Introduction

Are you living with an unresolved, consistent foot pain that is stopping you from enjoying your sunny weekends? You might have metatarsalgia and the relief you have been looking for is not too far, it's hidden within the shoes you are wearing right now. While the causes of metatarsalgia may vary from excessive weight to busy lifestyle, the pain should not be underestimated.The stinging pain under the ball of your foot can turn your morning walk into agony, as if you are walking on a beach full of pebbles. Living with metatarsalgia can hold you back but with simple changes to the shoes you wear, you can easily reduce the pain. In this article, we will discuss what metatarsalgia is, and what kind of footwear meets your needs.

Understanding metatarsalgia

What is metatarsalgia?

Let's start by breaking down this complicated long-term. “Metatars” comes from metatarsus which points to the location - metatarsals (a group of long bones connecting your toes to the middle of your foot) and “algia” means pain.⁸  Metatarsalgia is the medical term, which defines the localised, sharp, burning pain and inflammation in the ball of the foot, on your metatarsals.¹⁰ Metatarsalgia is a symptom and can arise from various root causes.⁴ The solution might differ depending on the cause of the pain but regardless, proper footwear will give you the support and relief you are looking for. Losing excessive weight, resting and stretching exercises can help you with easing the pain.⁸ Metatarsalgia can be also linked to structural abnormalities in forefoot and neurological disorders like cerebral palsy.⁴

Symptoms of metatarsalgia

The symptoms of metatarsalgia are hard to ignore, often interfering with your daily activities. If you are dealing with metatarsalgia, here are some symptoms you might be experiencing:

• Pain under the forefoot, just beneath the toes that worsens with physical activity or standing. Pain might get better with rest 
• Pain may have a sharp, stabbing or burning sensation
• Pin and needles in the feet, tingling sensation

Common causes of metatarsalgia

Several factors and their combinations may be involved in developing metatarsalgia. Understanding the most common causes can help you to determine what's behind your pain and with several lifestyle modifications, we can reduce the pain you experience every day.

Ill-fitting shoes

Shoes with poor arch support, not enough cushioning and high heels can be your biggest enemy and exacerbate your pain.⁶ Shoes that are tight fitting around toes or too loose for your feet can disrupt the pressure distribution and contribute to the pain.^6,8

Overuse

High-impact activities like running and jumping or standing for a long time apply repetitive, continuous load, localising on your metatarsals, leading to the pain.⁵ If you are an athlete, training hard or have long shifts of work, you might have a higher chance of developing metatarsalgia. Unfortunately, that might mean that you need to stay away from your choice of activity to keep yourself fit for a while. Instead, switching to low-impact activities like swimming and cycling to stay healthy can be recommended.

Excessive weight

The risk of metatarsalgia may increase with weight gain.⁸  While walking, the excess body weight creates additional pressure on the forefoot, causing pain and frequently lead to callus formation which may even further worsen your symptoms.⁵ So think twice before eating the last cookie in the box, think again about how this can affect the long-term health of your feet. 

Structural issues

Conditions like bunions (painful bumps at the joint of the big toe), hammer toes (downward curling of the toe), Morton's neuroma (harmless growth on a nerve), flat and high-arched feet may increase the risk of developing metatarsalgia.^5,7

Age

As we get older, the amount of fat in some areas of our body decreases. Decreased fat cushioning under your toes might cause metatarsalgia.⁹

Treatment of metatarsalgia

Rarely, surgeries might be recommended by your doctor if you have other conditions like hammer toes. It is preferred only if recommended self-care strategies are not enough to relieve the intensity of your pain. Simple at home practices are all you need to relieve the pain you are experiencing. Feel free to try these tips to ease your symptoms:

• Ice therapy: Applying ice for 10-minutes several times a day may help.⁵ Try wrapping the ice pack with a towel to protect your skin from cold burns 
• Exercise: You can try stretching exercises that reduce the pressure on metatarsals⁵
• Painkillers: Over-the-counter paracetamol tablets can reduce the pain. Anti-inflammatory agents that reduce the swelling and pain like ibuprofen would be a stronger option to go for.⁵ Please see your pharmacist or doctor before taking any medicines
• Medical treatment: Corticosteroid injections could be offered by your doctor with ongoing, severe pain but they are not common as there are many limitations
• Footwear modifications: Wear the right shoes. Avoid high-heels and tight shoes and try shoes that provide arch support to your feet^3,8 

The role of footwear in managing pain

Now that we have explained what the term metatarsalgia means and what are the possible causes, it's time to explain why it's crucial to have the proper footwear for metatarsalgia. Whether it's caused by the shape of your foot or the style of the shoes you prefer to wear, metatarsalgia is the result of continuous pressure applied to the ball of your foot. The shape and type of your shoes can disrupt the natural distribution of weight and increase the pressure built in that particular area, worsening your symptoms. The right shoes will provide you the support in targeted areas and reduce the pain you have been experiencing on your foot. 

