Metatarsalgia – Treatment, Symptoms, Exercises, Shoes, Causes

What is Metatarsalgia?

Metatarsalgia (also known as stone bruise, painful foot or ball-of-foot pain) is a medical term used for the inflammation and pain affecting the metatarsal part of the foot. It includes the joints and bones as well as the nerves therein.

Metatarsalgia Symptoms, Signs

Metatarsalgia may be acute, recurrent or chronic. It is also referred to as a symptom and it may conclude another disease therefore, careful examination of the foot must be done. A person may suspect having metatarsalgia when there is:

  • Pain felt on the toes (metatarsal area) described as burning, sharp, aching, increasing, localized or extremewhen standing, walking or moving around, alleviated when on bare foot on hard surface and lessened when immobilized.
  • Tingling sensation and/or numbness in the toes.
  • Swelling.
  • May have visible skin lesions and callous formation in the toes especially underneath the second, third and fourth toe.

Metatarsalgia (forefoot) picture

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Metatarsalgia Causes, Risk Factors

  • Stress due to intense exercise such as running wherein the weight of one’s body is transferred to the toes
  • Foot injury/fracture
  • Faulty distribution of weight on the toes
  • Bunion or toe-joint arthritis and gout
  • Poor blood supply to the feet due to poor fitting or high-heeled shoes, as well as having diabetes or edema
  • Being overweight. Upon standing, the feet become the shock absorber and carry the weight of the body.
  • Foot structure or deformities/ flat feet
  • Overuse of the toes as to those of the runners and athletes who always undergo strenuous physical activity
  • Older people havethinner foot pads therefore have greater pressure on their toes and may cause metatarsalgia
  • Morton’s neuroma (Morton’s metatarsalgia) is a benign growth of fibrous tissue that leads to the thickening of the nerves of the toes and contributes to metatarsal stress. This nerve damage has no certain cause, and is common to women who wear high-heeled and constricting shoes. In Morton’s neuroma, sharp, shooting, intermittent pain can be felt when the person wears shoes and relieved immediately when shoes are removed and the foot is manipulated. Localized tenderness over the site of the neuroma can be assessed.

Diagnostic Tests


A. Simple measures

Sample measures to lessen pain at the front of the foot

  • Remove shoes and massage the painful toes gently several times a day.
  • Rest and elevate your feet.
  • Apply ice packs wrapped in thin sheet of cloth to the painful area for 20 minutes as needed
  • Compress by putting pressure bandage on the area.
  • Wear nice fitting shoes and socks. Avoid walking barefooted.
  • Keep a normal weight.

B. Medications for metatarsalgia

  • Non-steroidal Anti-inflammatory Drugs (i.e. Ibuprofen, Diclofenac Sodium)
  • Astringents
  • Emollients
  • Ointments
  • Corticosteroid injection
  • Anaesthetics
  • Sclerosant injections

C. Orthotics or footpads

Footpads duly fitted and prescribed by a podiatrist or physician

  • Rigid
  • Semi-rigid

D. Shock absorbing insoles

Shock absorbing insoles to cushion the toes

  • Cork
  • Rubber
  • Plastic
  • Gel-like substance

E. Exercises for Matatarsalgia

  • Calf muscle stretch, done as if you are pushing the wall. Put your hands on the wall, one foot in front of the other, and the back heel on the floor and knee straight. Do this for 30-60 seconds, twice a day.
  • Ankle extension and flexion is done while sitting in a chair, with your painful foot over your other knee. For the ankle extension, hold the ankle and pull the toes of your painful foot towards you. For the ankle flexion, hold the ankle and pull the toes towards your lower leg. Do this for 10 seconds, in 3 sets of 8 repetitions per day, 10 seconds of rest on between.
  • Achilles Tendon Stretch is done while sitting on a chair, with your legs straight infront of you. Grasp your toes and pull it towards your knees. Hold this for 10 seconds and relax. Do 3 sets of 10 per day.
  • Plantar flexion and dorsiflexion is done with your legs extended while sitting in a chair. Curl your toes as tightly as you can, relax, then, point the toes towards your knee. Hold for 10 seconds and relax. Repeat 10 times.

