Metatarsalgia

Metatarsalgia is a general term used to describe pain and inflammation in the ball of the foot (the area between your arch and toes). It’s not a specific disease itself, but rather a symptom of other underlying problems. This common condition can affect anyone but is frequently seen in active individuals or those whose feet experience excessive pressure. Understanding metatarsalgia is the first step towards effective management and finding relief with the help of a podiatrist in Singapore.

The symptoms of metatarsalgia can develop gradually or appear suddenly, often worsening with activity. Key signs include:

• Sharp, Aching, or Burning Pain: Primarily felt in the ball of the foot, just behind the toes. It might feel like you’re walking on pebbles or have a stone in your shoe.
• Pain Worsens with Activity: Discomfort typically increases when standing, walking (especially barefoot on hard surfaces), or running, and improves with rest.
• Numbness or Tingling: Some individuals experience pins-and-needles or numbness extending into the toes.
• Increased Pain When Flexing the Foot: Pointing the toes upwards can sometimes aggravate the pain.
• Callus Formation: Hard skin (callus) may develop under the affected metatarsal heads due to increased pressure.

If these symptoms interfere with your daily life, seeking a professional diagnosis is crucial.

Metatarsalgia arises when something changes the way your foot normally works (biomechanics), leading to excessive pressure on the metatarsal bones. Common causes and risk factors include:

• Intense Training or Activity: High-impact sports (running, jumping) or a sudden increase in activity level puts repetitive stress on the forefoot.
• Foot Shape and Structure: Certain foot types are more prone, including:
  • High arches, which can increase pressure on the forefoot.
  • A second toe that is longer than the big toe, causing more weight to shift onto the second metatarsal head.
  • Bunions (Hallux Valgus), which can alter foot mechanics.
  • Hammertoes, which can depress the metatarsal heads.
• Improper Footwear:
  • Shoes with narrow toe boxes squeeze the forefoot.
  • High heels shift excessive weight onto the ball of the foot.
  • Shoes lacking adequate padding or arch support.
• Excess Weight: Carrying extra weight increases the pressure on the feet, particularly the forefoot.
• Stress Fractures: Tiny breaks in the metatarsal bones can cause pain mimicking metatarsalgia.
• Morton’s Neuroma: A non-cancerous growth of nerve tissue, typically between the third and fourth metatarsal heads, causing similar symptoms.

Arthritis or Gout: Inflammatory conditions affecting the foot joints.

• Chronic Pain: Persistent discomfort that affects mobility and quality of life.
• Altered Gait: Limping or changing the way you walk to avoid pain, which can lead to secondary pain in the hips, back, or other leg.
• Progression of Underlying Issues: If caused by conditions like hammertoes or bunions, these may worsen without proper management.
• Reduced Activity Levels: Pain can discourage physical activity, impacting overall health.

A podiatrist at Fine Podiatry Clinic will diagnose metatarsalgia through:

• Detailed History: Discussing your symptoms, pain patterns, activity levels, footwear choices, and medical history.
• Physical Examination: Assessing your foot structure, checking for tenderness, swelling, calluses, and evaluating your range of motion. Your podiatrist will palpate (feel) the ball of your foot to pinpoint the exact location of pain.
• Gait Analysis: Observing how you walk to identify any biomechanical issues contributing to the pressure.

Imaging (If Necessary): X-rays may be ordered to rule out stress fractures, arthritis, or other bone abnormalities. An ultrasound or MRI might be used if soft tissue issues are suspected.

The primary goal of treatment is to relieve pressure on the affected metatarsal heads and address the underlying cause.

• Conservative (Non-Surgical) Treatments: This is the mainstay of metatarsalgia management. At Fine Podiatry Clinic, we focus on personalised non-surgical strategies, which may include:
  • Footwear Modifications & Advice: Recommending appropriate shoes with wide toe boxes, low heels, and good cushioning.
  • Padding and Strapping: Applying specific padding techniques to offload pressure from the painful area.
  • Custom Orthotics: Prescription insoles designed to correct biomechanical imbalances, redistribute pressure across the foot, and provide cushioning. These are often highly effective for long-term relief.
  • Activity Modification: Guidance on temporarily adjusting activities that aggravate the pain.
  • Callus Management: Gentle removal of any associated callus build-up.
• Surgical Options: Surgery is rarely required for metatarsalgia itself but might be considered if conservative treatments fail and there is an underlying structural deformity (like a severe hammertoe or bunion) that needs correction. This would be discussed in detail if deemed necessary after a thorough evaluation.

Note: Our podiatrists will create a tailored treatment plan based on your specific diagnosis and needs, focusing on relieving your pain and preventing recurrence.

You can take steps to reduce your risk or manage mild symptoms:

• Wear Appropriate Footwear: Choose shoes that fit well, have a wide toe box, good arch support, shock-absorbing soles, and avoid high heels for prolonged periods.
• Maintain a Healthy Weight: Reducing excess weight decreases pressure on your feet.
• Use Metatarsal Pads: Over-the-counter pads placed just behind the ball of the foot can help offload pressure (consult our podiatrists for correct placement).
• Consider Orthotic Inserts: Arch supports or cushioned insoles can improve foot mechanics and comfort.
• Manage Calluses: Gently use a pumice stone on damp skin, but avoid aggressive filing.

Gradual Activity Increase: Avoid sudden spikes in training intensity or duration.