Metatarsalgia: What is Causing the Pain in Your Forefoot and Toes?

Feet are funny things. They have lots of structures squeezed into a very small space relative to the rest of your body.

When a patient presents with a problem, we tend to run through all the possible diagnoses in our minds until we find the one that fits with both what we hear (the symptoms) and what we observe in our assessments.

There are many things that can occur in the forefoot and the toes, and here we will outline a few of those including:

But before we jump into these conditions, let’s talk about metatarsalgia.

What is Metatarsalgia?

Metatarsalgia is the general term that refers to the pain that you may experience in the area of the foot that is on the bottom of the foot, between the toes and the arches – otherwise known as the ball of the foot.

Metatarsalgia pain can be caused by a variety of conditions (some of which we will discuss today) and anyone can get metatarsalgia pain. Though it can affect people with higher arches or who participate in high impact sports more than other people.

Keep reading to learn about some of the most common conditions that can lead to metatarsalgia pain.

Common Conditions That Can Affect the Forefoot and Toes

Bursitis

This is an inflammation of the fluid filled sac, known as the bursa, that sits between structures to decrease friction and irritation. Some areas these sacs sit between include the achilles tendon and the heel bone or between the tendons of the toes and the metatarsals.

Most people will have about 160 bursae located throughout the body.

When you consider that your feet have 26 bones, 33 joints and a heap of other structures including muscles, tendons and ligaments, there are a lot of bursae located in the feet!

Bursitis can occur due to either repetitive trauma where a certain bursa is taking on too much load, or in an acute injury as part of the inflammatory process.

Medical conditions such as gout and rheumatoid arthritis can be a contributing factor to bursitis.

Bursitis is usually very painful on both direct pressure and through movement. This pain usually builds up over a period of time, however it can sometimes occur quite suddenly.

If bursitis is a likely diagnosis, your podiatrist may send you for an ultrasound just to be sure.

Treatment options for bursitis include resting and icing the area, whilst also avoiding the movements or activities that cause pain. Anti-inflammatory medications such as voltaren or nurofen may also help as they work to reduce inflammation and swelling associated with bursitis.

Often, your podiatrist will examine the way that you walk and your foot posture in order to determine whether we can change these to help take the pressure off the painful bursa.

Depending on where you are experiencing bursitis, we may use taping or padding to help reduce the pressure on one spot and move it elsewhere to reduce pain.

To read more on how we can treat bursitis, check out our blog “Bursa, Bursae, Bursitis! What is it?“.

Synovitis

This is an inflammation of the synovial membrane which lines the joints, helping to lubricate them and allow for fluid movements.

Again, there are a lot of joints within the feet and therefore, numerous spots where you may suffer from synovitis.

The forefoot is the most common site of synovitis in the feet due to the number of joints.

Synovitis is caused by repetitive trauma to the area, meaning that there is too much pressure being placed on certain joints, leading to inflammation of the synovium.

This can be caused by a number of factors including your foot type, footwear, activity and the presence of other conditions such as a bunion or osteoarthritis.

Synovitis results in pain that is usually worse when you are using the joint and tends to ease with rest.

If your podiatrist suspects you are suffering from synovitis, we will often send you for scans to determine the extent of the inflammation.

Treatment initially involves managing the inflammation through rest, ice and sometimes anti-inflammatory medication such as voltaren and nurofen.

Treatment then moves to offloading the affected structures using padding, taping or orthotics to reduce the pressure on the affected joints. To read more on synovitis, check out our blog “Condition Spotlight: Synovitis“.

Fractures

Fractures of the toes are quite common and present as an achy, constant pain that is often present at night.

Fractures can be caused by direct trauma to the area such as dropping something onto your toes or even stubbing your toes.

They can also be caused by repetitive trauma as a result of what activities you participate, particularly those that require running and jumping such as football, netball and basketball, and these are referred to as stress fractures.

