Metatarsalgia or Forefoot Pain in Runners

Metatarsalgia is the general name given to pain in the forefoot, otherwise called the ball of the foot. There are many, many bones in the foot. By number the feet contain a quarter of the bones in the body:

• There are the tarsal bones in the back section of the foot, which include the calcaneum, the heel. These make up the ankle and sub talar joint.
• There are the mid tarsal joints which are a complicated arrangement of small cube shaped bones, there are the long metatarsals and the phalanges which are the bones that make up the toes.
• The feet also have many ligaments, tendons and muscles within them.

The metatarsal head is the name given to the foremost part of the metatarsal. Pain can be experienced under the metatarsal heads and can be a sign of a number of different conditions. It is usually felt more when standing, walking or running, but not so much when resting or sitting.

Possible Conditions leading to Metatarsalgia

• Synovitis of the metatarso-phalangeal joint is a condition where the joint between the metatarsal head and the phalangeal bone is inflamed. The synovial sac swells due to collection of fluid and usually leads to pain when walking or running. It can occur as a result of overtraining or running abruptly on an uneven surface.
• A stress fracture is an incomplete fracture of a bone. The metatarsal bones of the feet can suffer a stress fracture as a result of overtraining. This type of stress fracture is also known as a march fracture, since soldiers marching for very long periods tended to develop it.
• Morton's Neuroma affects one of the nerves which run between the metatarsals, usually between the third and fourth toes. Tissue can build up and put a lot of pressure on the nerve, leading to a very painful forefoot. It can come about by using ill-fitting, narrow shoes.

Self-Treatment

If you are concerned about pain in your forefoot it is advisable to see a doctor or a podiatrist for a proper diagnosis. You will then be able to tackle the problem in the right way. Here are some things which you can do to help yourself:

• Rest, with the feet elevated.
• Use hot and cold treatment. Cold is good at the onset, but if the condition becomes longer-term it is good to combine heat with cold.
• Take a course of anti-inflammatories, such as ibuprofen.
• You can also add some foods to your diet and drop others from your diet to help reduce inflammation and ease pain. See Foods that Fight Pain
• Wear running shoes which are well-fitted and have a wide toe area. Bear in mind that the shoes you wear when not running can affect your feet, e.g. high heeled shoes, shoes with a narrow toe box.
• Wear a metatarsal pad or an orthotic insert to reduce pressure on the metatarsal heads.
• Stretch out your calf muscles (tight calf muscles will lead to more pressure on the forefoot). See Running Stretches for Beginners.
• You can also use a roller to help ease tight muscles.

Professional Treatment

A doctor or podiatrist may suggest an X-ray, ultrasound or a bone scan if the underlying cause is not immediately obvious. In some cases the problem area could be injected with cortisone to reduce the inflammation. In other cases surgery may be the appropriate course of action.

This general information is not intended to diagnose any medical condition or to replace your healthcare professional. If you experience any pain or difficulty with these exercises/advice, stop and consult your healthcare provider. Always seek the advice of a qualified healthcare professional with any questions you may have regarding this subject.