Metatarsalgia – Ball of the Foot Pain

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Metatarsalgia is an inflammation involving the ball of the feet. The feet are a delicate part of the body’s foundation. The feet will go through an extensive amount of wear and tear during our lifetime. Each individual’s pair of feet have a unique story to tell and hold the memories of the miles accrued throughout the years. Whether spending a significant amount of time standing, walking or the impact from running, can take a toll on the structure and overall, foot health. It is imperative to understand preventative measures, in order to maintain status quo, when leading an active lifestyle.

Etymology

“meta-“: this Greek a prefix means “pertaining to”,”alongside”, “after”, “behind”, and “beyond.”

“tarsos-“: this Latinized Greek term refers to the bones of the tibia and metatarsus of the ankle.

“-algos”: This word comes from ancient Greek and pertains to Greek mythology, meaning pain.

What are a neuroma, Morton’s neuroma, and metatarsalgia?

The feet, support the entire weight of the body and the anatomy of each foot can be broken down, into its functional role. Metatarsalgia is a name that describes the pain that develops in ball of your foot, under the heads of the metatarsal bones. There are three parts that make up the bone structure of the feet. The tarsals are the largest area of the foot that form the heel of the foot. As well as the metatarsals, which are tubular in shape and makeup, part of the bones in the mid-foot. They are numbered from first to fifth, with the first being the strongest, as the big toe. The metatarsals are between the phalanges and tarsal bones and convex in shape, are long bones and make up the arch of the foot. Their role is to work as a team with the connective tissues, ligaments, and tendons to activate movement in the foot.

Metatarsalgia, may cause both pain and inflammation to the ball of the foot. Also, commonly known by the name of stone bruise. . The ball of the foot’s location is the sole area of the foot, just before the toes. The pain can vary for each sufferer and may affect one, two toes or sometimes the entire foot. It is known to be a common overuse injury in many high impact athletes. Metatarsalgia, is most common in middle-aged women, although anyone can develop it. Athletes that exude an intense amount of stress to the forefoot, such as soccer players, tennis, basketball, and football, may experience metatarsalgia injuries. Morton’s neuroma is a specific, painful condition that an individual may feel as though there is a small, hot pebble in between the third and fourth toe. Morton’s neuroma, is a more specific condition that explains the exact location of the discomfort that, metatarsalgia pain causes. Runners, spend a significant amount of time distributing weight over the forefront of their feet while running. Although this injury will cause a person to be forced to rest, it is not life-threatening.

Symptoms

The tell-tale signs of metatarsalgia is the pain of the ball of the foot which is heightened by putting pressure by walking, running and even just standing. The build up of pain typically occursur with the build up of time. The amount of pain can vary from mild to severe and will be diagnosed by the physician. Most patients describe the pain as if they are stepping on a small pebble. Commonly, the pain is derived under two metatarsal heads, but it has been clinically reported that some patients will develop pain under all. When your daily routine becomes hindered by gradual discomfort, it is best to keep a look out for the correlated symptoms.

What are signs and symptoms?

Sharp aching in the ball of your foot, mainly in the metatarsal region, behind the toes.
Pain that worsens when you run, stand, walk or flex your feet.
Numbness and Tingling sensation in the toes.
A feeling of having a hot pebble between your toes.

Causes

We know there are endless ways to protect ourselves from harms way, but with our full packed lives, events do cause injuries to slip through the cracks. Now that we understand the warning signs for injury to the metatarsals, let’s look into the causes. One of the main causes of metatarsalgia is Morton’s neuroma, which was diagnosed by Dr. Morton in 1876. Morton’s neuroma is a condition that affects the nerve, usually between the third and fourth metatarsal toe bone. This condition is also referred to as inter-digital neuroma and the initial cause of the nerve swelling is unknown. However, there are reported causes that contribute to the cases of Metatarsalgia.

In short words, the cause is either intrinsic or extrinsic, meaning from the inside or from the outside:

Intrinsic means that the problem is genetic. For example, due to a rare congenital birth defect of the foot. The problem is the abnormal form of the foot.
Extrinsic means that the problem comes from outside the body. For example, inadequate footware may put extra pressure on the  5th metatarsal which may provoke pain and severe discomfort.

The following list includes the causes of metatarsalgia:

1. Anatomy of the foot: a high arch puts additional pressure on the metatarsals. As, well as having a second toe that is longer than the big toe, which causes extra pressure on the second metatarsal head. Hammertoe deformity, which is permanently bent at its middle joint and puts extra stress on the ball of the foot.

