Foot Health Blog
Find expert articles from physical therapists and podiatrists to help understand, diagnose, and treat different foot health issues such as plantar fasciitis, bunions, flat feet, and more.
MetatarsalgiaBest Exercises and Stretches for Metatarsalgia Pain ReliefMetatarsalgia refers to pain that occurs in the ball of the foot, and it affects the regular body mechanics, making daily activities difficult to perform. The major cause of metatarsalgia is excessive and repetitive loading of the foot. This can be due to intense physical activity like running and jumping, improper footwear, high arches, foot deformities, and obesity (overweight).
This guide covers the best metatarsalgia exercises. For a more general blog about metatarsalgia, read What Is Metatarsalgia: Symptoms, Causes, Treatments, and More.
How Stretching and Strengthening Exercises Relieve Metatarsalgia Pain
Generally, stretches and exercise can improve the quality of life for metatarsalgia patients through the following potential benefits:
Stimulated healing by increasing blood flow and, consequently, healing white blood cells to the areaReduced pain and swelling in the ball of the footImproved range of motion within the ankle, foot, and knee jointsImproved balance, strength, and muscle coordinationImproved gait mechanics
Stretches for Metatarsalgia
Several stretches can be performed to increase the flexibility at the foot and ankle. Three common ones are:
1. Toe Pumps
From a seated position, prop your foot on your heels so that your toes are off the floorContinuously bend and extend the toes while moving the foot backward and forwards slightlyRepeat 20 times for 2-3 sets
2. Toe Flexor Stretch
Sit in a chair with the affected foot bent over the knee of the other leg so you can reach your toes with your handsUsing the palm of your hand as support, bend your toes towards your shinHold the position where you feel a strong stretch in the bottom of the foot for up to 30 secondsContinue for 2-3 sets with 15-20 reps each
3. Sitting Calf Stretch
From a sitting position, wrap a stretch strap, towel, or belt under the ball of your footWhile keeping the knee straight on the surface, use the belt, strap, or towel to pull the toes up toward the shinYou’ll feel a stretch at the back of the ankle around the Achilles tendonHold this position for up to 30 seconds and then relaxRepeat up to 5 times for 2-3 sets per leg
Exercises for Metatarsalgia
The level of exercise you can perform will depend on how much pain you have and how physically fit you are. As a precaution, you want to avoid any high-impact exercises to limit loading the feet. You also want to ensure you use proper fitting footwear during the exercises and avoid direct pressure on the painful area.
Once these precautions are taken, there are three critical exercises to perform to reduce the symptoms of metatarsalgia:
1. Toe Raises
This may prove uncomfortable if you still have a lot of pain in the ball of your foot; otherwise, it won’t be a problem.
Stand erect, holding on to a chair or wall for balanceLift your heels off the ground, transferring weight gradually to the ball of your footGradually lower your heel back to the groundRepeat 10-15 times for 2-3 sets
You can progress to doing this exercise on only one leg at a time as your strength increases.
2. One-Leg Stance
Standing near a wall or chair for balanceSlowly transfer your weight to a foot and lift the other foot off the groundEnsure the foot is resting firmly on the ground and hold the position for 30-60 secondsRepeat on the alternate leg for 1 completed setRepeat the entire set 2-3 times
3. Towel Scrunches
Stand bare-footed with a foot on a towelWith your knee slightly bent, use your toes to pull the towel under your foot without raising your heelsRepeat 3 sets of 15 reps for each foot
Managing Metatarsalgia Pain
Thankfully, metatarsalgia is responsive to treatment. In addition to exercises, you can use NSAIDs, rest, ice, activity modification, weight reduction, and splinting to relieve symptoms of the condition. Pain can be addressed at home, though intervention must be gradual and progressive to reap the most benefit. By so doing, the body can build up strength and increase flexibility over time.
Also, inserts can be used with properly fitting shoes to cushion and support the foot, thereby easing metatarsalgia. Custom orthotic inserts tailored to your feet can be attained through our online store.
MetatarsalgiaTreating Metatarsalgia With Insoles and Other Orthotic DevicesMetatarsalgia is the most common condition of the forefoot (the ball of your foot), whereby inflammation and pain may lead to reduced activity in severe cases. In this condition, pain originates from the metatarsal heads of the outside of the foot after being put under abnormal loads. The condition is usually not serious, and adaptations can be made to remedy it, preventing future symptoms from occurring.
This article looks at the different types of metatarsalgia and how to treat the condition with the use of orthotic insoles.
