Metatarsalgia simply means pain in the metatarsals and is not a true diagnosis of any specific foot condition. This terminology is a reflection of how complex and difficult to diagnoses and treats pain in the forefoot is, with surgery often being the first approach.

The causes are also multifactorial with shoes, traumatic injury, and repetitive injury from either sport or poor foot mechanics being the most common causes but systemic illnesses such as Rheumatoid Arthritis, Gout, Osteoporosis, and many others are also seen regularly.

A common symptom 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 strain/tear, capsulitis of the metatarsal phalangeal joints, or simple nerve compression from shoes that are too tight can give the same symptoms.

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 the majority 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.

Understanding what is causing your forefoot pain is essential when choosing the best orthotic. If you feel that compression, e.g. it is worse when wearing slip-on shoes or high heels, then 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.

In both cases, an Upstep custom orthotic will move some of the pressure in the forefoot into the heel and arches of the foot and reduce some of the underlying causes of the pain. However, it is again important to stress that there is no replacement for a professionally obtained diagnosis of what is wrong and what is causing the problem.