2. Excess weight: due to the amount of weight on the forefront of the foot while walking, it puts extra strain on the metatarsals.

3. Overuse and intense training: aside from improper fitting sneakers, the impact of long distance runners when the front of the foot absorbs majority of the impact, makes a candidate for metatarsal inflammation.

4. Poorly fitting shoes: sneakers that lack support, high heels that force the weight to the front portion of the foot and boots, with a narrow toe box contribute to the metatarsal injury.

5. Age: with time, the foot padding starts to thin, which lessens the shock to absorb the body weight’s daily load.

6. Medical conditions: Rheumatoid arthritis, bunions, diabetes, Achilles tendon and having a stiff ankle can all contribute to the force put on the metatarsals. Bursitis, is common among high impact athletes. Repetitive motion in sports can cause inflammation and bursitis can develop. The pain due to this condition can spread from the mid-foot and to the forefoot. The same symptoms from both metatarsalgia and bursitis include aggravation of the foot due to activity. The same regime is delivered to both by resting the foot and taking time away from the strenuous engagement.

It is best to consult your physician when feeling any signs of discomfort in the feet. A thorough examination and digging deeper into lifestyle and overall foot health will help the proper treatment plan.

Forms of metatarsalgia and neuromas:

Functional metatarsalgia refers to a painful forefoot due to a local defect of the structural manner. Some anatomic defects may include the following:

• Abnormal metatarsal formation
• Loss of forefoot joint mobility
• Local metatarsus equinus
• Associated toe deformity such as a hammer, retracted, trigger, and claw deformity.
• Iatrogenic change due to surgical intervention
• Muscular plantar fibrofatty pad atrophy
• A rigid pes cavus
• Rigid plantarflexed ray
• A subluxation of one or more metatarsophalangeal joints
• Generalized joint hypo or hypermobility

Non-functional metatarsalgia refers to the result of a pathology of on or more parts of the foot and body. The following is a short list of possible diseases:

Soft-tissue diseases
• Hyperkeratosis of the focal plantar
• One or more connective tissue pathologies such as plantar fibromatosis, plate rupture etc.
• One or more synovial pathologies such as nodules and ganglions, capsulitis, gouty tophus, adventitious bursitis, rheumatoid bursae etc.
• One or more vascular pathologies such as ischemia, venous and/or lymphatic insufficiency etc.
• One or more neurological problems such as sensory dysfunctions, nerve damage or entrapment, Morton’s neuroma, neuritis etc.
• One or more muscular pathologies
• Neoplasm growth

Bone diseases
• Stress/march fracture
• Osteochondritis (Freiberg’s infraction; sesamoid osteochondritis)
• Sesamoid pathologies
Systemic disease
• Rheumatoid disease
• Autoimmune disease
• Osteoarthritis
• Ankylosing spondylitis
• Connective tissue diseases
• Reactive arthritides
• Sero-negative arthritides

Other diseases
• Back pain
• Paget’s disease
• Obesity
• Infection
• Neoplasm growth

Neuromas or lesions that damage or irritate a local nerve in the foot can trigger multiple symptoms in somewhat specific locations. The following enlists the most common nerves and their afferent locations in which symptoms may manifest:

  • A neuroma or a lesion on the proximal tarsal tunnel can damage or irritate the branches of the posterior tibial nerve and cause pain and other symptoms in the medial ankle area.
  • A neuroma or a lesion on the distal tarsal tunnel syndrome can damage or irritate the medial plantar nerve and cause pain and other symptoms in-between the navicular tuberosity and the belly of the abductor hallucis. It’s also called the Jogger’s foot.
  • A neuroma or a lesion on the distal tarsal tunnel can damage or irritate the lateral plantar nerve and cause pain and other symptoms in-between the bellies of the abductor hallucis, quadratus plantae, and the abductor digiti quinti minimi. Also called Baxter’s neuritis.
  • A neuroma or a lesion on the medial plantar nerve can cause pain and other symptoms in the first metatarsal head. A neuroma in this location is also called Joplin’s neuroma.
  • A neuroma or a lesion on the first intermetatarsal plantar nerve can cause symptoms between the first and second metatarsals. Such a neuroma is also named Houser’s neuroma.
  • A neuroma or a lesion on the second intermetatarsal plantar nerve can cause pain and other symptoms between the second and third metatarsals. A neuroma in this position may also be called Heuter’s neuroma.
  • A neuroma or a lesion on the third intermetatarsal plantar nerve can cause pain and other symptoms between the third and fourth metatarsals. It’s also called Morton’s neuroma.
  • A neuroma or a lesion on the fourth intermetatarsal plantar nerve can cause pain and other symptoms between the fourth and fifth metatarsals. It’s also known as Islen’s neuroma.