F. Metatarsalgia shoes

Metatarsalgia shoes must  have:

  • Soft and comfortable soles;
  • Cushioned and well-fitted arch;
  • Enough space for the forefoot to relax;
  • Ability to help feet absorb shock;
  • Proper materials for individual needs


Surgery is not so often necessary but it could be done to realign, reshape or modify metatarsal bones. In Morton’s neuroma, there are two surgical options. One is tocut the metatarsal ligament to give space for the nerve known as nerve decompression, and the other is to remove the nerve on the affected area known as nerve resection.

A small incision will be made either on the top or on the sole of the foot, in between the painful toes.

The operation is mostly done in an out-patient basis, depending on the severity of the condition. The patient may or may not be put in cast, and may or may not be allowed to walk. It may take up to 3 months or more to recover, but, might still have limitations on foot activities.

So with the other surgeries, there are risks involve which includes infection, delayed healing of the surgical incision, broken pins, delayed bone-healing and nerve injury that can cause damage in the circulation and altered sensation of the toes.

Chronic Venous Insufficiency (CVI)

What is Chronic Venous Insufficiency?

Chronic Venous Insufficiency or CVI is a medical condition that happens when the non-oxygenated blood stream back to the heart does not flow freely due to ineffective work of the venous wall and/or venous valves. This allows the blood to leak backward. In the end, it results to pooling of blood in the veins, or venous stasis.

This is long-standing condition, but treatable at early detection.


Veins are pathways of non-oxygenated blood returning to the right atrium of the heart from other organs of the body. Anatomically, what defers veins from artery, veins has one-way valves. These valves keep the blood continually flowing, but controlled.

There are many of reasons why chronic venous insufficiency occurs. CVI happens when these valves are damaged, resulting to the back-flow of the non-oxygenated blood. This by then causes stasis of the blood.

Damaged veins develop as a result of extended periods of sitting or standing, or combination of aging and reduced mobility.

Other risk factors in developing CVI include being female due to the presence of hormonal level of progesterone, obesity, being tall as well as pregnancy.

CVI is also commonly caused by blockage in the vein from a clot. This happens normally on patients diagnosed with deep vein thrombosis or DVT.

Chronic venous insufficiency developed after deep vein thrombosis is medically termed as post-thrombotic syndrome. Study shows that approximately 30% diagnosed with DVT usually develop CVI later within 10 years after diagnosis.

Damaged veins like that of varicose veins rarely results to chronic venous insufficiency.

Another common cause of CVI is congenital absence of venous valves. Pelvic tumours and vascular formation adds in the development of CVI. This however, happens for unknown reasons.

Signs & Symptoms

It is important to be keen observant once known to have the risks in developing chronic venous insufficiency. Once one must see signs and symptoms and report immediately to medical practitioners for medical diagnosis and prompt medical treatment be rendered.

Signs and symptoms include:

  1. Tiredness in the legs
  2. Pain while walking or shortly after walking
  3. Superficial varicose veins: blue, bulging and twisted
  4. Swelling and redness in the lower legs and ankles, common after prolonged standing: due to pressure on blood pooling in the vein
  5. Venous stasis ulcers on legs and ankles
  6. Thickening and hardening of the skin on the legs and ankles/ leather-looking skin (lipodermatosclerosis)


Chronic Venous Insufficiency is treatable in its earliest stage. Specialist would recommend combination of treatment of vascular medicine and vascular surgery. There are basic treatment strategies that prevent pooling or stasis of blood in the veins. These include:

  1. Avoid prolonged standing or sitting. One must take a few breaks in between. Do leg and ankle exercise – flex, dorsi-flex and rotate ankle for 10 minutes every 30 minutes; if standing for long periods, take a break to sit down and elevate legs above heart level.
  2. Eat healthy balanced diet. Avoid junk foods and fatty foods. Eat fruits and vegetables.
  3. Stop smoking. Components in cigarette constrict blood vessels.
  4. Lose weight if overweight. Monitor your body mass index.
  5. Exercise regularly. There’s no easy way than walking. Walking is highly recommended, walking for 30 minutes is beneficial enough.
  6. Elevate legs. This is to promote blood flow while sitting or lying down for extended periods, position above the level of the heart. It would be better to elevate legs not more than 90 degrees for 10 -15 minutes.
  7. Wear compression stockings. It is also called as anti-embolic stocking, use it especially on long periods of lying down or sitting. Wear it in the morning before getting out of the bed. This squeezes the veins and prevents non-oxygenated blood stream backward. It is also help heal skin sore and avoids from developing it again.
  8. Religiously take medications as doctors prescribed. Antibiotics are ordered for infection and prevention of its recurrence. This is also used in treating ulcers.
  9. Patients with history of post-thrombotic syndrome are treated with anticoagulants. This aids in the prevention in the formation of blood clots.
  10. Skin Care and Proper hygiene. Proper hand hygiene is most important. This helps prevent infection. Keeping skin moisturized prevents skin from itchiness and flakiness. Physician may prescribe cream containing zinc oxide to protect the skin.

