Metatarsalgia is a generic term used to describe non-specific
forefoot pain in the region of the metatarsal bones. Most clinicians agree that
metatarsalgia is actually pain from the metatarsal bones that is the result of
overuse, overloading or use of inappropriate shoes for a particular activity.
Metatarsalgia may be considered a precursor to a stress fracture of the
Treatment of metatarsalgia
Metatarsalgia can be treated
with a metatarsal pad,
arch support with metatarsal pad
of the forefoot in the shoe. Forefoot rockers
soles (seen at right) are an important shoe modification used by pedorthists to decrease the
load to the forefoot. Stiffening the shank of the shoe tends
to carry load more effectively past the metatarsal bones to the ball of the
foot. Stiff shank shoes and boots are helpful, or a
graphite inner sole called a spring plate, can help.
Oral and injectable anti-inflammatories, such as cortisone, can be
helpful in cases of metatarsalgia. But it's important to recognize
that metatarsalgia is a mechanical problem. It's a problem that occurs
again and again with each step. Anti-inflammatories may help to decrease
pain, but they don't specifically target the primary mechanical problem
contributing to the pain of metatarsalgia. Therefore, effective treatment
of metatarsalgia must focus on correcting the pathomechanics of the foot.
algia - suffix relating to the pain or ache of an
metatarsal - one of five bones found in each
pathomechanics - problem or condition that is cause by
'pathological' or bad mechanics.
There are five metatarsal bones in each foot.
The metatarsal bones span the distance between the arch and the forefoot. Each metatarsal is a long shaft with cartilage on both ends to
form articulation with the midfoot and toes.
The size of the metatarsals vary. The first
metatarsal is always larger and more stout. The lesser four metatarsals
are typically close in size. Any increase in metatarsal size may be
suggestive of an increase in the long term load bearing of the individual
The metatarsal bones reach the ground at a 20-30
degree angle as they travel from the midfoot to the toes. The overall
length of the metatarsal is very important in diagnosing cases of metatarsalgia
related to one or two isolated metatarsals.
When viewing an AP X-ray (from the top of the
foot to the bottom) the overall length of the metatarsals is referred to as the
metatarsal parabola. The typical parabola is 2,1,3,4,5 meaning that the
length of the metatarsals is the second as longest, the first and third as a
close second and the fourth and fifth close behind. To understand the importance
of metatarsal length, or parabola, consider this simple example;
Let's say you have two bamboo poles, one 5 feet
in length and the other 10 feet in length. You hold the poles under your
arms level to the earth and slowly lower them. Obviously the ten foot
pole is going to hit the ground before the five foot pole. This is
exactly what happens with long metatarsals, over and over again with each
step. Eventually, metatarsalgia develops as a result of the over loading of the 'ten foot' pole.
Much of the treatment of the biomechanical
factors found in metatarsalgia relate to correcting the imbalance of the
metatarsal length and restoring the normal metatarsal parabola.
The symptoms of metatarsalgia can be acute or chronic in nature. Symptoms may include dull ache and
sharp pain on the bottom of the foot. Typically, symptoms of metatarsalgia increase with the amount
of time spent on the feet and are relieved by rest. The picture
to the right shows the area most commonly effected by metatarsalgia.
Symptoms may vary in severity and location
Arthritis of the forefoot
Stress fracture of the metatarsal
Products Recommended for Metatarsalgia:
This article was written by Jeffrey A. Oster, DPM and last updated
2/8/13. Additional references include;
Albert, S. F. Soft tissue causes of
metatarsalgia. Clin Podiatri. Med. Surg. 7(4):579-595, 1990
Chairman, E.L. Restoration of the plantar fat pad
with autolipotransplantation. J. Foot Ankle Surg. 33:373-379, 1994
Scranton P. Metatarsalgia; Diagnosis and
Treatment. J of Bone and Joint Surg Am. July 1980;62(5):723-732
McPoil T, Management of Metatarsalgia Secondary
to Biomechanical Disorders. Physical Therapy. June 1986;66(6):970-972
Stapleton B. Primer on Rheumatic Diseases. 9th
ed. Atlanta Ga: Byrd Press; 1988
Viladot A. Metatarsalgia Due to Biomechanical
Alterations of the Forefoot. Orthop Cl of N. Am. Jan 1973;4(1):165-178
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