How to Self-Treat Metatarsalgia

Pain in the female footMetatarsalgia is a general term that refers to pain in the foot (typically around the ball of the foot).

It’s common in runners, track and field athletes, and for those who participate in high impact related sports (such as basketball and soccer). It’s also commonly associated with overuse syndrome.

Metatarsalgia is pain and irritation at the end of the metatarsal joints near the toes. Potential causes for the pain include: a stress fracture; gout; osteoarthritis; hammertoes; calluses; and pain in the joint from swelling and irritation. It can also be from neuromas, in which nerves tend to bundle and become irritated between the metatarsal heads.

How to Self-Treat Metatarsalgia

Metatarsalgia typically begins as a mild discomfort which grows steadily and quickly to the point that a person may struggle to walk, stand, or run. The key to treatment and management of this condition is to intervene quickly and to identify the actual cause or causes that led to the pain and irritation. Learn the potential causative factors for metatarsalgia and how to self-treat this condition so you don’t lose too much time with your training.

Risk factors for developing metatarsalgia include:

  • Excessive foot pronation. Your feet tend to roll inward as you stand, walk, and/or run.
  • Either excessively high arches or overly flat feet.
  • Spending long periods of time standing or walking (overuse).
  • High impact activities and sports.
  • Spending long periods of time on hard surfaces, such as concrete.
    Obesity.
  • Your shoes don’t fit well or the shoe is worn out. Typically due to shoes being too narrow or wearing high heels.
  • You have transitioned too quickly from a more built up running shoe into a minimalistic style.
  • Poor ankle mobility, particularly excessive tightness in the Achilles tendon or calf muscles.
  • Poor foot muscle strength, particularly the foot intrinsic muscles which help to support the arch of the foot.
  • Prominent metatarsal heads.
  • Having a hammertoe deformity.

Initial Treatment

Metatarsalgia is a condition that can start off as a minor annoyance. It can quickly progress into a painful irritation, and then suddenly sideline you for weeks. Take the pain seriously, and begin treatment right away. Whenever possible, begin the rehabilitation upon injury or the onset of pain. The goal is to restore normal range of motion (ROM) while reducing pain, irritation, and swelling. Restoring strength and function as soon as possible is also critical. Depending on the amount of pain and swelling, begin with RICE (Rest, Ice, Compression, and Elevation).

  • Rest. Initially, limit any activities that are causing pain. As the pain subsides, you can slowly taper up the use while taking care to avoid pain.
  • Ice. Apply ice to the painful area–typically the sooner, the better. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel pack style. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Compression. If swelling is present, utilize a simple ACE wrap around the foot and ankle to help with the swelling and pain. Start at the toes, and work up the leg. Take care to not apply the ACE wrap too tightly. Depending on the cause of the injury, over squeezing the foot can be irritating.
  • Elevation. Use pillows to position the foot above the level of your heart to help reduce swelling. This would be an excellent time to apply ice, too.

After you have initiated RICE and the pain and swelling have decreased, address any risk factors noted above (if possible). Please refer to Metatarsalgia Rehabilitation Exercises.pdf for detailed descriptions and photos on how to address other causative factors including: poor tissue mobility in the feet; tightness in the Achilles tendon; weakness in the foot intrinsic muscles; and balance deficits.

How to Self-Treat Metatarsalgia:

  • Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) can lead to excessive strain on the tissues on the bottom of the foot including the plantar fascia. I recommend initiating a complete ankle/foot strengthening protocol. Please refer to Ankle Resistance Exercises.pdf.

  • Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as weakness in the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which ultimately can lead to metatarsalgia. Improving your balance can help to reduce the risk of metatarsalgia and is an important part of the rehabilitation process. For more ideas on how to improve your balance, please refer to Improving Balance by Using a Water Noodle. As your pain level improves, I recommend that you perform these balance exercises without shoes on.

