Metatarsalgia, a form of neuralgia, is an inflammation of the nerve that runs between the third and the fourth metatarsal (foot) bones.
Metatarsalgia is caused by the compression of a small toe nerve between two displaced metatarsal bones. Inflammation occurs when the head of one displaced metatarsal bone presses against another and they catch the nerve between them. With every step, the nerve is pushed together by the bones and then rubbed, pressed again, and irritated without relief. Consequently, the surrounding nerve tissue becomes enlarged, with a sheath of scar tissue that forms to protect the nerve fibers.
Metatarsalgia really covers a group of foot disorders. The classic symptom is pain in the front (ball) of the foot. Many people say that it is “like walking on pebbles,” but x-rays usually show nothing irregular.
The problem affects males and females from adolescents to older adults. It is most common in middle-aged women.
The most common causes are:
Heredity: Narrow, high-arched feet can focus stress on the balls of the feet. Also, if the legs are not equal in length, the metatarsal-phalangeal joints of the shorter leg receive additional stress.
Skin Irritation: Metatarsalgia often occurs with bunions or tender calluses under the metatarsal-phalangeal joints.
Foot Disorders: Rheumatoid arthritis, stress fractures, fluid accumulation and muscle fatigue can help cause metatarsalgia. If one is born with - or develops - flat feet, there is also a risk.
"Overloaded" Feet: Excess weight from pregnancy or obesity can contribute to metatarsalgia. So can persistent and abnormal stress on the feet. For example, soldiers, letter carriers and dancers are at risk because of extensive standing and walking.
Nerve Disorders: Morton’s neuroma is a benign growth that can develop on a nerve in the foot. The neuroma can cause a burning sensation that may radiate to other parts of the foot. Soreness can persist even when resting.
In most cases, simple measures will lessen pain at the front of the foot.
Foot freedom: If you wear tight shoes with thin soles and high heels, give them away. If you have symptoms of a Morton’s neuroma, remove the shoes periodically and gently massage the painful area. If you pinch or rub vigorously, you may experience pain as intense as when you hit your “funny bone.”
Orthotics (or metatarsal pads): Consult your podiatrist or physician for a footpad that relieves pressure on the metatarsal area.
Medications: Your doctor may prescribe nonsteroidal anti-inflammatory medications such as ibuprofen or sulindac. This is the most common treatment. Ibuprofen, sulindac, or diclofenac sodium, prescription astringents, emollients or ointments can help treat bunions or calluses, which sometimes are associated with metatarsalgia. Rarely, injections of a corticosteroid into the tender area may be used.
Surgery: An operation seldom is necessary. In severe cases of Morton’s neuroma, surgeons remove the nerve associated with painful symptoms. Surgical options for other types of metatarsalgia include reshaping joints and modifying irregularly shaped bones.
What is causing the pain in my feet?
Is a foot disorder involved?
Are the feet being abnormally stressed?
Is this a nerve disorder (Morton’s neuroma)?
What can be done to relieve the pain?
Do you recommend new shoes?
Would metatarsal pads help?
Are anti-inflammatory drugs indicated?
Under what circumstances would surgery be necessary?