Metatarsalgia: Pain in the midfoot

Metatarsalgia: Some people are familiar with the unbearable pain in the metatarsus. Sometimes drilling, sometimes stabbing, maybe even burning. Walking becomes torture. We can also forget about fancy shoes. But what kind of pain is that? The doctor says it has to be operated. Is there another way? Can we get rid of this metatarsal pain ourselves? This article should answer all our questions.

What is metatarsalgia?

As so often in medicine, simple terms are complicated. As a result, the patient does not look through and disease names gain a higher weight.

Oh no, I have metatarsalgia. Now I see my whole life passing me by. Why me? In such young years already…….

It’s not that bad after all. Because matatarsalgia means nothing more than foot pain, more precisely midfoot pain.

Metatarsus = midfoot
Algos = pain

It is a collective term for different types of pain in the metatarsus with different causes. It describes all forms of pain from the second metatarsal to the fifth. Problems with the first metatarsal bone get different names. Depending on the cause, there are 2 types of metatarsalgia.

Forms of Metatarsalgia

There are not only one but two sorts. Namely the primary and the secondary metatarsalgia.

Primary: The cause of metatarsal pain is in the metatarsal bone itself. For example, a splayfoot.

Secondary: The cause is a systemic disease affecting the whole body. For example, circulatory disorders.

Causes and what happens in the foot

Because this disease is a collective term for various pains, the causes are just as numerous. Therefore I explain each cause with the course of the disease in the foot.

Hallux valgus and splayfoot

What a Hallux Valgus or a splayfoot is, I do not need to explain at this point. But what happens in the foot, that it comes to pain in the middle foot, I love to tell.

In the splayfoot, the first metatarsal bone is a little loose and over-mobile. Therefore this metatarsal bone can move upwards when we roll the foot. This means that this bone absorbs less stress.

Unfortunately, the second metatarsal bone is firmly connected to the foot root. When the foot rolls, it cannot evade and has to bear the load. Plus the load which was not taken over by the first bone.

The second metatarsophalangeal joint suffers from this heavy load. Metatarsalgia occurs.

Claw toes and hammer toes

Also a very widespread disease. We often owe it to tight footwear. I will explain the claw toes and hammer toes in more detail elsewhere. Here a short explanation is enough.

The small toes are overstretched in the base joint. Thus at the metatarsal heads stretched upwards and bent strongly in their further joints.

This stretching upwards at the metatarsal heads is important. This causes the joints to bulge out. This exposes the metatarsophalangeal joints.

When we walk, the small toes have to absorb the load. They cannot do this now because they are bent upwards. So the foot rolls over the metatarsal heads. Therefore they are overloaded and inflame. This is followed by metatarsal pain.


That’s a cause I didn’t think possible until recently. Until a young patient came to me for treatment. He had severe metatarsal pain throughout his left forefoot.

The calluses were not unusual on the sole. Only a tiny little corn was there. Even smaller than I knew from other patients with no pain.

I treated him for his metatarsal pain with everything I knew so far. But it only got slightly better. He was frustrated. I was frustrated. There was no real progress.

He happened to go to the pedicure sometime. She cut out his corn, very deep and pointed. In the next treatment with me he was painless. Apparently the corn pressed on a certain spot. It radiated into the entire forefoot.

This showed me again that the textbooks are not always complete and that I have to broaden my horizon more and more every day.

Symptoms of Metatarsalgia

Metatarsal pain is not the same as metatarsal pain. They appear in different forms. And just as we are different, everyone has their own feeling for pain. Therefore my symptoms here are not quite complete and only show what is possible.

  • Burning pain in the anterior metatarsus
  • calluses and horny skin, maybe even a corn crab.
  • Tarnishing pain, you have to warm up before the pain goes away.
  • You’ve got a slow gait.
  • Stabbing in the metatarsal heads
  • Pain in the front metatarsus when you stand on your toes.
  • Shooting pain from the metatarsus into the small toes
  • Spasmodic pain in the anterior sole of the foot
  • Pulling pain along the metatarsals to the tarsus

Possible consequences of metatarsalgia

A problem often brings with it further problems. Especially if you don’t take care of it right away. But how far can the effects of metatarsalgia go?

Morton neurom: Broken metatarsal bones, swelling and soft tissue shifts can cause increased pressure on the nerves. The Morton Neurom is a special form of metatarsalgia in which a nerve is affected.

Pain in the ankle joint: Some of my patients go through a gentle gait on the outer edge of the foot. This is why the ankle joint is overloaded because it is no longer unrolled properly.

Pain in the knee: The same thing happens here. Because of the load distribution, the knee no longer moves as it should. The pain often occurs on the inside of the knee.

Back pain: Because of a limp, people make evasive movements in the upper body. Sometimes they tilt strongly to one side or diagonally forward. This is why the back becomes tense and starts to hurt.

Heel spur: Another problem of evasive movements. It can form a strong pull on the fascia in the sole of the foot or in the Achilles tendon. Therefore a heel spur can develop. Either at the heel bone in the sole of the foot, or at the point of attachment of the Achilles tendon.

Immediate aid

Pause: If metatarsal pain sets in during heavy exertion, pause immediately. Do not continue with sport or work. In some cases it does not work and pain does not come suddenly. But getting stronger during the day. Then after the load if possible spare. After working in work shoes, do not necessarily continue to strain but relax and read the other tips.

Pain gel: I am not a friend of medication. But in some cases it makes sense. Before you can no longer walk at all, grab a pain ointment. However in moderation use. And if the metatarsal pain has disappeared, do not exaggerate again immediately. Many then often overestimate themselves and continue with the strain as before. This can make it even worse, because you can no longer feel the limit so well.

Massage: If you are flexible enough, massage your feet. If not, then let massage. Muscles and tendons want to relax. And with a massage the blood circulation is stimulated. In this way, metabolic waste products and inflammatory substances can be better removed.

Mobilization: Take 2 metatarsal heads with your fingers and move them slightly against each other. If you don’t get it, let someone else do it. Because this gentle movement relaxes the tendons a little, increases the blood circulation and overlays the pain.

Foot bath or warmth: Relax your feet with a foot bath or a hot-water bottle. The warmth also relaxes your muscles and tendons. But enjoy with caution. Because warmth is not appropriate for acute inflammation. The next tip will help.

Cold: Cold quickly overlays pain. If it is an inflammation, it is slightly alleviated. After cooling, the foot heats up again and is better supplied with blood. Several times a day in acute cases.

Shoe change: Your feet hurt in your shoes after some time. Then change them throughout the day. So your feet have some variety and some structures can relax a bit.

When should I go to the doctor for metatarsalgia?

You shouldn’t run to the doctor for every ailment. Does it make sense with metatarsalgia?

As an exception, I say yes now.

Because as you have seen above, pain in the metatarsus has various causes. It can be harmless for you. But maybe not. And caution is better than indulgence. Just let it be clarified.

I have already experienced patients who have broken a bone without noticing it directly. They had only a little pain which disappeared after a few days. Only months later did they experience serious pain. Then the x-ray showed that the bone was broken.

So don’t take metatarsal pain lightly. Let it be clarified for safety’s sake.

Leave A Reply

Your email address will not be published.