Risk Factors

The risk factors correlated to metatarsalgia include the following:

High-impact sports: can change when an athlete may increase the intensity of a running work-load too fast and before they are ready. Runners, also explore the barefoot running and minimal footwear trend and it can result in forefoot pain. Without easing into this niche running style, the impact of the feet with an entirely different support system underneath the ball of the foot, needs time for adjustment. It is best not to train through the pain and give your feet time to rest and adjust without discomfort.

Shoes with tight toe boxes: will cause damage to the formation of the foot, causing pain. The assumption may be that with aging we will not escape foot issues later in life. However, this is far from true. With a little effort and research, you can ease your mind knowing there are answers. Shoes with tight toe boxes force the toes to squish towards each other and force weight onto the ball of the foot. This is especially apparent in women’s high heel shoes, that are simply just too narrow. If heels are a must due to professional careers requiring a dress code, it is best to switch the height of the shoes throughout the days of the week. When choosing a proper fitted shoe, note that the shoe will fit the form of your foot and not the other way around.

Problems with circulation: may be caused by diabetes, hypertension, and high cholesterol. The risks involved with the reduced blood flow is lack of oxygen delivered to to the foot, which can make a condition, such as Morton’s neuroma, harder to heal.

Obesity and physical imbalance by causing friction to the metatarsals: has been studied by the International Journal of Obesity in 2001. The results have concluded that compared to the non-obese group of subjects, the obese group has increased forefoot pressure which is reported under the longitudinal arch of the foot and the metatarsal heads. With more detail that woman are reported to have higher pressures then men due to less strength in ligaments of the foot.

Feet with abnormally long bones or high arches: cause imbalance in the pressure put on the foot. Individual’s with a shorter first metatarsal bone and longer second metatarsal bone seem may contribute to the anatomical condition. The weight is pushed onto the second metatarsal bone and results in stress and forefoot issues, leading to Morton’s neuroma. The instability of the toe joints can cause trauma to the nerve, resulting in inflammation. Bio mechanical deformities, as in a high arch of the foot, can cause increased stress onto the metatarsal heads due to uneven distribution of pressure while walking. Because the high arch is unable to participate in receiving some of the shock during a heel strike, it creates stress on the soft tissues of the foot.

Aging due to tendon and connective tissue changing: the fat padding underneath the sole of the foot starts to lessen. Collagen production starts to slow down as we age, resulting in less cushioning. With less protection supporting the metatarsals, the likeliness of injury become higher. The feet also widen and flatten. Conditions that take a toll during older years of life include, arthritis and circulatory disease. Lack of stability leads way to developing forefoot pain.

Musculoskeletal conditions, such as gout and arthritis: can cause pain and swelling in the joints of the body. Gout, a type of inflammatory arthritis, that can cause pain and is a risk to developing metatarsalgia. Gout comes from problems with metabolizing uric acid. Uric acid is produced in the body during the breakdown of foods, such as meat, seafood, and poultry. These foods are high in chemicals called purines and the chances of being diagnosed with gout are higher if alcohol and food consumption are too high. When the levels go above normal in the blood, small crystals form in the joints, causing inflammation.

Diagnosis

For a detailed diagnosis about any pain, burning and discomfort it is best to seek medical attention. A podiatrist, who specializes in the lower extremities, will be able to ask valuable questions and may order tests to go more in depth. Initially, the physician will ask questions about lifestyle, medical history, occupation and pain. Then, the podiatrist will begin a manual exam, checking on all areas of the foot and lower extremity. Moving each toe through range of motion, specifically keeping an eye out for the second to fourth metatarsal and to see if it’s riding high or shifting medially. The podiatrist is looking for instability and will continue to examine the intermetatarsal spaces for pain. By laterally compressing the great toe towards the fifth toe, the physician will listen for a clicking, which may indicate a neuroma.

