Why is the term metatarsalgia is a bad name?

Metatarsalgia is a commonly used term for pain in the forefoot, however the term is pretty useless. Metatarsalgia literally means pain around the metatarsals in the forefoot and as a diagnosis it about as good as saying someone has a ‘sore knee’. Like a sore knee, metatarsalgia could be any one of literally 100’s of different things. Each of these different diagnoses that could get called metatarsalgia all have different causes, different treatments, and different outcomes. The term probably should not be used as it leads to so much unnecessary confusion. You often see questions online with people asking about things like what the cause of metatarsalgia is, what are the best shoes for it and how long does it last. There is absolutely no way that these questions can come close to being answered unless the specific diagnosis is known. This actual diagnosis could vary from a callus under the ball of the foot to a stress fracture of a metatarsal to arthritis in a joint. It should be clear from that just how bad a term metatarsalgia is.

Probably the most common cause of pain in the forefoot that gets lumped under the term metatarsalgia is what is called a plantar plate tear. The plantar plate is a strong ligament under the joints in the ball of the foot. They can be strained or even have minor tears and cause pain under the ball of the foot. They are most likely due to an overuse or due to things like a hammer toe. The pain is usually under the metatarsophalangeal joint and on the end of the joint if you bend the toe backwards. The best treatment for this is to wear stiffer shoes so that the toe does not have to bend so much when walking and to use strapping to hold the toe down. If that does not help, there are surgical options to treat the problem. If the pain is further back in the ball of the foot and can also be felt on the top of the foot and comes on slowly, then that could be a stress fracture. That is almost always due to an overuse injury and the first approach to the treatment is rest and then get into a moon boot to restrict weightbearing. These can take up to six weeks to heal up. If the is a shooting pain from the ball of the foot up into the toes, then this could be a pinched nerve which is often called Morton’s neuroma. This is caused usually by wearing too tight of a shoe that compresses the metatarsal bones onto the nerve. The treatment for this is to get into wider shoes and use a metatarsal pad to separate the metatarsal bone so that they do not pinch on the nerve.

Just from these few examples, it should be obvious just what a bad and meaningless term metatarsalgia is as a diagnosis. If you have pain in the ball of the foot, then get it diagnosed properly.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.