Metatarsalgia - Soreness at the Bottom of the Foot - Member Case Study

author : AMSSM

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Metatarsalgia simply means “painful metatarsal” without defining the cause of the pain. Metatarsalgia most commonly causes pain at the second metatarsal head.

Question from Stacers:

Okay, I have a persistent problem with soreness on the bottom of my feet when I run distances more than 2.5-3 miles.  It feels like bruising (i.e. is sore to the touch afterward) on the bottom of the ball/front of my feet.  It isn’t a sharp pain, and doesn’t affect my training too much, but it’s annoying to have sore feet all the time.

I checked with my doctor about it and she told me I just need to wear cushioned shoes and that it is probably related to years of ballet dancing when I was younger.

I already have good cushioned running shoes, and would like a better explanation of what would cause this and/or prevent it!!  It also bothers me when I hike or walk – do I just have less padding on the bottom of my feet than the average person or what?
 

Answer:

Pain located at the ball of the foot is lumped into a group of problems commonly referred to as metatarsalgia.  Metatarsalgia simply means “painful metatarsal” without defining the cause of the pain.  Metatarsalgia most commonly causes pain at the second metatarsal head (near the base of the second toe on the bottom surface of the foot).  Runners with flat feet (planus feet) and/or a tendency toward hyperpronation (foot and ankle roll inward during walking and running) may be at greater risk for metatarsalgia. 

The cause of the pain has a variety of possibilities: bruising of the capsule around the joint of the metatarsal bone and the toe, bruising of the tendons that cross the metatarsal joints on the bottom of the foot, stress fracture(s) of the metatarsal bone(s), interdigital neuromas (entrapment of a nerve that runs along side the metatarsal bones), or arthritis, and other rare problems.  If the pain is only at the base of the big toe, injury to the sesamoid bones may be the source of pain.  The sesamoid bones are small, round bones found within the tendons beneath the big toe.
 
To direct specific treatment, your sports physician will have to decide the cause of the pain and address that diagnosis.
 
Some general recommendations that may improve symptoms include wearing low-heeled shoes with wide toe boxes, foot strengthening exercises (toe curls, heel raises), and barefoot walking.  Medicines may relieve symptoms, but probably do not affect the outcome.
 
Rob Johnson, M.D.
Minneapolis, MN
 

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date: April 17, 2005