Sharp pain in the ball of the foot

Metatarsalgia

What is that?

Metatarsalgia is a collective term for pain that occurs in the metatarsal bones two to five. This pain can be triggered by a variety of different causes. 

How does this manifest itself?

The pain is often felt as a stabbing pain and is localized in the ball region of the foot. Symptoms usually begin after longer periods of exertion. In addition, in most cases, pronounced calluses and hard skin develop on the sole of the foot in precisely this area. 

Patients with forefoot pain often experience increasing wear on the outer edges of their shoes. The patient tries to "avoid" the pain when walking and therefore uses the outside of the foot more. 

Where does it come from? 

One of the most common causes of metatarsalgia is hallux valgus. Hallux valgus displaces the little toes, especially the metatarsophalangeal joints, from their anatomical position. The capsule surrounding the joint tears, and the underlying connective tissue plate can atrophy or even be injured by the permanent incorrect loading.

Many runners develop metatarsalgia due to running on hard surfaces, unsuitable footwear or misaligned feet. This is clearly visible due to the callused skin under the metatarsal heads. 

The protective tissue between the bone and the skin can also shrink and become inflamed as a result of age. Such degeneration is often irreversible and can only be corrected by external biomechanical measures, but this can certainly be done until the symptoms are completely gone.

Finally, the symptoms may also have a genetic component. Autoimmune diseases such as lupus, rheumatism or gout can have a negative effect on the condition of the tissue. 

The diagnosis is made by the doctor based on the symptoms. Imaging evidence is often obtained using MRI or sonography. 

What happens if I don’t act here?

Metatarsalgia should be treated at an early stage to avoid a rupture of the joint capsule and/or the connective tissue plate, as the healing process in this case can take up to six months. If there is no or only incomplete scarring of the connective tissue, the risk of a claw toe forming is very high. In this case, the middle joint of the toe would stick out upwards and would not only create a permanent shoe conflict, but would also become a visual burden. 

How do I find out if I have something like this?

Burning pain under the heads of the toes two to three minutes after walking, or even while walking, is an indication of inflammation of the soft tissue under the joints. This area of the sole of the foot is often swollen and bulges forward.

How do you treat this?

The therapeutic approaches are primarily aimed at healing the capsule and the connective tissue. This requires immobilization and reducing the load on the inflamed area.

kokochii® insoles can also be individually designed in the forefoot area. The metatarsal heads are relieved by means of a splayfoot pad. This lifts the metatarsal heads and reduces the pressure load. Additional forefoot pads with the appropriate recesses demonstrably reduce the pressure on the inflamed area. 

In the long term, the foot muscles should be trained, especially in the transverse arch, in order to lift the metatarsal heads out of the stress zone.