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Todd Borenstein MD

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What is metatarslagia?

Metatarsalgia refers to pain in the “ball” of the foot, under the metatarsals in the forefoot. Usually it is located under the 2nd or 3rd metatarsals.

What causes metatarsalgia?

Metatarsalgia can have multiple causes. It is the result of continual overloading of the area, which may be brought on by a bunion deformity, arthritis, a tight heel cord or calf muscle, ligament instability, clawtoe deformity, and congenital foot deformities.

What are the symptoms of metatarsalgia?

Patients with metatarsalgia often complain of aching in the “ball” of their foot that is worsened with prolonged standing and walking. They sometimes notice swelling in the ball of their foot as well. Patients sometimes describe the pain as walking with a rock in their shoe. Overtime, structures like the joint capsule and plantar plate can become injured as a result of the chronic overloading, leading to toe deformities.

How is metatarsalgia diagnosed?

Metatarsalgia is diagnosed by thorough history and physical examination. X-rays are typically ordered to assess for any abnormality of the joints, the toes and to assess for a predisposing cause such as a bunion or big toe arthritis.

How is metatarsalgia treated?


Conservative treatment for metatarsalgia is typically very successful for the majority of patients. The main goal is to diminish repetitive loading through the painful forefoot. This is often achieved by using metatarsal pads, comfort shoes, calf stretching, orthotics, activity modifications, anti-inflammatory medications and occasionally walking boots.

Operative treatment

Operative treatment can necessary in a small percentage of patients who fail conservative therapy. The surgery is targeted towards the underlying cause, and may include correcting toe deformities, repairing torn ligaments, lengthening tendons, calf lengthening and shortening the metatarsals.