  • Add a metatarsal pad. Using metatarsal pads can help to provide pain relief (particularly, in the early phases of treatment). Some people don’t have much padding over the metatarsal area. This is particularly true as you age. Shoes with adequate cushion around the ball of the foot (or the area where the metatarsal heads are located near the base of the toes) can make all the difference. Visit your local running store to purchase a quality metatarsal pad. If unavailable, you can usually find one at a specialty shoe store or you may need to call a local podiatrist for recommendations.

  • Add an orthotic. Semi-rigid corrective devices worn in supportive shoes have been shown to be an effective treatment for metatarsalgia. If the metatarsal pad is helpful, but it doesn’t fully address the pain, you may consider orthotics. If you have flat feet or an excessively high arch, you may need a specially fitted orthotic that also includes a metatarsal pad. Supportive shoes worn alone, with or without soft corrective devices, may not provide adequate pain relief. Most orthotics requiring a metatarsal pad are custom made by either a podiatrist or a physical therapist that specializes in orthotics.

  • Did you progress too quickly into a minimalistic shoe? The standard built up shoe offers more foot support and padding than most minimalistic style shoes. If you attempt a quick progression, you may be at risk of developing metatarsal pain. Unless you are a child or teenager, expect a safe transition to take at least three months. Don’t transition during a period of intense training. A slow transition will allow your body to adequately adapt to the new stresses. I highly recommend waiting until the off season as progressing slowly is always a better choice. Taper back your running and implement my recommended strengthening exercises and balancing activities prior to a slow transition.

I recommend following this protocol for two to three weeks. While you’re self-treating your metatarsalgia, you’ll likely need to modify your exercise or running program. This would be an excellent time to focus on cross training activities.

If you’re not experiencing significant relief upon progressing into your exercise program, please consult a medical professional. I recommend a physical therapist that specializes in feet or who works with athletes for the treatment of metatarsalgia. The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. You may also consider consulting with a podiatrist.

For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.

19 Responses to How to Self-Treat Metatarsalgia

  1. sharon December 2, 2016 at 10:28 am #

    what are some good shoes for metatarsalgia?
    i mostly walk and do not run.

    • Ben December 18, 2016 at 9:39 pm #

      Hi Sharon,

      This is a difficult question to answer as the right shoe will differ for everyone depending on the shape of your foot. I personally like shoes with a larger toe box as I find the narrower shoes hurt my feet. Also depending on how your foot reacts to the ground a different shoe may be needed. For example if you have a “flat foot” then you may need a shoe that has more arch support. My recommendation would be to go to your local running store and have your foot mechanics analyzed. Let them recommend the right shoe for you. Most running stores have a lot of people that buy from them that walk only. So they should be very good at fitting the proper shoe and carry some good ones in stock. If they don’t seem to know what they are doing or don’t carry shoes for people that walk a lot then go to a different store. The goal is to find a shoe that fits your foot shape and will help hold your foot in a neutral position as you walk.

  2. Suzanne Herlihy January 7, 2017 at 6:44 pm #

    Hello…. I started with swelling And edema in both feet over two years ago. Most of the swelling has gone down but now both feet have what looked like planters warts on both balls of the feet. It has put me in a wheelchair. They started with blisters on the ball of the foot. The callus on both balls of the feet are so painful especially on a hard floor. Forget about wearing shoes or slippers. I can only wear white socks. Everyone says to go see a doctor but they would have to strap wings to my back and get me to the car because I can’t walk.. Thanks for any advice??

  3. Ben January 9, 2017 at 9:45 pm #

    Hi Suzanne,

    It sounds like your condition is really bad. Unfortunately, there is likely not a good home remedy fix. You need to see a podiatrist. The callus will need to be professionally trimmed and likely fairly deep as you may have a small plug of tissue that is causing them to be overly painful. The plantar warts will also need to be addressed. In my experience plantar warts do not respond overly well to over the counter medications. I realize it is painful to leave the home but at some point you may have to decide that it is worth the effort to seek out the right medical assistance to get this condition under control. You may also consider working with the Podiatrist or a good shoe specialist to insure you are wearing properly fitting shoes to address your particular condition. I wish you a speedy recovery.

