Metatarsalgia is a painful condition we frequently see at the San Diego Running Institute. This video and article will define “metatarsalgia” and provide possible causes and treatment options for metatarsal pain.
Metatarsalgia is a broad term used to describe pain the ball of the foot. The word “metatarsalgia” literally means “pain in the foot bones”. “Meta” means “metatarsal” (bones that make up your foot) and “algia” means pain. A metatarsalgia diagnosis can be frustrating, because you are usually already aware that you have foot pain!
A runner will complain of pain in the ball of their foot usually just behind the second or third toe. The pain can be intense or just a dull ache that they describe as “walking on a rock’ or “walking right on the bone”. Essentially the ligament that helps support and stabilize the 2-4th metatarsal bones and metatarsal arch is sprained. This causes laxity in the ligament which allow the metatarsal bones to “drop” and be lower to the ground. The pain can be intense enough to cause you to stop running.
Metatarsalgia is often misdiagnosed or confused with other common conditions, including:
If you have pain in the ball of your foot or have been diagnosed with plantar fasciitis, Mortons Neuroma or metatarsalgia and have not been helped stop by the San Diego Running Institute and talk to one of our running specialists. You can also schedule an appointment with Dr. Runco by calling (858) 268-8525.
It is important to know why you have metatarsalgia. There are many common conditions that can cause this type of foot pain. The San Diego Sports Injury Clinic employs techniques including:
Metatarsal pads are a common treatment option for metatarsalgia, but they must be applied correctly to be effective. Many runners and athletes have been to a foot doctor or sports doctor who made them custom sports orthotics with a metatarsal pad. When we ask the runner if it helps, they typically reply “No” and that “It does not help at all and may be making it worse”.
The problem is that the metatarsal pad has been placed incorrectly on the custom orthotic. It is essential to have the metatarsal pad in the correct location in order to ease the condition. As noted above, the ligament that helps support and stabilize the metatarsal bones and metatarsal arch is sprained. This allows the metatarsal bones to “drop” and be lower to the ground.
When the metatarsal pad is placed correctly just behind the metatarsal head (just behind the painful location) alleviation of the foot and arch pain is achieved. It is not unusual for us to correctly place a metatarsal pad for a patient and have them walk pain-free right then and there!
Properly placed metatarsal pads are a fast and effective treatment for metatarsalgia, but they are sometimes not enough to fix this common running foot injury. When this “quick-fix” fails the San Diego Running Institute can refer you to Dr. Victor Runco. He is a foot pain specialist and has helped hundreds of runners and non-runners with metatarsalgia and other foot pain conditions.
There are many different metatarsal pads available but we have found the Pro-Tech Metatarsal pad to be the easiest, most convenient and effective metatarsal pads to use.
Once you have them, do the following:
Please note the pad is not supposed to be beneath your pain. It is NOT a cushion for your painful area. It needs to be just BEHIND where your pain is, which is why the placement is so critical. Many patients have told me they tried metatarsal pads before and they did not work… they do work, they were just placed wrong.
Metatarsalgia is related to repetitive high-pressure loading under the metatarsal head (MH) that causes pain. The high pressure under the MH can be reduced by adequately applying metatarsal pads (MPs). Plantar pressure measurements may provide a method to objectively evaluate pressure loading under the MH. However, it is still unclear if the decrease in plantar pressure under the MH after MP treatment is associated with subjective improvement. This study aims to explore the correlations between subjective pain improvement and outcome rating, and the plantar pressure parameters in metatarsalgia patients treated using MPs.
Thirteen patients (a total of 18 feet) with secondary metatarsalgia were included in this study. Teardrop-shaped MPs made of polyurethane foam were applied just proximal to the second MH by an experienced physiatrist. Insole plantar pressure was measured under the second MH before and after MP application. Visual analog scale (VAS) scores of pain were obtained from all subjects before and after 2 weeks of MP treatment. The subjects rated using four-point subjective outcome scales. The Wilcoxon signed-rank test was used to analyze the difference between the plantar pressure parameters and VAS scores before and after treatment. The Kruskal-Wallis test was applied to compare the plantar pressure parameters in each outcome group. Pearson’s correlation was applied to analyze the correlation between the changes in plantar pressure parameters and VAS scores. Statistical significance was set as p < 0.05.
MP application decreased the maximal peak pressure (MPP) and pressure-time integral (PTI) under the second MH and also statistically improved subjective pain scores. However, neither the pre-treatment values of the MPP and PTI shift in the position of the MPP after treatment, nor the age, gender and body mass index (BMI) of the subjects were statistically correlated with subjective improvement. Declines in the PTI and MPP values after MP application were statistically correlated with the improvement in VAS scores (r = 0.77, R2 = 0.59, p < 0.001; r = 0.60, R2 = 0.36, p = 0.009).
We found that the successful decline in the PTI and MPP under the second MH after MP application was correlated to subjective pain improvement. This study provides a strategy for the further design and application of MPs for metatarsalgia treatment.