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Pain in the Ball of the Foot - Metatarsalgia

Pain in the Ball of the Foot - Metatarsalgia

If you have pain in the ball of your foot you are not alone. Pain in the ball of the foot is a common complaint.  When someone is referring to the ball of the foot they are usually referring to the location of the metatarsal heads.  The long bones of the foot are called metatarsals.  The metatarsal heads are the knobby ends of the metatarsals that form a joint with the toes. Thus the ball of the foot is the area where the toes form a joint with the long bones of the foot, the metatarsals.

Pain in the ball of the foot can come from a problem with the nerves as seen in conditions such as neuropathy or a neuroma, which will be discussed shortly.  Often, pain in the ball of the foot can is the result of one or more of the metatarsals taking more than their share of the load.  Metatarsalgia is a general term which simply means pain in the metatarsal bones.  For this discussion I am going to be talking specifically about pain in the metatarsal heads.

There are several reasons why one or more of the metatarsal heads can become overloaded.

  • Some people gradually lose the fat pad that cushions the area under the metatarsal heads as they age. If there is less cushion the bones feel more of the load and this causes pain.
  • Some people were born with a deformity known as Morton’s toe in which the first metatarsal bone (long bone of the big toe) is short.  As a result the second metatarsal or second toe is longer than the big toe.  This causes most of the body weight to be put onto the second metatarsal head. This overloads this bone and causes pain.
  • Some people with high arches have pain in the ball of the foot.  In the person with the high arch we often see that they load the foot primarily at the heel and then again in the ball of the foot.  The mid-foot does not take its share of the load.  This again overloads the metatarsal heads at the ball of the foot.
  • Another painful condition felt in the ball of the foot is Morton’s neuroma.  This is usually felt between the 3rd and 4th toes.  One quick way to tell if you may have this condition is to grab your foot around the metatarsal heads and squeeze your whole foot.  If you have a neuroma this squeezing will causes pain at the site of the Morton’ Neuroma.

Although the cause of pain in the ball of the foot is varied, the treatment, at least the initial treatment, is the usually the same.  We try to reduce load and if necessary movement of the metatarsal heads.  This is accomplished by adding a metatarsal pad to an orthotic or arch support.  The metatarsal pad fits in the ball of the foot just behind the metatarsal heads.  This allows more of the weight to be taken up by the long shafts of the metatarsals and less on the metatarsal heads. The metatarsal pads can be added to a custom arch support.  They can also be purchased over-the-counter from a pharmacy or specialty shoe store.  The correct placement of the metatarsal pad is critical so follow directions or ask your physician or podiatrist for help.

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