  4. John March 24, 2017 at 3:41 pm #

    Hi Ben,
    I’m a 58yo male and run about 25 – 30 miles per week, both street and treadmill. After a week vacation in Florida that include a lot of walking on the beach, I have pain around my 3rd mtp joint. When I complete a stride on that foot, I get a quick jab of pain that is felt at the tip of the 3rd or 4th toe – hard to say for sure. On palpation, I feel only a mild tingling with pressure applied over the 3rd mtp. My calf is relatively tighter on that side as well. Does any of this info help narrow down what my diagnosis might be, and how long it will side-line me?
    Thanks,
    John

    • Ben Shatto April 4, 2017 at 8:39 pm #

      Hi Jon….it sure sounds like you may have metatarsalgia. I would work through the suggested exercises and see how the symptoms fair. You will definitely need to address the tightness in the calf as it can also lead to Achilles issues and plantar fasciitis. Because you are reporting tingling you may also be suffering from a Morton’s neuroma. If you symptoms don’t start to resolve after a week or two of being diligent about working through the suggested exercises and eliminating risk factors then you may want to have it officially looked at by a medical professional. Ben

  5. Julie March 30, 2017 at 9:28 pm #

    Thank you. I’ve been reading for hours and this post offers me more than anyone else has.
    I have begun training for my first 1/2 marathon. I’ve had some irritation for over a year on my 2nd metatarsal due to doing my job (massage therapist) barefoot on a hardwood floor. It hadn’t been bothered too bad by my running (I am still in the walk/run phase) until I was recently fitted with more stabilizing running shoes. I initially was having some knee discomfort. The knee pain is gone, but it’s been replaced with the metatarsalgia. I never really thought I’d like to run, but I do, so this setback is very frustrating. I will be laying off the running for a bit and trying your advice. Thanks.

    • Ben Shatto April 4, 2017 at 8:53 pm #

      Hi Julie,

      Well it sure sounds like you are dealing with Metatarsalgia. From your description I would say your shoe is the culprit. One of three things has likely happened.

      One…..The new built up shoe has changed your running form slightly causing you to put more pressure over the metatarsal heads and giving you pain.

      Two….The shoe fit isn’t right for your foot. The bottom of the sole is flexing at a point that does not line up optimally with the metatarsal joint and so this increases the pressure over the MTP joint. When fitting the shoe the flex point of the sole is an important consideration as to where it will located on your foot. I hope that makes sense.

      Third….The new shoe feels really good so you tapered up your mileage too quickly and your old irritation point at the 2nd MTP has flared up. Remember to progress slow and steady don’t taper up so quickly your body can’t adjust.

      Check out those 3 possible issues and see what you can to do resolve them. In the mean time try to follow the suggestions in the post to get the pain to calm down.

      Good Luck! Ben

  6. Greg April 25, 2017 at 5:18 am #

    Hi Ben,

    I’ve assumed for a few years I had plantar fasciitis but now I’m realizing, after starting to run again, that the pain is localized to the pad where my fifth toe connects to the ball of my foot.

    Every time this pops up I have to stop running due to the pain and it seems to take months before I start running again. I’ve been dealing with this for three years now and woke up last night with pain. It sucks because as badly as j want to run, I can’t because I worry I’m going to make the situation worse.

    Should I run through the pain while treating it or stay off of it? Since I had always assumed it was PF, I would lay off the running.

  7. Benjamin May 10, 2017 at 8:29 pm #

    Hi, Ben

    Thank you for the wonderful post.
    I use minimalist shoes for five or six years now.

    I have some minor pain and swelling on my right feet and I know that I walk putting most of the weight on then and almos don’t use the heels.

    What do you recommend to change the way I stand and walk?

    • Ben Shatto May 10, 2017 at 10:12 pm #

      Benjamin,

      Thanks for the kind words. Running with a mid foot strike is a good technique for a lot of runners. But many also run with a heel strike and do just fine. So far the evidence cannot prove one way is better than another. So if you run with a mid foot strike that is fine. But walking is another matter. One should really walk with a partial heel strike. If you tend to walk landing toes first I would work on landing heel first. Even if it is just slight. If you like the minimalist type shoes I would keep with them. I hope that answers your question. Let me know if you have more questions.

