|
Metatarsalgia
Your ego used to be the only thing that got
bruised during pickup basketball games. But lately, the jump's gone out of your
jump shot — you can still leap, but landing is pure torture. What's more,
running and even walking cause the same burning pain on the bottoms of your
feet. If this sounds familiar, you may have metatarsalgia — a condition marked
by pain and inflammation in the ball of your foot.
Metatarsalgia frequently affects runners
and other athletes who participate in high-impact sports. That's because
excessive amounts of running or jumping put extra stress on the metatarsals —
the long bones located in the front part of your feet just below your toes.
People with certain foot shapes that create more stress on the metatarsal bones
also may have these problems.
Although generally not serious,
metatarsalgia can sideline you, whether you're an Olympic contender or a weekend
warrior. Fortunately, conservative treatments such as ice, rest and physical
therapy can often relieve symptoms. And proper footwear, along with special arch
supports (orthotics) or nonprescription shoe inserts, may be all you need to
prevent or minimize future problems.
Signs and symptoms
The main symptom of metatarsalgia is pain
in the ball of your foot — the part of the sole just behind your toes. The
pain may be sharp, aching or burning, and you may feel it in the area around the
second, third and fourth toes or only near your big toe.
Other symptoms of metatarsalgia include:
 | Pain that gets worse when you stand,
walk or run and that improves when you rest
| | Sharp or shooting pain in your toes
| Numbness or tingling in your toes
| Pain that worsens when you flex your feet
| A feeling in your feet as if you're
walking on pebbles or have a bruise from a stone
| Increased pain when you're walking
barefoot, especially on a hard surface |
| | | |
Sometimes these symptoms come on suddenly,
especially if you've recently increased your usual amount of running, jumping or
other high-impact exercise, but problems are more likely to develop over a
period of months.
Causes
In each foot you have five metatarsal bones
that run from your arch to your toe joints. The first metatarsal is shorter and
thicker than the other four bones, which are usually similar in size. During the
push-off phase when you walk, jump or run, your body weight is transferred to
your toes and metatarsals. The first and second metatarsal bones take the brunt
of this force, which can be as much as 275 percent of your body weight.
Most metatarsal problems develop when the
impact load or the mechanics of your foot affect the way your weight is
distributed. This can put excess pressure on the metatarsals, leading to
inflammation and pain, especially in the metatarsal heads — the rounded ends
of the bones that connect with your toe bones.
Sometimes a single factor can lead to
metatarsalgia, but more often several factors are involved, including:
| Intense training or activity.
Runners have the highest incidence of metatarsalgia, primarily because the
front of the foot absorbs more force when running than during any other
activity — as much as 110 tons of force per mile. But anyone who
participates in a high-impact sport is at risk. Training intensely or for
long periods puts even more stress on the metatarsals, often leading to
chronic irritation and inflammation.
| Certain foot shapes. A
high arch (pes cavus foot) can put extra pressure on the
metatarsals. So can having a second toe that's longer than your big toe,
which causes more weight than normal to be shifted to the second metatarsal
head.
| Hammertoe. This foot
problem has a genetic basis but can also develop when high heels or
too-small shoes prevent your toes from lying flat. As a result, one of your
toes — usually the second — curls downward because of a bend in the
middle toe joint. This contraction depresses the metatarsal heads.
| Bunion. This is a
swollen, painful bump at the base of your big toe. Sometimes the tendency to
develop bunions is inherited, but the problem can also result from wearing
high heels or too-small shoes. Bunions are much more common in women than in
men. A bunion can weaken your big toe, putting extra stress on the ball of
your foot. Sometimes surgery to correct a bunion also can lead to
metatarsalgia.
| Excess weight. Because
most of your body weight transfers to your forefoot when you move, even a
few extra pounds mean more pressure on your metatarsals. Sometimes just
losing weight can reduce or eliminate symptoms of metatarsalgia.
| Poorly fitting shoes.
High heels, which cause more weight to be transferred to the front of the
foot, are one of the most common causes of metatarsalgia in women. Shoes
with a narrow toe box or athletic shoes that lack support and padding also
can contribute to metatarsal problems.
| Stress fractures. Small
breaks in the metatarsals or toe bones can be painful and change the way you
put weight on your foot.
| Morton's neuroma. This
noncancerous growth of fibrous tissue most often occurs between the third
and fourth metatarsal heads. It causes symptoms that are similar to
metatarsalgia and can also contribute to metatarsal stress. Morton's neuroma
frequently results from wearing high heels or too-tight shoes that put
pressure on your toes. It can also develop after high-impact activities such
as jogging and aerobics.
| Aging. As you grow
older, the fat pads on the balls of your feet become thinner, making the
metatarsal bones more susceptible to injury. |
| | | | | | | |
Risk factors
Almost anyone can develop metatarsalgia,
but you're at higher risk if you:
| Are athletic. You're
especially at risk if you're a runner or participate in other sports that
involve running or jumping, such as soccer, tennis, baseball, football and
basketball. Swimming and cycling, which don't put pressure on your forefoot,
aren't likely to cause metatarsalgia.
| Wear high heels or shoes that
don't fit properly. High heels transfer extra weight onto the front
of your foot, and shoes that are too tight can compress your toes, affecting
foot mechanics. Wearing athletic shoes that aren't well padded or that
aren't appropriate for a particular sport — for example, playing
basketball in tennis shoes — also can put you at risk of metatarsalgia.
| Weigh more than is healthy.
Extra pounds mean more weight is transferred to your metatarsals.
| Have other foot problems.
