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What is metatarsalgia and how is it treated with canting?

Metatarsalgia | Can you or can’t you cant?Metatarsal bones

Metatarsalgia describes pain in the metatarsal bone.  Metatarsalgia can be caused by a number of contributing factors and can affect any of the 5 metatarsal bones of the foot.  Metatarsalgia is most commonly caused by eccentric loading of the forefoot resulting in mechanical load applied to one metatarsal.  In the early stages of this eccentric loading, the metatarsal reacts by becoming painful.  If the load continues, the outcome may be a stress fracture of the metatarsal.

Metatarsalgia caused by ski boots

Cardinal planes of the bodyI saw a case of 5th metatarsal metatarsalgia in the office this week in a patient who is an avid snowboarder.  He told me that his feet were fine whenever he was off the slopes but every time he used his board, the outside of his foot would start to hurt.  The clinical exam showed no swelling but the entire 5th metatarsal was achy and sore to palpation.  X-rays were negative for a fracture.  Our working diagnosis was 5th metatarsal metatarsalgia.

The eccentric loading previously described that caused this patient’s metatarsalgia was due to the canting in his board set up.  To describe canting we need to refer to body planes.  Use this mental image – you’re standing facing out of a glass sliding door.  The door represents what’s called the frontal plane.  For a skier, a board adjustment in the frontal plane is an adjustment to canting.  Raise the outside of the boot (pronate the foot) or raise the inside of the boot (supinate the foot).  An adjustment in canting that pronates the foot will decrease load to the 5th metatarsal.  Patriot Footbeds has a great video that describes the concept of canting and modification ofLateral Sole Wedges ski boot.

Lateral Sole Wedge - treatment of metatarsalgia

How can you cant your boot or shoe at home?  The simple way is to use a Lateral Sole Wedge.  A Lateral Sole Wedge is a thin insert that fits into the shoe or boot and limits the supination of the foot (rolling to the outside of the foot).  The use of a Lateral Sole Wedge will decrease load to the 5th metatarsal and heal cases of 5th metatarsal metatarsalgia.

This example of a ski boot adjustment is just one small example of how metatarsalgia is treated.  Metatarsalgia is by no means exclusive to skiers and is found in all walks of life including sports, work or daily activities.


Dr. Jeffrey Oster
Jeffrey A. Oster, DPM

Medical Advisor

Updated 3/15/2021

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