In intensive cases, nonsurgical and surgical treatment may be an option.

Nonsurgical Treatment for Chronic Venous Insufficiency

  1. Sclerotherapy : A solution is directly injected to an affected varicose vein. This causes the vein to collapse and disappear. Several sclerotherapy treatments may be done to achieve desired outcome. This can be done in physician’s clinic. It is also inexpensive. It relatively relieves pain and discomfort and lessens the possibility of haemorrhage.
  2. Endovenous thermal ablation. Using high-frequency waves or laser, it creates intense heat on the walls of the varicose veins and eventually destroys vein tissue that is gradually absorbed by the body.

Surgical Treatment for Chronic Venous Insufficiency

  1. Ligation and stripping. This is usually done together. Ligation is cutting of the vein and tying both ends. Recovery is fast. Stripping is done by removing larger veins through smaller incisions. It is more extensive and causes bruises days after surgery.
  2. Bypass. This is done only in intense condition when other treatment found ineffective. Like heart bypass, healthy vein from other part of the body and transplanted to the affected area connecting left healthy veins and rerouting blood flow continuously.


Chronic Venous Insufficiency images

Chronic Venous Insufficiency pictures 3

Chronic Venous Insufficiency pictures

Muscle Strain

What is Muscle Strain?

A muscle strain or a “pulled muscle” is an injury to a muscle fiber unit caused by overuse, overstretching, or excessive stress. Strains are graded along a continuum based on post-injury symptoms and loss of function, and reflect the degree of injury.


There are three types of muscle strain that are recognized:

First degree

A first-degree type of muscle tear only affects few muscle fibers. In addition, a first-degree tear manifests swelling, mild spasms and tenderness but with no observable functions being loss.

Second degree

A second-degree muscle strain on the other hand has more muscle fibers that are affected than a first-degree. Similarly with the first degree strain, it also manifests swelling, muscle spasm, tenderness, and bruising but has also manifestations of having problems in weight bearing.

Third Degree

A third-degree muscle strain is the most severe type involving a complete tear in at least one of the muscle fiber unit and may also possibly involve muscle from muscle, muscle from tendon or tendon from bone.

Strained muscles are mostly heard from athletes being injured but same can also happen to anyone. Muscle strain can happen to a person who is lifting a heavy object just as an athlete is sprinting 100 meters.

Symptoms and Signs

In general, strained muscles have the same signs and symptoms regardless of their location and severity. This includes the following:

  1. Swelling, bruising or redness, in more severe types, open cuts as a result of injury.
  2. Pain at rest.
  3. Pain when moving the muscle affected or the joint near to the location of the strained muscle.
  4. Weakness.
  5. The most severe of all is the inability to use the muscle.

Muscle Strain at Various Body Regions

Strained Back Muscles

Back pain is one of most people’s frequent complaints. Back muscle pain is frequently related to disk or joint problems and most of all stretched muscles. The pulled muscle is mostly located in the extensor (responsible for standing and lifting objects), flexor (responsible for flexing, bending forward, lifting and arching the lower back) and the oblique muscles (responsible for proper posturing). A person who had a pulled back muscle may also have constraints in doing some activities like lifting and difficulty standing. In addition, he also has swelling, pain and weakness. Just as he may not be able to do these activities, more often than not, these activities are also the ones that caused the muscle to be strained such as lifting heavy objects.