Certain foot shapes, such as high arches, a long second toe or unusually
long metatarsals, all can contribute to metatarsalgia. So can other
conditions such as hammertoe, Morton's neuroma, arthritis and even gout.
These can cause pain and inflammation that change the way you walk and the
distribution of weight in your feet. |
| | |
When to seek medical advice
Not all foot problems need medical care.
Sometimes your feet simply ache after a long day of standing or a punishing
workout. But it's best not to ignore any foot pain that lasts more than a few
days. If you experience a burning pain in the ball of your foot that's not
improving, even after changing your shoes and modifying your activities, see
your doctor.
Screening and diagnosis
A number of foot problems can cause
symptoms similar to those of metatarsalgia. To help pinpoint the source of your
pain, your doctor will examine your foot and ask about your lifestyle and
activity level. You may also have an X-ray to help rule out a stress fracture or
other foot problems.
Complications
Avascular necrosis (Freiberg's disease), a
condition that usually affects the second metatarsal head, occurs when a
temporary or permanent loss of blood to the feet causes the death of bone
tissue. Without treatment, the bone itself may collapse. Although metatarsalgia
alone doesn't cause avascular necrosis, it may help trigger the condition in
people who have a predisposition to develop it.
Untreated metatarsalgia may also lead to:
| Injury to ligaments in the feet
| Pain in other parts of the same or
opposite limb due to altered weight bearing
| Toe problems
| Chronic stiffness and loss of range of
motion |
| | |
Treatment
Although different cases may require
different treatments, your doctor is likely to suggest conservative approaches
first, including one or more of the following:
| Ice. Applying an ice
pack or package of frozen peas to the affected site several times during the
first 24 hours can reduce inflammation and help relieve pain.
| Relative rest. To
recover from metatarsalgia, you need to keep stress off the injured area,
but you also need to remain active so that you don't get out of shape. Sound
impossible? Not at all. You may not be able to play your favorite sport for
a while, but you can stay fit with low impact exercises, such as swimming
and cycling. And you can continue with stretching and lower body strength
training as your pain permits.
| Medications. Sometimes
your doctor may prescribe a nonsteroidal anti-inflammatory drug such as
ibuprofen (Advil, Motrin, others) to help reduce pain and inflammation.
| Orthotic devices. These
fit inside your shoes and help minimize stress and improve foot function.
They're usually prescribed by your doctor and can be custom-made from a
plaster cast of your foot. You can also use off-the-shelf orthotics, which
come in various shoe sizes and can be fitted immediately, although they
usually wear out more quickly than molded ones do. Orthotics are categorized
as rigid, semi rigid and soft. As the name suggests, rigid orthotics are
constructed of a firm material such as plastic or carbon fiber. They're
designed to control motion in two major foot joints below your ankles. Semi
rigid orthotics are made of softer materials such as leather and cork
reinforced by silicone. Orthotics designed to treat metatarsalgia may also
have a metatarsal pad placed in your shoes just ahead of the metatarsal
bone. These help deflect stress away from the painful area. You can also use
metatarsal pads on their own, without an orthotic.
| Shock-absorbing insoles.
These are cushioned inserts that fit inside your shoes to help cushion
shock. Insoles are often made of cork, plastic, rubber or a gel-like
substance called viscoelastic that's found in brands such as Sorbothane,
Airplus and Spenco. You can buy insoles in drugstores and athletic shoe
stores. Your doctor may suggest trying inexpensive insoles or foot pads
before turning to orthotics.
| Proper shoes. Your
doctor may recommend a shoe that's especially suited for your foot type,
your stride and your particular sport. The right shoes are important in
helping prevent re-injury. |
| | | | |
Surgery
For most people, rest, physical therapy, proper shoes and orthotics or insoles
can effectively treat metatarsalgia. When these conservative measures don't
provide relief, your doctor may recommend an operation to realign the metatarsal
bones, especially if you have a bunion deformity. If you're considering foot
surgery, be sure to discuss the benefits and risks carefully with your doctor.
Prevention
When you're serious about sports, your
metatarsals take a beating. But that doesn't mean you have to live with pain and
injuries. To help protect your feet:
| Choose the right shoes.
The "I'll make it fit" philosophy didn't work for Cinderella's
stepsisters, and it won't work for you. Wearing high heels or too-small
shoes can set the stage for a host of foot problems, including metatarsalgia.
The same is true of shoes that don't provide enough support and cushioning.
Look for shoes with a wide toe box and a rocker sole, which redistributes
weight on the bottom of your foot. If you're having trouble finding the
right shoes, consider talking to a podiatrist, who can analyze your stride
and make helpful recommendations. The knowledgeable staffs at some athletic
shoe stores also are a good resource.
| Consider cushioned insoles,
metatarsal pads or orthotic devices. Over-the-counter cushioned
insoles or metatarsal pads may help relieve metatarsalgia. If not, you may
want to ask your doctor or a podiatrist about orthotic devices you can use
in your shoes.
| Maintain a healthy weight.
Keeping your weight within a healthy range can help prevent diabetes, high
blood pressure, coronary artery disease and some types of cancer — as well
as take a load off your feet.
| Don't train through the pain.
For most athletes, taking time off is more excruciating than the most
grueling workout. But continuing to play or train when you're injured
usually leads to more severe problems and longer layoffs later on. And when
you're recovering from an injury, don't try to resume strenuous activity too
soon. If you're not completely healed, you're likely to re-injure yourself. |
| | |
Jan. 24, 2005, Mayo Clinic
|
