Ball of the foot pain or Metatarsalgia
- Pain across the ball of the foot when walking. Pain is most commonly felt beneath the 2nd and 3rd metatarsal heads, but can be felt beneath any of the metatarsal heads or metatarsal phalangeal joints
- Swelling, mainly across the front of the foot and into the toes
- Numbness and tingling
- Joint stiffness
- Joint pain
Diagnosis is made by a comprehensive foot and ankle exam by Dr. Stewart along with x-rays of the foot. Imaging studies such as MRI are sometimes required to differentiate metatarsalgia from other conditions with similar symptoms such as a neuroma.
Metatarsalgia is commonly seen in association with hallux limitus. Hallux limitus leads to stiffness in the 1st metatarsal phalangeal joint and as a result the weight transfers to the 2nd and sometimes the 3rd metatarsal phalangeal joints leading to pain. Another common cause of metatarsalgia is a shorter 1st metatarsal that leads to weight transfer beneath the 2nd and 3rd metatarsals.
Ball of the foot pain or Metatarsalgia generally takes 6-8 weeks to improve and early activity on the healing bone and joint can result in a setback in recovery. Non-compliance can double the recovery time and can be very frustrating for patients.
Early and aggressive conservative treatment is recommended to prevent further bone and joint injury such as stress fractures. Dr. Stewart terms metatarsalgia a pro-active condition. Conservative treatments include and are not limited to immobilization in a walking boot, stretching, icing, therapeutic laser, custom foot orthotics and stiffer supportive shoe gear.. Although we can never offer a 100% guarantee, the majority of Dr. Stewart’s patients improve with conservative (non-surgical care).
I would recommend Dr. Stewart and his team to anyone in need of Podiatric (Foot and/or Ankle) care. He will give you a realistic appraisal of your situation, the proper course of treatment, and a great result. – Ray Cameron
Conservative treatment for Ball of the foot pain or Metatarsalgia includes:
- Immobilization of the foot in a walking boot
- Modification of physical activity including avoidance of walking, jogging, running, and the elliptical for exercise; recommended exercises include circuit training, swimming, and bicycling
Ice along the tendon 2-3 times per day for 20 minutes at the area of maximum tenderness. Elevation is recommended while icing
- Compression therapy generally with prescription compression stockings
- Therapeutic laser
- Custom foot orthotics
- Medications including anti-inflammatory medications (NSAIDs), Tylenol, oral steroids, and in some cases narcotic pain medication
- Avoidance of flip-flops, flats, and barefoot walking
- Supportive shoe gear including a motion control running shoe such as Brooks, Asics, New Balance, or Saucony. Keen and Merrell style shoes are also recommended
- Weight loss and dieting
If all conservative intervention fails, then surgical intervention may be required. Dr. Stewart will determine which procedure is best for you.
Surgical treatment for Ball of the foot pain or Metatarsalgia includes:
- Shortening of the longer metatarsal bone
- Removal of the prominent metatarsal head
- Adjunctive treatment of common conditions seen with metatarsalgia such as hammertoes and hallux limitus
- Gastrocnemius recession when indicated to offload forefoot pressure