X-Rays: The medical provider will take an x-ray to rule out stress fractures and any other anatomical issues.
Radiological Imaging Test (MRI Scan): For more in depth information, the MRI, is useful in showing more than an x-ray and will assist in detecting and diagnosing the patient’s pain.
Blood work: Will help in diagnosing underlying conditions, such as diabetes, gout and arthritis.
Gait: An assessment of the patient’s gait will display which areas of the foot are causing pain during an active state of walking.
 Ultrasound: Can help pinpoint if the pain is a cause of Morton’s neuroma or bursitis.

With the results achieved from the overall assessment of the health of the feet, will help the Podiatrist in creating the best treatment plan for the patient’s needs.

P.R.I.C.E. first aid

Upon injury realization, it’s advised you halt all sports activity to avoid further damage and complication.

Protection: the affected foot should be protected from further hard impacts. This means no more running, dynamic sports, jumping, and other activities that put a repetitive strain on the ball of the foot. Depending on the severity of the case, medical devices such as casts or crutches can be deployed to better protect the affected area.

Rest: the patient has to take some time off strenuous, high-impact activities to allow the body to heal itself. However, some cases may not require a full immobilization of the foot, meaning that certain low-impact activities such as walking, cycling, swimming, and so on can prove beneficiary towards recuperation by stimulating the body in producing healing hormones and other substances.

Ice: as soon as the injury is evident, ice should be immediately applied to the affected area to decrease inflammation and pain. Roll some ice cubes into a towel and gently apply the ice to the entire affected area of the foot. Hold for about 10 minutes, multiple times a day.

Compression: some compression can prove helpful in decreasing inflammation, pain, and bruising. Sports tapes should suffice, but other specially designed medical devices can also prove helpful. Compression is most important immediately after the injury has occurred.

Elevation: most types of injuries of the foot can benefit from elevation as is reduces inflammation, edema accumulation, and discomfort. Best deployed immediately after injury realization, alongside ice, compression, protection, and rest.

Treatment

Thankfully, there are many opportunities to treat acute metatarsalgia. After the physician deduces the amount of time a patient has suffered and severity, a treatment plan will be delivered. The list of nonsurgical treatments is extensive and give great hope to healing the cause of the pain.

To ease pain and discomfort

It is recommended within the first 24 hours of diagnosis to keep weight off the foot. Along, with rest, it is advised to keep a icing regime throughout the day for 15-20 minutes at a time. Be mindful to keeping the ice wrapped in a secure covering, avoiding direct skin contact. To keep the inflammation and pain at bay, it is recommended to take an oral, anti-inflammatory medication.

Footwear

Padding: Provides support for the metatarsal arch, which decreases pressure on the on the nerve and metatarsal bones
Orthotic Shoe Insoles: It may be ordered to get custom fitted orthotics, depending on the anatomy of the foot. Orthotics will protect the ball of the foot.
Shoe Modifications: Comfort over style with foot health. Find a reliable shoe with a wide toe box, giving your toes room. Flat shoes, as opposed to narrow-toe, high heels are ideal.
Arch Support: There are times where insoles do not work and an arch support is the next in line.
Rocker Bottom Shoes: Also known as round bottom shoes, are made with a thicker than usual sole. These shoes are created to compensate for lost range of motion. The rounded heel, assists with the gait and helps re-calibrate the before painful walking experience in previous shoes.

Getting back to running: the 10% rule

It states that you should never increase your weekly mileage by more than 10 percent over the previous week.
Returning to a normal activity level should be gradual. The principle is valid for all sports activity, but mainly for running, you should never increase your total weekly mileage by more than 10% over the prior week. In other words, every week, increase the total work volume by no more than 10% after resuming activity post therapy or surgery. For example, if you ran a total of 1 km the week before, you should run no more than 1.1 km the week thereafter.

Physical Therapy

Physical therapy will aid in all intentions of restoring the use of the feet and obtaining full range of motion. A physical therapist is written as part of the treatment plan in the early stages of the diagnosis.

Gait Assessment: A physical therapist will perform tests to look for gait during walking and running exercises. This test will look at the body’s movements and how the unit, as a whole, is running. If there are areas that are compensating, the gait analysis will show imbalances in the joints. With frequent repetitive motions, especially in runners, the small stabilizing muscles are forces to compensate for larger prime movers and result in injury. Each gait is unique to each individual and with the assistance of the physical therapist, he/she will be able to break old habits and create a new regime that will prevent further and future dysfunction within the body. The goal is to have a well-round body that is strong in the core, balanced and flexible.

