foot under the heads of your metatarsal bones. This is the area on the sole of your foot, just before your toes. It is sometimes called the ball of your foot. Metatarsalgia can be caused by a number of different conditions affecting the foot. It is really a symptom of other problems rather than a specific disease itself. You may experience metatarsalgia if you're physically active and you participate in activities that involve running and jumping. Or, you may develop metatarsalgia by wearing ill-fitting shoes. There are other causes as well. In the U.S., forefoot injuries, including metatarsalgia, are common in athletes who participate in high-impact sports. Some anatomical conditions may predispose individuals to forefoot problems. They include: Ensuring that shoes are well fitted, low-heeled and have a wide toe area. This may help to prevent some causes of metatarsalgia, including Morton's neuroma. Morton's neuroma. This is sometimes called Morton's metatarsalgia. It is a condition that affects one of the nerves that run between the metatarsal bones in the foot (the plantar digital nerves). Symptoms include pain, burning, numbness and tingling between two of the toes of the foot. See separate leaflet, 'Morton's Neuroma', for more detail.
Tight Achilles tendon The separate leaflets on Morton's neuroma and bunions (hallux valgus) have details of specific treatments for both conditions. Other treatment will depend on the underlying cause of your metatarsalgia. For example, if diabetes is the cause, you may need better control of your diabetes. If gout or arthritis is the cause, you may need treatment for these conditions. Surgery is sometimes needed to treat metatarsalgia if other treatments have failed. This will depend on the underlying cause - for example, straightening of hammer or claw toes or surgery for Morton's neuroma.
The forefoot absorbs as much as 110 tons of cumulative force per mile during running, which makes your metatarsals, the five long bones that run from your arch to your toes, one impressive set of shock absorbers. When you push off the ground, your body weight is transferred to your metatarsals. If the weight distribution across the foot is uneven when it hits the road (because of your foot's mechanics, a tight Achilles tendon, or calluses), the metatarsals can become irritated and inflamed, resulting in metatarsalgia, according to John Cianca, M.D., associate professor of physical medicine and rehabilitation at Baylor College of Medicine in Houston.
Read the Understanding Blisters -- Symptoms article > > Metatarsalgia can be caused by a number of different conditions. Common causes include: Physiotherapy may also be helpful. This may include exercises to help a stiff ankle or exercises to help stretch your Achilles tendon if these are problems for you. Bunion (hallux valgus). A bunion is a deformity of the base joint of the big toe, causing the big toe to be angled towards the second toe. This causes a bump on the side of the foot at the base of the big toe. There is often thickening of the skin and tissues next to the affected joint. The thickened skin and tissues may become inflamed, swollen and painful. Because of the bunion, extra stress is put on the ball of the foot and this can lead to metatarsalgia. See separate leaflet called 'Bunions' for more detail.