Strained Calf Muscles

The calf muscle is one of the muscles that always get injured. The injury occurs mostly in the lower leg (gastrocnemius or soleus), most commonly in the medial gastrocnemius. The injury usually occurs just above the midpoint of the leg (between the knee and ankle). This area of the calf becomes tender and swollen when a muscle strain occurs. Other causes from calf strain aside from functional causes, are baker’s cyst, leg cramps and blood clots. They would experience pain while sitting or at rest, pain at night and difficulty in walking.

Neck Strain

Muscles in the neck are strained mostly because of an acute injury. Most of these injuries are indirect trauma causing the head to fling backward (hyperextension) or forward (hyperflexion), collectively known as whiplash. Motor vehicular accidents are one of the main causes of whiplash. In addition, injuries caused by rotation and compression (when the force of impact lands on the top of the head) can also result in neck strain. Pain is the cardinal symptom of a neck strain. It is also not uncommon that some discomfort may not show initially as inflammatory changes happen slowly. Inability of doing some previous tasks may also be manifested. Sometimes neck stiffness may also occur and radiate to the lower back.

Pulled Groin Muscle

The groin muscle strain usually occurs when the adductor muscles (muscles of the inner thigh) are overstretched. This can result in small muscle tears that cause pain and swelling. These muscles pull together when they contract and help stabilize the hip joint.  Groin strain is the most common cause of groin pains. A severe tear can cause a sudden, acute pain that can be accompanied by swelling and bruising. The pain increases with resistance movements and stretching of the inner thigh and hamstrings and are painful to touch.

Strained Chest Wall (Intercoastal) Muscles

Strained chest wall muscle is a result of a trauma that may occur several days prior to the occurrence of the pain. This might be a result from a direct trauma that causes tenderness. The tenderness may be noticed by pressing the area with fingers. In addition, forceful coughing and weight lifting may also cause the chest muscles to be pulled. Sometimes the mildest injuries could not cause weakness or tears. Muscle spasms and swelling may also occur as a result of inflammation. It is important to note the cause of the discomfort or pain in the chest as this might be more than just a strained chest muscle and might be a more life-threatening condition such as heart attack.

Pulled Quadriceps (Thigh)

The quadriceps or quad muscles are the four large groups of muscles located in the thigh that stretch from the hip to the knee. These muscles are responsible for extending the lower legs, working opposite to the hamstring. A quad muscle strain occurs when there is a tear in one or more of these muscles. Quad muscle pulls manifest pain, swelling, and weakness to the affected leg. Pulled quadriceps is also one of the most common injuries by the athletes such as in football, track and field events, basketball, rugby, tennis and cycling.

Stomach Muscle (Abdominal) Strain

Pulled stomach muscle is also called as abdominal muscle strain. This occurs when there is overstretching in one of the abdominal muscles such as the rectus abdominis, internal and external oblique. Most abdominal strains affect the rectus abdominis muscle; the muscle that runs down from the ribs to the pelvis in the middle of the abdomen. Abdominal strain can immediately cause pain to the area of the injured muscle. Muscle spasm is also the other symptom that can also occur. Less commonly, bruising and swelling can also occur. Abdominal muscle strains are most often the result of heavy lifting or sudden twisting. However, any sudden and forceful activity, including vigorous or prolonged coughing or sneezing, can cause abdominal strain also.

Treatment of Strained Muscles

Treatment of strained muscles consists of resting and elevating the affected part, applying cold, and using a compression bandage.  The treatment may be sum up to this acronym, RICE (Rest, Ice, Compression, Elevation).


This prevents additional injury and promotes healing.


Intermittent application of moist or dry cold packs for 20 to 30 minutes during the first 24 hours to 48 hours after injury producing decrease blood flow to the area, which decreases bleeding, swelling and discomfort. It should also be noted that care should be undertaken to avoid skin damage from excessive cold.


An elastic compression bandage controls bleeding, reduces swelling, and provides support for the injured muscles.


This controls the swelling by decreasing the blood flow to the affected area.

In addition, after 24 to 48 hours during the injury occurred, heat may be applied intermittently (for 15 to 30 minutes, four times a day) to relieve muscle spasm, to promote blood flow, absorption and then repair. Injuries that are severe require more intervention than just the above. Some injuries may require casting and splinting. Pain medications are also given in order to alleviate the pain. Depending on the severity of the injury, active and passive exercises can be started in just 5 to 7 days. In some cases, those that are severe, it may take months for the strained muscles to be healed.