Exercises: Start with a dynamic warm-up. Engage the muscles that you will be using throughout your desired work-out. The following exercises are recommended:

1. Swimming: Allows you to keep active without putting too much pressure on the ball of the foot and joints.

2. Ankle Up & Downs: Position yourself on a couch, with the ankle hanging over the edge. To perform the exercise, push the foot as far down as manageable and then pull the foot towards your body. Aim to complete up to 20 repetitions.

3. Toe Walking: With bare feet, raise up to the toes and balls of the feet and begin to walk around the room for up to 20 seconds.

4. Foot Grab: Using a piece of cloth or anything small enough to pick up, aim to grab the object between the toes and ball of the foot. Complete 8 repetitions.

Stretching

Stretching at all ages and level of activity are beneficial to the body. According to the American College of Sports Medicine it is recommended to stretch the major muscle groups at least twice a week and hold each stretch for 60 seconds. With a condition, such as metatarsalgia, there are specific stretches to be performed. If participating in an activity or some type of exercise, you can perform your stretches as part of the cool-down. The focal areas are strengthening the foot and calf muscles. Strengthening these muscles will lighten the load on the front of the foot. The following stretches are beneficial:

1. Toe Stretch: Gently taking each toe individually and flexing and extending with a 5 second hold, at 5 times each.

2. Toe Pulling: Standing in a forward position, feet hips distance apart, curl the toes of one foot, imagining you are grabbing onto a ball. Aim to perform 25 repetitions and be sure to repeat on the other side.

3. Achilles Tendon Stretch: This can be performed by standing on the edge of a stair or curb, where your heels will have height to lower. While hips are facing forward, feet at hips wide distance, begin to lower the heels down toward the floor. Give yourself 10 seconds to hold the position and then slowly release, back to neutral, both feet flat, at starting position. Aim to complete 3 sets of 12 repetitions per day.

4. Bent Knee Calf Stretch: With both feet facing forward, step back with the right leg and begin to drop the knee slightly down towards the floor, while keeping the heel of the foot on the floor. The goal is to feel a stretch in the calf muscle of the back leg. It is best to hold this stretch for 30 seconds at 3 repetitions. When the right side is completed, switch to the left and repeat.

5. Ankle Extension: The ankles contribute to the performance of the foot and it is best not to neglect this area. By sitting in a chair and crossing the injured foot over your leg, take hold of the toes of the injured foot, with the opposite hand and start to pull them towards you. Despite, the source of pain becoming apparent, it is advised by the Sports Injury Bulletin, to hold this stretch for 5-10 seconds. Take a 10 second break in between completing 3 sets of up to 8 repetitions.

6. Bare Foot Stretch: In bare feet, take a walk in the grass for a few minutes per day to allow the deep tendons and muscles of the foot stretch.

Don’t forget to gradually increase both the intensity, variation, and volume of training as soon as you’re asymptomatic and healed up.  Follow the 10-percent rule and progress to impact training, weight lifting, plyometrics, and so on. Start slowly and listen to your body, stop if there’s any foot pain. Don’t just jump back in the old training regiments as your body may not be yet prepared to withstand such activity level. Instead, slowly bring your body to that level by strengthening both bone, muscle, and mind. Focus on free weight lifting with dumbells and barbells to strengthen all body parts, especially the feet muscles, calves, and legs.

Weightlifting: Focus on working the tiny feet muscles by using a wrap-around weight. Next, perform as many possible calves raise variations. Also, don’t forget about squats, lunges, box jumps, and so on. It’s imperative you rebuild the lost muscle and bone mass.

Cardio: Start by engaging in impact-less cardio exercises such as swimming, static bicycle, elliptical machine, and so on. Slowly progress towards impact cardio to stimulate the bone and muscle regrowth. When deciding to incorporate impact cardio, consider starting with rope jumping, light jogging, and similar as to give the body enough time to rebuild and adapt.

Massage:

Massage is another helpful part of treatment. The goal of massage to the affected area is to increase local circulation, reduce pain and swelling through the use of pressure. You can also massage the balls of your feet with analgesic gels such as Ben-gay as to catalyze the healing process. Use circular, longitudinal, and vibrated massage motions to stimulate blood flow and tissue rebuilding. Consider using vibrating infrared heat massager for better results and easier use. Have a massage session once a day or every other day, stop if you feel pain. and don’t over do it.