There are different types of fractures, including open, closed, displaced and non-displaced fractures and it is important to know what kind of fracture it is before we start treatment. Open fractures involve the bone breaking through the skin, whereas closed fractures do not. Displaced fractures involve a divide in the ends of the broken bones.

Generally, patients will come to the clinic finding it quite difficult to walk and may have some bruising and swelling in the area. We will ask questions about when the pain started and what it feels like.

If we suspect it is some sort of fracture, we will send you for an X-ray. It is important to note that whilst an xray is the first thing we refer you for, fractures, in particular stress fractures, may not always show up on an X-ray depending on how new they are.

If the stress fracture is less than 2 weeks old, it may not show up and we may need to send you to your GP to be referred for an MRI.

It is very important that we gain a really comprehensive picture of what exactly is going on so we can tailor our treatment and rehabilitation accordingly.

Treatment of a fracture involves offloading the fracture to allow the bone to heal properly. Every step we take, we put our whole body weight through our toes, so if a bone in the foot is weak it will not be able to heal with this constant pressure.

Depending on which toe and which bone is fractures, sometimes we can simply taped the toe to the one next to it, called ‘buddy-taping’ to try to restrict motion. Alternatively, you can try to wear wider, more supportive shoes in order to help reduce the pressure.

If the fracture is more significant, you will be required to wear a moon boot. This allows you to put weight through your foot, however the pressure is taken from you foot up to your knee so the fracture isn’t under constant pressure.

Plantar Plate Injuries 

The plantar plate is a ligament that runs under the bottom of the forefoot and its role is to provide stability to and align the toes.

We would suspect that the plantar plate has been compromised if we see a ‘splaying’ of the toes. Plantar injuries typically result in a sharp pain or cramping sensation through the bottom of the forefoot and it is generally most painful when the toes are flexed or when the plantar plate is under the most amount of pressure.

It can be caused by wearing inappropriate footwear, bunions or through trauma such as stubbing the toes or landing awkwardly on the forefoot.

Treatment typically involves resting and icing initially, and then the aim is to offload and support the plantar plate as much as possible. This may include taping, padding or orthotics.

To read more on plantar plate injuries, head to our blog “Condition Spotlight: Plantar Plate Injuries“.

 Morton’s Neuroma

Do you ever feel as though there is a pebble in your shoe under the ball of your foot, only to find that there is nothing there? Or that your socks have folded beneath your toes, however they’re flat when you take a look? Do you ever have sharp, burning pains or numbness in the ball of your foot or your toes?

These are symptoms of what’s called a Morton’s neuroma, which is a thickening of the nerves that supply your toes with feeling. The nerve can become squashed and trapped under a ligament that runs across the ball of your foot, which can cause a lot of pain. It occurs between the toes, also known as the web spaces, with the 3rd webspace between the 3rd and 4th toes being the most common place.

A simple way to reproduce pain and diagnose a Morton’s neuroma is through a test that is called a Mulder’s click, whereby the podiatrist will squeeze the ball of your foot together and then apply pressure to the area where you usually feel the pain (see picture below). If you do feel pain or any neurological symptoms such as numbness, pins and needles, burning or tingling during this test, then there’s a pretty high chance that a neuroma is causing your problems.

There are a few treatment options available to relieve pain associated with a Morton’s neuroma. This can include padding, taping or orthotics to offload the area as much as possible, anti-inflammatory medications and changes to your footwear. In severe cases, surgery may be required.

To read more on Morton’s neuromas, check out our detailed blog at “Pain in the Forefoot? It Could Be a Morton’s Neuroma!

If you’re suffering from pain in your forefoot

If any of the things we’ve talked about today sounds like what you’re feeling now, then it’s probably a good idea that you come and visit us here at Watsonia Podiatry. We can assess your feet and give you an accurate diagnosis, which will get you on your way back to being pain free again!

Book in to see us by calling us on 03 9432 2689 or online here.