Metatarsalgia is a general term describing pain in the forefoot, mainly in the region of the metatarsals (the bones located just before the toes). It is a common condition that may affect gait and daily life, particularly in people who walk or stand for many hours.

Causes and Risk Factors

Metatarsalgia may be caused by various factors, such as:

1. Excessive pressure on the metatarsals

• Prolonged standing or intense physical activity (e.g. athletes, runners, dancers).
• Increased body weight or obesity, which intensifies pressure on the metatarsals.

2. Inappropriate footwear

• High heels or shoes with thin soles that do not absorb shock.
• Tight shoes that compress the metatarsals and toes laterally.

3. Anatomical and musculoskeletal abnormalities

• Flat feet or pes cavus, which alter weight distribution across the foot.
• Hammer toes or claw toes, which affect pressure distribution over the metatarsals.
• Osteoarthritis or rheumatoid arthritis, which may cause inflammation and pain.

4. Injuries or overuse

• Stress fractures of the metatarsals caused by repetitive strain (e.g. in athletes).
• Neurological conditions, such as Morton’s neuroma, which may cause pain and numbness in the forefoot.

Symptoms

• Pain or a burning sensation in the forefoot, especially during walking or weight-bearing.
• A feeling as if there is a small pebble inside the shoe.
• Numbness or tingling in the toes.
• Worsening of the pain during physical exercise or when wearing inappropriate footwear.

Diagnosis

Diagnosis is made through:

• Clinical examination to assess gait and weight distribution across the foot.
• Plantar pressure assessment to evaluate weight distribution.
• X-rays or MRI, if there is suspicion of a fracture or another underlying pathology.
• Pressure testing of the foot to identify areas receiving excessive load.

Management and Treatment

1. Conservative treatments

• Rest and avoidance of activities that worsen the pain.
• Use of orthotic insoles, which reduce pressure on the metatarsals and provide significant relief.
• Footwear modification: choosing shoes with soft soles and proper support.
• Avoidance of narrow or high-heeled shoes, which increase pressure on the front part of the foot.
• Cryotherapy (ice applied to the sole for 10–15 minutes) to relieve inflammation.
• Physiotherapy and stretching exercises to strengthen the muscles of the foot and ankle.
• Anti-inflammatory medication (such as ibuprofen) for temporary relief of pain and inflammation.

2. Invasive treatments

• Cortisone injections, if inflammation and pain are severe and do not respond to conservative treatment.
• Surgical treatment: in rare cases where there is severe deformity of the metatarsals or failure of conservative management.

Prevention

• Use of appropriate footwear with adequate shock absorption.
• Maintenance of a healthy body weight to reduce pressure on the metatarsals.
• Avoidance of excessive strain on the feet without adequate rest.
• Regular strengthening and stretching of the foot muscles for pressure relief.

When to Visit the Podiatrist

• If the pain persists and makes walking difficult.
• If numbness or neurological symptoms develop in the feet.
• If you notice deformity of the toes or the metatarsals.

Metatarsalgia is a common but manageable condition that can be prevented and treated through footwear modification, appropriate support of the foot with orthotic insoles, and physiotherapy. If symptoms persist or worsen, consultation with a podiatrist is essential for personalised treatment.