Laser Therapy:

Laser therapy is designed to help acute conditions. The various types of lasers use different wavelengths of light or other substances to stimulate cellular reproduction. Most commonly, the low-level laser therapy (LLLT) is used to treat chronic injuries by enhancing cell function within the affected tissue. It uses low-powered light-emitting diodes (LEDs) to treat the area without incision or unwanted side-effects.

Cryotherapy:

For reduction of pain, cryotherapy is administered to inhibit the nerve’s transmission signals through the use of low temperature. Furthermore, the low temperature also decreases inflammation, spasms, and pain while increasing cellular survival. Different methods include localized or whole-body therapy (WBC).

 

Medical Treatments Include:

1. Injection Therapy:

 

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Non-steroidal anti-inflammatory drugs (NSAIDs) are usually deployed to lower inflammation and stop the pain. Make sure you read the package leaflet and eat a full, fiber-rich meal beforehand.
Common brand names include ibuprofen and naproxen.

Steroids are prescription drugs with strong anti-inflammatory and anabolic proprieties. They can shorten the healing process, but it’s strongly advised that you talk to your doctor before considering them because of some side-effects that may ensue such as virilization, organ damage etc.

Corticosteroids such as cortisone injections are administered for Morton’s neuroma. Although the result may be temporary, it will assist in decreasing pain. This steroid is typically used for inflammation in smaller areas of the body for a fast relief.

Human growth hormone can be another viable therapy for certain cases. HGH can drastically reduce inflammation and aid in tissue building and reconstruction. Ask your doctor about human growth hormone and see if it may benefit your case. For middle-aged men and older, a short cycle can prove extremely beneficiary with little to no side effects.

S.A.R.Ms (Selective Androgen Receptor Modulators) are new-age drugs that can replicate steroid effects without most side-effects. In fact, these drugs can help build bone mass and prevent certain bone diseases. Although the medicine is somewhat high-priced, the side-effects are drastically reduced in comparison to steroids because of their selective action. SARMs do less damage to the testes, prostate, breasts, and other organs while reducing virilization (masculinization) in women.

TB-500 or Thymosin beta-4 is a synthesized human protein with tissue regeneration and anti-inflammatory capabilities. The new-age peptide is used to treat post-infarct patients with damaged hearts and many other conditions related to tissue damage. It comes with very few side effects and can be injected anywhere. TB-500 may prove extremely beneficiary to metatarsalgia patients, consider asking your doctor about it.

2. Foot Surgery: for Morton’s neuroma is generally not advised. The following reasons are a description as to why this surgery may be more harm than good. Complications include pain, treatment plan, and scar tissue. The pain threshold has been documented that patients have reported more pain after the surgery. Post surgery pain can be caused by a stump neuroma. A stump neuroma, is an adhesion that develops near the area of the metatarsal head. This is one of the reasons it is not advised, as it makes it challenging for the patient to express where the actual pain is stemming from. Foot instability is caused by the first surgery being performed through the top of the foot. This involves using the dorsal approach, by making an incision through transverse metatarsal ligament. The recovery time is shorter than operating through the bottom of the foot, but sets the patient up for forefoot instability and gait problems.

The recovery time is also a hindrance at upwards 3 to 4 months. After the surgery is completed it takes on average 3-4 weeks to manage. The range of mobility time to regain strength is months later. This can really drag on for an individual’s lifestyle and become a drag.

Surgical re-do can sometimes be required. The approach for the second surgery will be through the bottom of the foot. Unfortunately, the recovery period is even longer, at upwards 6 months and not to mention, more painful. If all other forms of therapy are not working to the best of their ability, foot surgery is last case scenario. Surgery will aim to correct any metatarsal abnormalities and release nerve pressure.

Holistic Treatments:

Acupuncture: A naturopathic doctor will focus on the inflammation and pain in the metatarsal region and access the entire body for imbalances. The needles are thought to have a stimulating effect on the immune system. Although research is rather inconclusive, usage is well spread throughout the world. Carefully search for a licensed and experienced practitioner, as the treatment is complicated and can create health complications if done improperly.
Essential Oils: Hydrophobic plant-based oils for topical use on the area of pain may provide excellent results. For example, peppermint is used for reducing pain and it also smells wonderful. Other commonly used oils include Eucalyptus, Castor oil, camphor, Borage, Yarrow, Comfrey, Chamomile, Arnica etc.
Hydrotherapy: The therapy consists of using different streams of water to massage the affected area. Furthermore, by alternating hot and cold water, the immune system is boosted, inflammation is decreased, and pain is reduced. It also helps circulation. You can also do it at home, just get into the shower and alternate between ice cold and hot water.

