Metatarsalgia- symptoms,causes and treatment

Metatarsalgia is the condition were the metatarsal joints, located at the ball of the foot, get inflamed and irritated due to excess force placed upon them. This force can be due to trauma or from repetitive stress on the area. It is a common foot pain presentation, especially as we break out the flip flops for summer.  The condition can often be very aggravating and limit people from walking or exercising. There are many simple things you can do to help your feet feel better.

Symptoms
The metatarsal joints are located at the balls of the feet were the toes meet the main body of the foot. These joints are formed in a way so that there is an arch transverse across your forefoot. The pain will be located in the metatarsal joint, with the second metatarsal being the most common to be aggravated. Symptoms usually occur with vigorous exercise involving high impact sports and is of gradual onset.  Other symptoms can include burning pain in the joints and the feeling of a stone under the skin at the metatarsal joints affected.  

Causes
Metatarsalgia can be contributed to a number of causes including:
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a) Overuse Injuries- The metatarsal arch is involved in shock absorption when walking and running.  Therefore, when excess repetitive force is placed on the arch, the metatarsal joints get irritated and inflamed.  This can occur when people take up running and progress too fast in their training and overuse the area. In excessive cases, a compression fracture can occur in one of the metatarsal bones, causing a  sharp, deep pain in the metatarsal area. 
b) Improper footwear- high heel shoes or poorly fitting shoes can place excess weight onto the metatarsal joints.  High heel shoes with a pointy end can compress the forefoot and also be a  cause of pain. 
c) Genetic Predisposition- People with high rigid arches tend to have a higher chance of getting metatarsal pain.  The foot is more rigid and the foot has a harder time rolling over to the first toe for push off and therefore the metatarsal area takes most of the force. Often over time, people with high arches tend to get hammer toes which also contribute to the problem. People with a Morton's toe, a shorter first toe, are more susceptible to metatarsalgia because the metatarsal area takes the majority of the force for push off. 
d) The Aging Foot- As we get older the thick fat pad on the bottom of our foot starts to thin.  Mileage and natural tissue changes can cause a decrease in our shock absorbing pad over the metatarsal bones. Arthritis and inflammatory arthritis can also cause joint irritation in the foot. 
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 Treatment

Treatment for metatarsalgia is usually very successful. The first step is to get a thorough foot examination to determine if there is a structural cause for your pain.  This would include: a fallen transverse arch, a Morton's toe, a hammer toe, or loss of the fat pad. An evaluation of your gait and your callus pattern on your foot can also be helpful to determine if the cause is of mechanical nature.  We have a force plate at the Neepawa Chiropractic Centre that can measure your foot in dynamic motion and determine the amount of force that is being distributed across the foot. The second step is to take a look at your footwear.  Stop wearing flip flops and high heal shoes and change to a shoe with fore foot padding.
Therapeutic treatments can include: massage, manipulation/mobilization of the toes and metatarsal joints, ultrasound, and ice or heat therapies. General foot exercises like pulling a towel under your foot with your toes, picking up a marble with your toes, or general foot stretches can also help. 
There are a number of items you can add to the shoe to help support the metatarsal arch or correct improper foot motion.  The most common used for metatarsalgia is the metatarsal pad.  This should be placed in a position on the insole of the shoe so that the pad lies behind the balls of the feet, not directly on them.  If you have a loss in the fat pad across the metatarsal area, a metatarsal bar pad is appropriate and can be placed in a position on the insole of the shoe so that the pad lies directly under the balls of the feet. Orthotic insoles are also often used to help correct improper gait. 

Activity fact: An ideal amount of steps in a day for the average person is 10,000. However, the average American only achieves 3,000 steps a day. Get up and get active!

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