      Ben

  8. Ben Shatto May 10, 2017 at 9:53 pm #

    Greg,

    Good questions. It sounds like something about your running form is affecting your foot. Its hard to know exactly since I can’t evaluate your foot. But there are several biomechanical factors that may need to be addressed. The most common are issues in the hip such as weakness that affect how your feet hit the ground or generally a specific style of running or possibly just a shoe issue. If you can I would have someone evaluate your running gait first. Often times there are free clinics offered at your local running store. If that isn’t available have someone record you running and look for issues that may affect how your foot is hitting the ground. You may also try a different style of shoe. I wouldn’t push the pain too much with your running. Try to get to the root of the problem. Start with the hip strengthening exercises and the foot/ankle mobility exercises and stretches. I hope that helps! Good luck!

  9. Gareth Jones June 17, 2017 at 1:30 pm #

    I am training for marathon and have changed from supported shoe (was told I had pronation in past but now assured I don’t) to a neutral shoe. Before change I had knee pain which is cured but in new shoes the balls of my feet hurt (on the inside below big toe) after 30/45 minutes road running. Found this post which seems to indicate this is common for such a shoe change. If I keep running will my feet get used to the new dynamics and things improve. The pads sound an option to help transition or am I barking up wrong tree.

  10. Ben Shatto June 17, 2017 at 8:56 pm #

    Hi Gareth, Yes it does sound as if you may have metatarsalgia. One needs to always go slow when changing to a new type of shoe. If you are getting pain with the new shoe you have a few options. You could stop wearing the shoe and find a different type of shoe. You may want to be re-fitted before looking at different brands. If possible, it is always a good idea to have your gait analyzed when you change shoe types. Another option is to keep the shoe and just reduce the mileage for a while as your foot accommodates to the new shoe. You would want to really focus on the mobility and stability of the foot as I wrote about in the post. You can also trial a metatarsal pad as you indicated but again be very slow with the initial mileage to insure the pain does not worsen. But I recommend against increasing mileage until the pain is resolved. Worst case scenario is to ignore the pain as you increase the mileage. This can lead to even worse pain or other issues. Definitely be proactive in managing the pain. I hope that helps.

  11. Jay July 25, 2017 at 9:53 pm #

    I went to the Doctor but they just said rest before they will do any mri’s or other tests. I would like your opinion. About 3 weeks ago I went walking in a mountain stream and there was a sudden drop off which caused me to hit the ball of my left foot hard on a rock, and then my leg caught between two rocks on the way out somewhat violently. I had no after effects whatsoever, except for a very light bruise near just below my shit on the left part of the leg where it got caught. After 3 days of no pain on the bottom of my foot, I developed badly aching metarsalgia that increased in pain upon walking on it (causing me to limp and eventually twist my ankle), it also can hurt badly when bending my toes back the right way. It’s been 3 weeks now with no improvement, but I have only rested it about half that time. Do you think it’s possibly a small acute fracture that caused it, from the impact of the rock? Coul that impact on the ball of my foot in the stream possibly just be a coincidence and not the actual factor?

    • Ben Shatto July 26, 2017 at 8:40 am #

      Hi Jay, based up your description I would be suspect for a small metatarsal fracture. Especially since over the last 2 weeks of “rest” there has been no improvement. I would recommend a follow up appointment and x-ray. Sometimes it can be difficult to see a small fracture in the foot on x-ray and so a bone scan can be done to at least rule in or rule out a possible bone injury. Keep us posted but I would definitely go in for a follow up.

  12. Jay July 25, 2017 at 9:54 pm #

    *shin

    • Timothy J. Gass July 26, 2017 at 10:56 am #

      have you tried toilet paper?

      • Trevor Spencer July 26, 2017 at 12:25 pm #

        Shin happens

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