Metatarsalgia & Neuroma

Metatarsalgia is pain at the ball of your foot (area where your toes connect to the foot).  It can be singularly or in multiple areas across your foot.  The term is really nonspecific as it is derived from multiple conditions or pathology.  Most common conditions are a capsulitis (inflammation of the soft tissue encapsulating the joint), a tendonitis, a neuroma or swollen nerve,  bruised bone or even thinning of the fat pad about the area.  Lesser common pathology would be a stress fracture, bone tumors or systemic conditions such as rheumatoid arthritis.

Most commonly, the cause is too much pressure on the metatarsal heads, usually from abnormal biomechanics.  Faulty footwear can contribute as well.   If there is a callous on the ball of the foot, then a biomechanical fault does exist. Therefore, it is best to seek professional help, especially if it is on the 2nd toe area.

The second toe area is of significant concern as the 2nd metatarsal is the most common area to get a stress fracture.  Also, this area is subject to deterioration of the ligament and capsule on the base of the toe.  If  damaged, it can lead to a disfigured 2nd hammertoe- even occurring overnight!  This condition is known as 2nd MPJ syndrome.

The reason for it is mechanical. The first metatarsal (where the big toe connects) is significantly thicker than the other metatarsals.  This is because it is suppose to bear up to 60% of your weight during gait.  If an imbalance of the feet is present, it can lead to the weight being transferred to the 2nd metatarsal.  This leads to deterioration and possible fracture of the 2nd.  A truly functional type of foot orthoses can usually control this.

Symptoms may be an aching, dull to a burning pain. There can also be tingling or shooting pain about the area and into the toes.

Sometimes simple metatarsal pads or gel may help, even soft soled foot wear or an over the counter foot orthotic.  With shoes, look for a shoe that curves up at the toes so as you can roll off your foot faster when bending occurs at the area.  Also, look for a softer sole and a toe box that does not “Crunch” your toes together.  If there is a callous, then a custom molded orthotic is typically best in order to ideally redistribute the pressures about the area. Metatarsalgia  rarely requires surgery.

NEUROMA:

A neuroma is a benign tumor of the nerve. However, in most cases, it is an inflammation of the nerve with a thickening of nerve tissues that may develop in various areas of the foot. The most common neuroma in the foot is Morton’s neuroma. This occurs between the third and fourth toes (bases of).  It is sometimes referred to as an inter metatarsal neuroma.

The thickening or enlargement of the nerve is thought to be the result of compression and irritation of the nerve.  It can get displaced under the bone and even trapped in fibrous,  scar like tissue.  Even though it can be palpated, it doesn’t always mean it is painful.

However, if it is palpable, something is probably wrong mechanically as something is irritating the nerve.  When it does become painful or symptomatic, you will know it.  Over the years, you name the symptom, I have probably heard it:  throbbing, aching,  burning, electrical, stinging. I have also heard, “I stepped down and felt a knife in and out of my foot,” ” I have to take my shoe off and rub it, there is a marble growing between my toes,” etc..

People with higher arches and other deformities are at a higher risk for developing a neuroma(s).  Treatment can vary as much as the symptoms.  A metatarsal pad, wider shoes, etc. in my experience are a 50-50 chance. One simple treatment for a neuroma is massaging.  This loosens the surrounding tissues and increases blood flow for healing.

Side Note:  Of course, one should not wear shoes too narrow. However, a patient once told me the neuroma felt better the tighter the shoe was.  This is due to the shoe re-positioning the bones and joints into a more supinated position like an orthotic may do.

In order to have a higher success rate, it is important to get at the cause of the irritation.  I have found that utilizing custom functional foot orthotics, along with simple to advanced physical therapy modalities, will address what is causing the irritation.  The orthotics should be coordinated with the appropriate shoe based on your foot type, ideal fit and needs. Improve the osseous (bone and joint) alignment as well as muscular function begets less irritation to the nerve.