METATARSALGIA/PAIN IN THE
BALL OF THE FOOT
Metatarsalgia as a diagnosis can be used for a
variety of conditions causing pain in the ball of the foot. Most
often the pain is caused by a trauma to the nerves that are located
between the bones
 of the foot (interdigital).
A very common cause of metatarsalgia is Morton’s
neuroma, which is a growth on a nerve. T his growth usually occurs at
the 3rd plantar interdigital nerve that innervates the toes. It
can however affect other nerves. Morton’s neuroma occurs most
often unilaterally rather than bilaterally (one foot), and is more
common in women than men. Morton’s neuroma can be a result of a
malformation of the bones of the foot beginning in our early years of
development. A flattening of the arch or the foot turning in or out (pronation)
can be a causative factor.
A phenomenon often found in individuals with
Morton’s neuroma is when the toes are flexed (curled under), it will be
found that the 2nd toe is quite a bit longer than the others and
somewhat shorter than the normal 1st metatarsal.
Pain in the metatarsal area (ball of foot) can
also be caused by stress fractures. A stress fracture is a minute
(micro-fracture) that occurs in a bone due to repetitive impact or of a
pounding nature to that particular area or bone, such as a runner would
encounter. These stress fractures most often affect the leg, ankle and
foot. Bones usually affected in the lower extremity are the tibia and
fibula. In the foot, the most common are the 2nd, 3rd and 4th
metatarsal. Other bones of the foot affected are the calcaneous,
navicular and cuboid.
Generally the pain will start as a vague ache that
will become a localized pain. The pain usually worsens when
stretching the foot or applying a pressure over the metatarsal area
(ball of the foot). Other movements of the foot will not cause pain.
Any pain in the foot, whatever the causative factor, may in all
probability have an impact on the biomechanical integrity of the foot.
This will in turn set up a mechanism of instability that will affect the
ankle and leg. This instability in turn will often cause related
symptoms, such as, leg, back and spinal pain.
Biomechanical factors are often created in
individuals who are involved in activities such as running as previously
stated, and sports that are of high impact to the feet such as aerobics,
basketball, football and long distance power walking. These are
the types of activities that are instrumental in causing stress
fractures, and generally are the precursor of future problems in the
feet.
In treating any foot condition, the individual
should have a definitive diagnosis. To accomplish this they should
see their Chiropractor or Podiatrist for an examination and evaluation.
This evaluation will consist of a case history, an examination that will
include orthopedic tests and probably x-rays of the feet. Although
the pain may affect one foot, x-rays may be taken of both feet for
comparison purposes. Once a definitive diagnosis is arrived at, the
condition will be treated to alleviate the pain and recommendations made
to prevent a return of symptoms.
Treating any such foot problems will be the
responsibility of the patient in the long run. They must of course
follow the recommendations made by their healthcare provider,
after-which they should take an active role in achieving the desired
goal of being pain-free, and remaining so in the future. In a
condition such as Morton’s neuroma, the goal is to treat with
conservative measures. However, in many instances, surgical
intervention may be necessary.
The individuals’ primary objective is to see to
their shoes. They must see that the fit of their shoes will not
cause further problems. The shoes of course must be of good quality with
a proper ergonomically designed fit. The quality is of the utmost
importance so as to prevent premature breakdown. A breakdown of
the insole will cause the feet to pronate, either inwardly or outwardly.
There is a simple check that you can perform to check how your shoes fit
in a proper fashion. While standing on a sheet of paper, have
someone trace an outline of your feet. Then place your shoes over
this drawn outline and trace the outline of your shoes. If the foot
outline is not well within the shoe outline will signify a cramping of
the feet by the shoes.
Cramping of the feet, caused by shoes that are to
small give rise to other conditions. One such condition is Bunions
(hallus valgus). The bunion is caused when the toes are squeezed
together over a long period of time. There callus formation and
overgrowth of bone in the joint of where the big toe and the metatarsal
joint meet. In some women there can be a genetic disposition to bunions.
Hammer Toes is another condition that can directly
be attributed to poorly fitted shoes. The 5th toe is the toe that
is most often affected. When the toes are cramped in the shoe, the toes
have a tendency to turn under because there is not room enough for them
to stay in a normal extended fashion, when standing or walking.
The rubbing action will cause calluses, and here too, the bone will
start to overgrow causing a hammer toe.
A great percentage of women have been found to be
wearing shoes that are too small for their feet, and it is in this
percentile that women have complaints of foot pain. High heels are
another significant cause of foot pain in women by placing increased
pressure on the metatarsal area of the feet. When there is a high
arch in the feet, a supplemental arch support will probably be of value
to prevent strain of the arch. The shoe must allow the toes to
spread and not cause a cramping of the toes, especially when stepping
off in walking.
Basically a man should be aware of the same
requirements for a proper fit as stated above. T he shoe should always
be fitted for comfort and not for the size you think you wear. When
fitting a shoe, late afternoon is the best time because your feet may be
slightly larger. T hey should also be fitted in a standing position to
make sure that the weight bearing is accommodated in the size of the
shoe. Some individuals will find that an orthotic support will be of
value. However, you must be certain that the orthotic will fit in
the shoe properly without undue cramping of the feet. For quality
shoes that are designed ergonomically to fit the foot please see
Aetrex™ PRODUCTS,
and the accessory items that will be extremely valuable in the health of
your feet.
For the individual who is in pain, they of course
must try to alleviate the pain. Warm foot soaks with Epsom salts
in warm water can be very soothing. Follow the soak by massaging
with a good analgesic balm, such as
BIOFREEZE. Use
the foot soak and massage, 3 to 4 times daily as needed. There is also
another type of shoe insert that may be of value. A magnetic insole such
as the MAGNE-SYSTEMS
will aid in circulation to the feet through its’ magnetic therapy,
To sum up, the individual must take control to
ease their pain and to further prevent the return of the condition that
is causing the pain. Making sure that they are wearing properly fitted
shoes will prevent the return of the initial causative condition and can
also prevent other conditions from arising. Easing the pain that
is initially present, by self-care is a
Priority. Following the procedures as
outlined above will make for a happier and healthier lifestyle.
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