What's in this article?
Metatarsalgia, also known as stone bruise, is a type of pain and inflammation that occurs in a part of the foot known as the metatarsal (ball of foot). It often occurs in the metatarsal heads where the three middle toes meet the ball of the foot. It is a common problem which can affect the bones and joints of the metatarsals.
Most commonly, the first metatarsal head is affected – the ball of the foot just behind the big toe.
A lot of physically active people suffer from this condition as it can be caused by high impact of the foot which is a product of running, jumping etc. Sometimes, the condition can be caused by badly-fitting footwear, or even an underlying medical condition.
The severity of the pain can vary and may affect just one or two toes sometimes the whole foot or even both feet might be affected. Metatarsalgia can worsen when weight is put on the foot, as may be the case when standing, walking, or running.
Metatarsalgia can affect males and females of all ages, but is most common in middle aged females.
Although the condition is not considered as serious or life-threatening in any way, the patient may be sidelined by it. Fortunately, symptoms usually respond well to plenty of rest, the application of ice, and some other conservative treatments.
Symptoms of Metatarsalgia
Symptoms of metatarsalgia may include:
- Sharp, aching or burning pain in the ball of your foot the part of the sole just behind your toes
- Pain that worsens when you stand, run, flex your feet or walk especially barefoot on a hard surface and improves when you rest
- Sharp or shooting pain, numbness, or tingling in your toes
- A feeling of having a pebble in your shoe
Sometimes symptoms develop suddenly especially if you’ve recently increased the time or intensity of your high-impact exercise, such as running but problems usually develop over time.
What causes Metatarsalgia?
Metatarsalgia can be caused by a number of different conditions. Common causes include:
- Overuse. For example, in runners and athletes, which can cause some mild inflammation in the metatarsal heads and nearby joints. Other sports such as tennis or sports that involve jumping may also put extra stress on the metatarsal heads and lead to inflammation and pain.
- Wearing high-heeled shoes. This can put extra stress on the metatarsal heads. Footwear that is poorly fitted or too tight may also be a cause.
- Being overweight. This can put extra stress on the feet in general.
- Having a stiff ankle or Achilles tendon (the tendon at the heel). This can affect the way that pressure is distributed across the foot and may lead to extra stress on the metatarsal heads.
- Morton’s neuroma. This is sometimes called Morton’s metatarsalgia. It is a condition that affects one of the nerves that run between the metatarsal bones in the foot (the plantar digital nerves). Symptoms include pain, burning, numbness and tingling between two of the toes of the foot. See separate leaflet called Morton’s Neuroma for more detail.
- Claw foot (pes cavus). In pes cavus, your foot has a very high arch which does not flatten when you put weight on your foot. It happens because of an imbalance in the muscles of the foot. It can run in families. Sometimes pes cavus can happen out of the blue. However, most people with pes cavus also have a neurological problem such as cerebral palsy, spina bifida, muscular dystrophy or polio. Pes cavus can mean that extra stress is placed on the ball of the foot, which can lead to metatarsalgia.
- Hammer toe or claw toe deformity. With a claw toe you have an abnormal position of all three of the joints in the toe. The joint with the metatarsal bone is bent upwards, the middle joint in the toe is bent downwards and the end joint in the toe may also be bent downwards. The toe resembles a claw. With a hammer toe, your toe is permanently bent at its middle joint so that it looks like a hammer. There are a number of conditions that can cause these toe deformities. These can include poorly fitted shoes, injury to the toes, bunions and rheumatoid arthritis. Hammer and claw toe can also occur in someone with pes cavus. They can also run in families. These toe deformities can mean that extra stress is placed on the ball of the foot, which can lead to metatarsalgia.
- Bunion (hallux valgus). A bunion is a deformity of the base joint of the big toe, causing the big toe to be angled towards the second toe. This causes a bump on the side of the foot at the base of the big toe. There is often thickening of the skin and tissues next to the affected joint. The thickened skin and tissues may become inflamed, swollen and painful. Because of the bunion, extra stress is put on the ball of the foot and this can lead to metatarsalgia. See separate leaflet called Bunions for more detail.
- Previous surgery to the foot. For example, previous surgery for bunions.
- Stress crack (fracture) of a metatarsal. A stress fracture is a type of incomplete fracture in a bone. Stress fractures tend to occur as a result of overuse and are known as overuse injuries. A metatarsal stress fracture is a stress fracture in one of the metatarsal bones in the foot. See separate leaflet called Metatarsal Fractures for more detail, including metatarsal stress fractures.
- Freiberg’s disease. This is a rare disease characterised by osteonecrosis of the second metatarsal, most commonly seen in teenage girls.
- Arthritis or gout. This can cause inflammation of the joints in the ball of the foot or of the big toe and can be a cause of metatarsalgia. See separate leaflet called Gout and those on arthritis for more detail.
- Diabetes. This can cause damage to the nerves in the feet and can be a cause of metatarsalgia. Please refer to the separate leaflets on diabetes for more details.
Treating and Preventing Metatarsalgia
The following measures will often help improve metatarsalgia and stop it coming back:
- rest your feet. put your feet up regularly and avoid activities that make the pain worse; try low-impact activities such as cycling or swimming instead of sports that involve a lot of running or jumping
- use an ice pack. apply an ice pack to the affected area for about 20 minutes several times a day (a bag of frozen peas will also work); make sure you wrap it in a towel so it doesn’t damage your skin
- change your footwear. try flat shoes that have plenty of room for your feet and have a well-cushioned sole; replace any worn out shoes as they could make things worse (read more about choosing sports shoes and trainers)
- use shock-absorbing pads or insoles. these can fit inside your shoes to help cushion your feet; they’re available from pharmacies and sports shops, or can be bought online
- maintain a healthy weight. adopting a healthy, balanced diet and doing regular low-impact exercises can help you lose weight if you’re overweight
- take paracetamol or ibuprofen to help relieve pain and swelling if necessary
Try these measures for a few weeks to see if your symptoms improve.
If problem persists, consult your foot doctor.
Metatarsalgia Look like (pictures)