Types of Metatarsalgia
Primary metatarsalgia results usually from anatomical abnormalities that occur in the foot that alter the distribution of forces under load. Conditions affecting the forefoot structures such as bunions (hallux valgus) and arthritis of the big toe (hallux rigidus) cause most of the force to be transferred through the smaller toes, causing inflammation and pain.
Flat feet (pes planus) or a rigid arch also fall under the primary classification.
Secondary metatarsalgia results from increased loading due to indirect causes brought about by systemic conditions that affect this area of the foot, not the metatarsals themselves. Rheumatoid arthritis, systemic lupus erythematosus, Morton’s neuroma (nerve compression due to footwear that is too tight), gout, and stress fractures are all examples of secondary metatarsalgia.
Other causes include leg length discrepancies, scoliosis, and kyphosis caused by increasing forces applied through the outside metatarsal heads.
How Does Orthotic Therapy Help Metatarsalgia?
Orthotics can play a significant role in shock and pressure reduction to the forefoot structures when walking, running, or jumping, making them a widely accepted treatment for metatarsalgia. Increased shock absorption qualities gained through wearing orthotics decrease the load through the ankle, knee, and hip joints, playing a vital role in decelerating the cartilage breakdown leading to arthritis over time.
Which Orthotic Treatments Help Metatarsalgia?
Metatarsal pads are applied behind the ball of the foot to provide pain relief by offloading the structures responsible for the pain and distributing the force through the rest of the foot structures. Improved functional ability will result through the redistribution of force away from the inflamed areas, leading to pain reduction.
Placement of these pads is important and will ensure that they are beneficial to improving your condition. Placing the pad right behind the ball of your foot, the soft region behind your toes, is key to ensuring that metatarsal arch structures are supported when forces are applied.
When applying the metatarsal pad, attempt to stand and walk with it on; you should experience a drastic relief in pain. Should the pain increase with the pad, adjust its position and try again until you find relief.
Supportive insoles are usually bought over the counter or online according to your shoe size, though custom orthotics purchased from a specialist and tailored to your feet are always recommended over generic insoles. Typically, the foot pronates (turns inwards), and the transverse arch flattens out. Supportive insoles prevent the foot from turning inwards (pronation) and flattening by providing enough support to the arch when weight is applied.
Repetitive impact forces applied through the foot will increase the risk of developing metatarsalgia, especially in runners and high-impact sports like basketball. Runners would benefit greatly from increased shock absorption, support, and cushioning.
However, not only athletes will find benefit from the use of orthotics. Nowadays, with footwear choices not always keeping functionality in mind and rather the looks thereof, it is ever more important to provide your feet and body with adequate support through a range of daily activities by using supportive insoles. Preventing pressure areas in the foot through the use of supportive insoles will provide a great sense of comfort to those wearing them.
» Thinking of getting orthotics? Invest in metatarsalgia custom orthotics that are designed for you
Are Orthotics Enough to Treat Metatarsalgia?
Orthotics are vital in treating symptoms related to metatarsalgia, but should be used in conjunction with other treatment methods. While you are considering the adoption of insoles into your shoes, ensure the shoes you are wearing to do exercise or daily activities have enough toe space, fit well, and have a low heel. For quality orthotics tailored to your feet, visit our online store to receive your impression kit and treat your pain.
Other than orthotics, include the following remedies for maximum benefit and chance of recovery:
RICE (Rest, Ice, Compression, Elevation)Medication in those who experience severe pain
» Worried about your metatarsalgia? Find out whether the condition ever goes away.
In cases where the severity of the condition may be such that you cannot walk or experience pins and needles, seek medical advice from a foot specialist or any medical practitioner. Management of the condition thereafter will be decided upon based on the severity and duration of symptoms experienced.
MetatarsalgiaWhat Is Metatarsalgia: Symptoms, Causes, Treatments, and MoreMetatarsalgia simply means pain in the metatarsals and is a relatively common condition, though it can still significantly reduce the quality of life. This terminology reflects how complex and difficult it is to diagnose and treat pain in the forefoot.
Pain caused by metatarsalgia is aching in nature, worsened by activity, and occurs with swelling and bruising at the metatarsal head. Metatarsalgia is progressive, and if not managed early, it can cause joint stiffness, limited range of motion (ROM), and pain in the rest of the kinematic chain (ankle, knee, hip, and lower back).
This article looks at the causes and symptoms of metatarsalgia, how it is diagnosed, and the various treatment options available.