Prevention:

To have a sound body, mind and soul there are preventative measures to take. For metatarsalgia, the following can be taken as a precaution to developing this discomfort:

Healthy Weight: Maintain a healthy weight to prevent additional stress that will add to the pressure put on the foot. Healthy food choices have medicinal benefits. There are specific foods that help in decrease pain throughout the body. The Mediterranean diet is a great way to keep weight at bay, as well as keep inflammation in the body low. The nutrients found in the following food items are helpful in calming the body’s inflammatory response.

1. Olive oil
2. Brown rice
3. Green and bright colored vegetables
4. Nuts, such as almonds and walnuts
5. Maple Syrup
6. Fruit, such as pineapple, strawberries, and oranges
7. Vanilla

As they say, what goes up, must come down. There is also a list of foods that will work against the body’s analgesic effects on pain nerves. Analgesic effects work to keep the pain threshold down and by avoiding the following foods, will work in your best interest.

1. Dairy products
2. Soda and other sweetened beverages
3. Red and processed meat
4. Fried foods
5. Refined carbohydrates, such as pastries and white bread
6. Margarine

7. Fatty fish

To completely reduce inflammation, cancer risk, and all-cause mortality, consider adopting a vegan diet. A well-diversified vegan diet will accelerate rehabilitation and healing time by providing high-quality nutrients and anti-oxidants. Keep in mind that meat, dairy, and all animal-derived products will definitely slow your progress.

Other important lifestyle and dietary rules include proper hydration and sleep pattern, vice reduction, warming up and cooling down, improving ergonomics, posture, exercise form, and cooking methods.

Hydration means you’ll have to drink around 2 liters of water (~70 oz) every day. Just remember the 8×8 rule: 8 cups of water of 8 ounces each, that means a total of 64 ounces of water per day.

Sleep is also extremely important towards rehabilitation as the body heals itself when it sleeps. Aim for 8 hours of uninterrupted sleep every day. Prepare your body for bedtime by getting accustomed to darkness one hour before bedtime. This means avoiding bright screens and light before going to sleep as to allows the sleeping hormone, Melatonin, to do its job. Also, drink a cup of water before sleep and immediately after you wake up. Set up the room temperature at about 15 to 20 Celsius (60 to 67 degrees Fahrenheit), lower humidity as much as possible, use memory foam pillows, a hard mattress, and don’t eat too many sweets, fats, and animal-derived products before bed as to not interfere with the growth hormone production.

Vice reduction should be a priority when injured as most vices interfere with the rehabilitation process by hindering or even blocking the healing process. More so, some vices may aggravate certain conditions. For example, smoking thickens the blood and causes tissue inflammation which will definitely slow down the healing process. Furthermore, alcohol weakens the body’s immune system and disrupts normal blood flow which can affect the healing process.

Warming up and cooling down are two important procedures you should never skip. The first one prepares your body for intense activity and the latter makes sure your body will recuperate successfully. Try to develop an adequate routine before and after strenuous physical activity as to increase your overall performance. Aim for 15 minutes of dynamic warm-up beforehand, and 5-10 minutes of cool down, afterward.

Warming up: start off by getting your heart rate up by doing jumping jacks, torso twists, shadowboxing, static running, and other similar movements for a couple of minutes, try to target all muscles and joints through such movements and drills. Proceed to focus on joints and muscles that you may not have warmed up completely, such as the neck, shoulders, ankles, wrists, and so on. Try to envision the joints and muscles and move them in every direction possible for a couple of times to get an adequate blood flow to the muscles and lubrification in the joints.

Cooling down: slowly get your heart rate down by gradually lowering the intensity level of your training. Subsequently, proceed to stretch your muscles statically by doing stretches and foam rolling. Try to envision the fibrous micro tears in the muscles as you hold your stretches. Hit all your muscles, hydrate, have a cold shower, and eat some nutritious plant-based food.

