Diagnosing & Treating Metatarsalgia

by Melinda Burris Willms

      Metatarsalgia is a painful condition of the foot that commonly afflicts track athletes and runners in general. This article explores the reasons track competitors are at a higher risk for developing metatarsalgia and explains how to identify the symptoms of the condition and how to treat it.

[am4show not_have=’g5;’]

[/am4show][am4guest]

[/am4guest][am4show have=’g5;’]

Athletes who participate in high impact sports are at a higher risk for developing metatarsalgia simply because the bursts of quick, repetitive actions required (think sprinting, hurdling) demand the feet to take on and absorb a greater amount of force.¹These repeated demands put pressure on the metatarsals—the long bones of the foot that extend across the balls of the feet to the ankles. There are additional risk factors you can avoid in order to lessen your odds of developing metatarsalgia.

RISK FACTORS

• Wearing shoes that are too small restricts the toes and places additional pressure on the ball line of the foot.²So, make sure your shoes fit properly. You should be able to comfortably pinch the front of your shoe after your toes end. Anytime your toes are visibly jutting above or beyond your shoes, you need to wear a larger size to relieve the increased pressure you are placing on your feet. Remember, your feet make up just 2% of your body mass yet, they carry 98% of your body’s weight!
• If you have high arches or your second toe extends longer than your big toe, this can mean you are placing additional pressure on the feet.²

SYMPTOMS

• The primary symptom associated with metatarsalgia is pain, which sufferers often label as a dull ache extending from the “top and sole of the 2nd to 4th toes.”¹It has been noted that this condition can particularly affect the performance of sprinters as they typically begin races by pushing off the balls of the feet to pick up speed. Doing this when you have metatarsalgia increases your pain level.¹
• As a rule, metatarsalgia pain develops slowly, generally over a period of months. The condition often occurs when a new activity is started or when new shoes begin being worn on a regular basis. However, track athletes may experience sudden onset of metatarsalgia because of the pressure they put on their feet.²
• The pain is usually exacerbated by prolonged standing or movement. Flexing the foot may also cause an increased level of pain.²
• While the pain usually begins as a dull ache, if the condition persists for an extended period of time, it may lead to a numb sensation in the toes^.2
• Metatarsalgia can be accompanied by edema (swelling), deformity, or bruising of the foot.^2,3
• Metatarsalgia can cause the skin around the affected area to become unusually thick.³
• Treatment options for metatarsalgia are varied and can include utilization of a variety of pressure absorption devices including the metatarsal bar or metatarsal pads and/or the use of insoles or orthotic arch supports to provide additional relief from pressure on the feet.²

Ron Sheckells, manager of The Good Feet Stores, specializing in orthotics, in Raleigh, Durham, Greensboro, and Winston Salem, North Carolina, explains why proper arch support is so essential in treating metatarsalgia: “Proper orthotics should take the pressure off the ball of your feet to help the metatarsals and take pressure off your heels since these are the main pressure areas of the foot.”⁴

TREATMENT OPTIONS

Treatment options for metatarsalgia are varied and if diagnosed, your course of treatment will depend on the cause and severity of your condition.

• The initial recommendation for treatment of metatarsalgia is a common-sense approach of “rest, ice, and a course of NSAIDs” (non-steroidal anti-inflammatory drugs), for example: ibuprofen.¹
• The utilization of orthotics and/or metatarsal pads to relieve pain and pressure on the foot.^1,2
• If possible, it may be helpful to avoid high impact exercise for a while to allow the metatarsals to heal. Some low impact exercises that could be substituted include swimming or cycling.²
• Stretching is an important part of any recovery program and should include ankle exercises and Achilles tendon stretches.²
• Additional stretches that can be beneficial in recovery include toe glides and mobility exercises.²
• It is vital that you address any underlying foot problems that may exist in order to effectively treat metatarsalgia. Over-pronation (fallen arches) and other ongoing mechanical issues of the feet must be adequately addressed and if home care measures are not successful in treating your metatarsalgia, a course of professional physical therapy may be required.¹
• If underlying mechanical problems are not properly addressed, you face the prospect of ongoing pain as well as a future filled with continual foot problems that could include serious conditions such as deformities of the toes or arthritis. If physical therapy is not successful, surgery may be required to repair the damage.¹

WHEN DO YOU KNOW IT’S TIME TO RETURN TO COMPETITION?

Once your pain is alleviated and the symptoms of metatarsalgia are gone and you find you can perform the high impact movements without the familiar pain, you can return to training and competition. Recovery in most cases takes somewhere between days and weeks, depending on the severity of the case. In order to prevent the condition from coming back, be sure to modify any footwear that is too tight.¹

CONCLUSION

Metatarsalgia is a painful condition that track athletes need to be aware of because of their increased risk as competitors in a high impact sport. Be sure to avoid shoes that are too tight and overly constrict the toes. If you do develop metatarsalgia, follow the common-sense care instructions above and be sure to resolve any underlying mechanical problems of the feet to avoid chronic problems with your feet in the future.

References

1. Brucker, J., & Young, C. Metatarsalgia.
2. Nordqvist, C. All About Metatarsalgia.(2017, December 21).
3. Butts, J.F., & Gebke, K.B. (Nov. 2011). Getting Injured Runners Back on Track.

[/am4show]