» Will orthotics help to relieve metatarsalgia symptoms? Upstep's metatarsalgia custom orthotics are designed specifically for you to reduce the causes of your pain
Causes and Symptoms of Metatarsalgia
The causes of pain in the foot are multifactorial, with the most common being incorrect shoes, traumatic injury, and repetitive injury from either sport or poor foot mechanics. However, systemic illnesses such as rheumatoid arthritis, gout, osteoporosis, and many others are also seen regularly.
Another significant cause of forefoot pain is an existing condition of the big toe joint. HAV’s (Bunions) and Hallux limitus/rigidus both affect this joint's ability to take most of the load when walking, resulting in an overload of the lesser toe joints. Also, previous surgery of this joint can result in dysfunction and, again, overload of the other parts of the foot.
A common symptom of this is numbness or tingling in the toes, and the most common diagnosis is a nerve-related injury called Morton’s neuroma. However, other pathologies such as plantar ligament strains or tears, capsulitis of the metatarsal phalangeal joints, or simple nerve compression from shoes that are too tight can give the same symptoms.
Several factors can make metatarsalgia worse, such as:
Poor work postureObesityImproper exercise techniqueModified gait due to surgery or injury
Risk Factors for Metatarsalgia
Anyone can develop metatarsalgia. However, you are at a higher risk if you:
Are obeseHave a history of foot injuryHave inflammatory arthritisWear improper footwear (high heels, narrow toe box, flat soles)Perform high-impact activities that are repeated often (running, jumping, high-impact sports, etc.)
How Is Metatarsalgia Diagnosed?
The symptoms of metatarsalgia are similar to those of many other foot injuries and disorders. If you have persistent pain in the foot even after resting or changing footwear, seek a medical expert. Your doctor will observe your gait and physically examine the foot to identify any deformities or problems, and there will also be questions about the nature of activities and pain history.
Several tests will be performed to arrive at a differential diagnosis to identify factors that may worsen the condition. There may also be radiological investigations to rule out stress fractures and identify the presence of neuromas, bursitis, or the presence of arthritic signs. You can also order a blood test to check for uric acid levels. The tests and investigations will allow your doctor to accurately prescribe treatments.
You may also expect to be transferred from a general practitioner to an orthopedist, podiatrist, or physiotherapist.
Treatments for Metatarsalgia
The good news is that metatarsalgia is treatable. The approach to the treatment of metatarsalgia depends on the cause, symptoms, and severity of the condition, though the first line of management is typically conservative.
Some of the other treatment methods are discussed below:
RICE (Rest, Ice, Compression, Elevation)
You may need to get off the foot to experience relief. You can also ice the leg for up to 20 minutes after prolonged activity. Compression and elevation above the heart can also aid in reducing swelling from metatarsalgia.
There may also be a need to make changes to your regular activities. For example, it may not be best for you to stand for long periods if you have metatarsalgia.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs directly address the pain and inflammation that occurs because of metatarsalgia, giving room for other treatment methods to be initiated.
Sometimes, it may be necessary to lose weight as the more you weigh, the more pressure is placed on the foot, and the more painful it becomes.
Use of Proper Footwear
The best shoes have adequate toe space, proper cushioning, and offer great arch support. Always ensure you use proper footwear instead of one with a stiff sole and inadequate support.
These can provide temporary relief from pain due to metatarsalgia that can sometimes last up to 3 months. However, the risks of corticosteroid injections need to be understood as this is not a cure for the condition and can cause lasting damage if used too frequently.
Physical Therapy Exercises
A physical therapist will work with you to relieve the symptoms and stretch or strengthen the muscles through metatarsalgia exercises. The physiotherapist will also encourage proper foot biomechanics and consequently relieve the pressure on the ball of the foot.
The use of custom orthotics is also very effective in treating metatarsalgia. Whether metatarsal pads, hammertoe crests, or arch supports, these provide extra cushioning and padding for the feet, helping to absorb some of the pressure.
Understanding what is causing your forefoot pain is essential when choosing the best orthotic. If you feel that compression is worse when wearing slip-on shoes or high heels, a ¾ length insole is required. However, if your foot has collapsed arches and it hurts more after standing or walking for long periods, and if you have a removable insole to make room for the custom orthotic, then a full-length insole is best as it allows us to add special soft padding under the metatarsal heads.
» Unsure which orthotics will suit you best? Explore Upstep's metatarsalgia custom orthotics to get started
When non-conservative treatment fails to bring improvement, surgery becomes the last option. The surgical approach will depend on the cause of the metatarsalgia, the severity of the condition, and any complications that may have resulted from it.