Ergonomics, posture, and exercise form are all fundamental factors in both prevention and healing. The way you conduct your life in everyday scenarios plays a huge role in your general health. You always should seek to improve the way you work, sit, sleep, run, and so forth.

Ergonomics at work: Analyze your work environment and determine if there’s anything that might negatively affect your rehabilitation process. For example, operating heavy machinery such as a pneumatic concrete breaker can prove detrimental. Furthermore, any other job that requires standing on feet for long periods of time can hinder the healing process. Principally, everything that has to do with your feet should be investigated with your doctor.

Properly Fitted Shoes: Whether you are a runner and need to be measured for custom built sneakers or a commuter that changes shoes before walking into the office, be sure they are comfortable enough to protect the anatomy of the feet.

Choosing your footwear.

While looking in the mirror, place your feet on the ground, firmly. Leave just a little bit of space in-between and try to determine if your fit one of the 3 typologies:

1. High arched feet with supinated (inwards) legs have a tendency to roll-out, wearing the shoes on the outside, predisposing the ankle to strain. Also, the forces aren’t equally distributed, so seek cushioned shoes. It’s better if they’re high-top as to protect the ankle.
2. Normal arched feet with neutral (perpendicular) legs leave no exaggeration in the footprint and wear the shoes between the first and second toe. This foot type is the most versatile, meaning it can adapt to many shoe types, but it’s recommended you seek a sneaker that has a large, flat, stable sole with some cushioning.
3. Flat-arched feet with pronated (outward) legs tend to roll inwards, consuming the sole and outsole on the inside part. It’s advised you seek sneakers with grippy soles and with minimum cushioning.

In fact, you should experiment with low heel-to-toe drop shoes and maybe transition towards minimalistic shoes because many feet conditions are due to the fact that the feet are unconditioned with repetitive stress, making the bones weaker and unprepared. It’s the principle of adaptation, meaning that certain tissues can be strengthened through various stimuli, including barefoot walking and running. So, investigate alongside your doctor and see if the aforementioned is pertinent to your case.

 

False Positives

Due to the foot being such a delicate area with many small moving parts, it is imperative to get the right diagnosis and treatment. This condition does not cling, solely to the athlete, it can occur in any individual. Morton’s neuroma is easily misdiagnosed for other causes of metatarsalgia. Other causes such as, a stress fracture, hammertoe, metatarsophalangeal joint synovitis, arthritic conditions, and others can be misdiagnosed as cause to metatarsalgia. Because of overlapping symptoms, it is wise to keep track of the discomfort you are having and be specific as possible. Less common conditions that have similar, clinical issues are ganglion cysts, true neuromas, neoplasms, and the like. Most of the same tests are run for these conditions, as you can see why it is easy for a professional to conclude it is the incorrect ailment.

Metatarsophalangeal Joint Synovitis: It is often mistaken that because of the pain in the ball of the foot area, that it is Morton’s neuroma. The tell-tale sign that separates the two is, metatarsophalangeal joint synovitis, is reported to have swelling and targeted pain, around the joint.
Stress Fracture: Stress fractures generally occur in the metatarsal bones of the foot. Medical professionals, listen to the patient’s chief complaint and know that pain can be vague. However, with x-ray testing to show the small, micro fracture in the bone, will conclude it is a stress fracture, instead of a Morton’s neuroma.

Conclusion

The word metatarsalgia derives from the clinical term, metatarsals, which are the long bones and algos, the Greek word referring to pain. Pain and discomfort will become apparent within the ball of the foot with this condition. More specifically, Morton’s neuroma, causes a localized pain in between the third and fourth toe. It is described as a small pebble underneath this area and with possible burning.

Morton’s neuroma has a history of affecting women more often than men, high impact athletes, those with feet deformities, and the effect of ill fitting shoes. If experiencing pain in the ball of the foot, it is advised to seek medical attention. A podiatrist, specializes in studying the lower extremities, will run tests to give a diagnosis. Taking precaution on lifestyle choices will make a difference in taking preventative action.

It is a life journey to be your own health advocate and why ignore the part of the body that help you get from A to B daily. Get educated, protect your feet and make wise selections when picking style over commitment.  Please seek a licensed physician for any inquiries regarding metatarsalgia. This article was written in good faith with research pulled from medical sources. The following sources denote the original articles that are utilized throughout this article.

Co-written by Edy Mihai

Curated by Diana Rangaves, PharmD, RPh

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