The right shoes can make all the difference: Key footwear features to look for

Next time, when you are shopping for your new favorite shoes or shoes for your choice of exercise, here are the features you need to look for:

Metatarsal pads

Metatarsal pads might be the first option to go for since they are safe and inexpensive. By spreading out the pressure under the metatarsals created by the weight or the motion itself into a larger area, these pads decrease the load on the forefoot.² Also, metatarsal pads elevate the arch of the forefoot and creates more space between metatarsals, reducing the pain.¹ 

Cushioned insoles

Cushioned insoles similar to metatarsal pads are used for metatarsalgia to reduce the load on vulnerable metatarsals and provide arch support to distribute the weight evenly.³ Additionally, cushioning absorbs the shock and pressure applied on the metatarsals and enhances the pain reduction.³ This can be groundbreaking for those who are spending too much time on their feet and looking for full-foot support.Since the size, material and placement of the padding play important role in minimizing the pain, custom made or tailored insoles can be recommended.³

Wide-toe box shoes

Wearing tight-fitting shoes increases the amount of force directed to the area and create repetitive overload, which can cause metatarsalgia.⁵ Naturally, feet become wider toward the toes.⁶ Lack of space limits the natural spread of the toes, bending the big toe towards others, restricts the weight distribution and disrupts the arch of the foot thus increases the pressure on metatarsals.⁶ Wide-toe box shoes provide enough space for the toes to spread and move freely. 

Low-rise heels 

In your natural posture, weight is evenly distributed between the heel, forefoot and the toes. Shoes with high heels alters the weight-bearing pressure distribution within the foot and increase the pressure and the force on the medial forefoot.⁵ Thus, wearing lower heels will help to reduce the pain generated on the ball of your foot.⁷

FAQ`s

Can metatarsalgia heal on its own?

Metatarsalgia can heal on its own but the pain can be frustrating. There are several simple actions you can take at home to relieve the pain and fasten the recovery process.

Is metatarsalgia a damaged nerve?

Metatarsalgia is the term used to describe the forefoot pain. Damaged nerves may result in metatarsalgia but that does not mean that everyone who has metatarsalgia has a damaged nerve.⁵ If you are dealing with pain on your forefoot, that doesn't necessarily mean that you have damaged nerves.

Does Diclofenac (generic Voltarol) help metatarsalgia?

Yes, diclofenac is under the drug class called NSAID (non-steroidal antiinflammatory drugs). These kinds of drugs reduce inflammation and pain and can be prescribed by doctors for several conditions including metatarsalgia for pain relief.⁸ Also, cream forms are available over-the-counter, and massaging in circular motion using the cream might help with the pain.⁸

What is the best exercise for metatarsalgia?

Calf stretches, and foot stretching exercises may help with the pain.⁸ These exercises can be done up to 60 seconds in and should be repeated 5 times a day, 3 times a week. You should be patient and carry on doing these exercises for at least 3 months.

Summary

Metatarsalgia is the expression which defines the pain in the ball of your foot that you might be dealing with every day but your choice of shoes can help you and make living with metatarsalgia more manageable. Shoes with the additional features that can reduce forefoot pressure, such as cushioning and arch support can reduce the level of the pain. Each person's style, foot shape and needs are different so choose the best shoes that can fit your own style with support to the arch of your foot and wide toe box. If every time you open your closet, your hand is reaching to your favorite pair of shoes but you are changing your mind because they are not comfortable enough, you can try metatarsal pads or custom-made cushioning insoles that will give you more support and confidence. You should consider avoiding high heels, flat sandals with no support, and tight shoes. Some professions or occasions might require you to wear them but try to reduce wearing them as much as possible. Choosing a pair of shoes that can provide the support your feet needs can increase your physical capability and quality of your life drastically.