Recovery From Metatarsalgia
Complete recovery after metatarsalgia is possible. However, it depends on several factors, including your age, health state, history of injury to the foot, the severity of the condition, complications, and the speed of intervention from the onset. Generally, recovery takes anywhere from a few days to several months, which is why it is essential that you seek treatment as soon as your symptoms cause you enough discomfort or pain to disrupt your normal daily functions. MetatarsalgiaMetatarsalgia: Causes for Swelling and 10 Ways to Reduce ItMetatarsalgia is a condition in which pain occurs in the sole or ball of the foot. Usually, this pain is aching by nature, worsened by activity, and occurs with other symptoms like swelling and bruising at the metatarsals. Metatarsalgia can lead to joint stiffness, limited range of motion (ROM), and pain in the lower back and hip due to altered body mechanics.
Causes of Metatarsalgia
Generally, metatarsalgia is due to repetitive loading of the foot and is caused by:
During running, jumping, and climbing activities, the front of the foot absorbs more force than usual. Without proper shoes to absorb some of this force, pain can result at the head of the metatarsals.
A high foot arch places extra pressure on the foot around the metatarsals. This is especially true around the second metatarsal head. This redistribution of weight can lead to metatarsalgia.
Poorly fitting shoes
High-heeled shoes and shoes with a narrow toe box can contribute to the development of metatarsalgia.
Hammertoes, claw toes, bunions, or any bumps in the foot due to foot deformities can lead to metatarsalgia.
Repetitive loading can cause small breaks in the metatarsals due to advancing age. These fractures can make the toe bone more painful.
The more you weigh, the more pressure on the ball of the foot.
11 Methods for Treating Metatarsalgia Swelling
Thankfully, the symptoms of metatarsalgia, including swelling, can be managed using any of the following methods;
6 Home Management Techniques
Between periods of intense activity like running or standing for long, keep the feet rested.
When you’re not standing, ensure the foot is kept elevated above the heart.
You can apply ice to the ball of your foot for up to 20 minutes. By stimulating vasoconstriction, ice can help reduce inflammation and blood flow, resulting in less swelling.
You can reduce pressure on the ball of your feet by performing a weight loss program.
Non-steroidal anti-inflammatory medications (NSAIDs)
NSAIDs help address the pain and swelling that results from metatarsalgia and also give room for other treatment methods.
There may be a need to change the activities you engage in daily. Where this is impossible, you may consider reducing the intensity and duration of the activities.
5 Other Non-conservative Management Techniques
Working with a physical therapist may reduce swelling due to metatarsalgia. The physiotherapist will encourage normal foot biomechanics through gait retraining. Consequently, this will relieve the pressure on the ball of the foot and the resultant symptoms.
Invest in high-quality footwear that has spacious toe room, is well cushioned, and provides adequate support for the arch, heel, and ball of the foot. Shoes with a stiff sole and a rocker bottom contour can reduce the pressure on the forefoot.
You can ease the pressure temporarily on a joint by splinting the affected joint, which means strapping a piece of rigid material to the area to prevent movement.
Custom orthotics: Orthotic inserts provide extra cushion and padding for the feet while absorbing pressure. This reduces the impact on the muscles, ligaments, and bones. Orthotics can be arch supports, metatarsal pads, or hammertoe crest pads.
i. Metatarsal pads: If your shoes are already good, metatarsal pads can provide additional comfort. They cushion the metatarsal bones and will help bear the redirect some of the pressure off the affected metatarsal.
ii. Taping/hammertoe crest pads: You can use taping to bring the toe back into its normal position. Similarly, you can use a hammertoe crest pad when there is a claw toe deformity that needs pushing back into position.
iii. Arch supports: These reduce stress on the metatarsal heads and encourage roper biomechanics when walking.
Corticosteroids can temporarily improve the quality of life when injected into the affected joint. The relief can continue for up to 3 months in some cases.
When non-conservative treatment fails, surgery becomes an option. Since the goal of surgery is to remove the primary cause, the surgical approach will depend on the cause of the condition, its severity, and any complications it may have caused.
Factors That Increase the Risk of Metatarsalgia
Anyone can develop metatarsalgia, and the following factors can increase your chances:
High-impact activitiesObesityFoot conditionsInflammatory arthritis (rheumatoid arthritis or gout)Wearing high-heeled shoes
Can Metatarsalgia Be Cured?
Metatarsalgia can be easily managed. With management, one can expect a full recovery, especially when intervention is prompt and early. One factor that cannot be overstressed is the need for correctly fitted shoes. Whether for sports or daily activities, ensure you wear proper shoes with shock-absorbing insoles or arch supports, as these can prevent or minimize future episodes of metatarsalgia.