How to Cure Metatarsalgia (Ball of Foot Pain)
The word “metatarsalgia” is unfortunately commonly given as a diagnosis for ball of foot pain, but it is no more of a diagnosis than the word “headache” is. t quite simply means pain in the metatarsal area of the foot. That pain could be from a variety of specific diagnoses which can be split into 3 main groups listed below with examples from each:
The first condition mentioned is NEUROMA which is like a cyst on a nerve, usually referred to as MORTON’S NEUROMA when it affects the forefoot. However this name is frequently incorrectly used because Morton’s neuroma specifically refers to one being in the 3rd intermetarsal space which is the most common location. Other forefoot neuromas are called Iselin’s, Heuter’s, Hauser’s, & Joplin’s.
Nearly all of the above examples (and more) can be diagnosed by a good foot specialist (Podiatrist) from a thorough understanding of the history of the problem and in-depth anatomical knowledge. Occasionally referral for X-ray or ultrasound scan may be required, but note that the former can only look at bones & joints, and the latter cannot easily distinguish between a neuroma and a bursa (a deep fluid-filled sack) – indeed ultrasound reports these days just identify such lesions as “neuromal-bursal complex”.
So if metatarsalgia is complex due to the variety of possible diagnoses, how can it be cured? Well in its simplest form, that just means cure from pain in the ball of foot area. That can be achieved in most cases with use of one (or more) of the following:
- Plantar metatarsal pad or dome
– If correctly placed, this can reduce the direct load on the painful tissue when weightbearing; if incorrectly placed, it can increase the direct load and make matters worse - Functional foot orthoses (orthotics)
– These are used as insoles inside footwear, but their prescription can vary greatly just like they vary with different glasses (spectacles). Trying to guess which prescription is best for you without good specialist advice could see a lot of money being wasted and non-resolution of the pain / problem - Rocker-soled footwear
– Altering the load going through the ball of the foot can help reduce pain, and rocker-soled footwear can be useful for this - Joint mobilisations / manipulations
– Scientific evidence is increasingly showing that this is the most effective intervention for certain causes of metatarsalgia - Injections
– Steroid injections are generally the first line treatment of many inflammatory musculo-skeletal (MSK) problems especially by the NHS as they are quick and simple. They can certainly be effective in many cases in the short-term, but not necessarily so in the long-term and complications can occur. These should be explained before undergoing any such injections, together with consideration of alternative products (such as hyaluronic acid). - NSAIDs (non-steroidal anti-inflammatory drugs)
– In the list of examples above, you will see many have a * next to them. This denotes that they have an inflammatory component to them, and therefore symptoms of that could be helped with appropriate anti-inflammatory medication. In its simplest form this means paracetamol and/or ibuprofen. But other options are available and may be more suitable. - Laser therapy
– For decades this has been known to be helpful in the veterinary world for animals with MSK problems. More recently it is being used safely & effectively in humans to reduce pain & inflammation. (My clinic was the Podiatry clinic in the UK to offer MLS laser therapy to help patients). - Surgery
– Removal of painful tissue (or tissue contributing to the problem) can be an effective treatment if done correctly. However it is no without its risks so needs careful consideration.
Please note this list is an overview of treatments for metatarsalgia, and not a comprehensive list for specific diagnoses. There are lots of treatment options not mentioned which may apply in specific cases, so it is best to see a good Podiatrist for expert professional advice in the first instance as they are the foot specialists.
Jonathan Small, Lead Podiatrist, Health First Foot & Gait Clinic, 01926 811272
“Don’t delay getting treatment and I can highly recommend Health First Foot. My very painful foot problem was diagnosed by them and a treatment plan put in place and it has cleared up the issue in just over 5 weeks” S.P., Kings Heath