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Metatarsalgia is a condition where there is pain in the balls (metatarsals) of the feet. (See figure M1) The bones involved are called the metatarsals, "algia" means pain. Normally a strong transverse arch lifts weight off the three center balls, leaving more weight to be borne on the great toe, little toe and heel. (See figure M2) When this transverse arch sags, the second, third and fourth toe bear excess weight and can become painful. Thus the long bones of the foot become more splayed. (See figure M3)
Age and excess standing or jumping on hard surfaces may cause the fat pad cushion under the toes to thin out so extra cushion in the inner sole of a shoe can bring pain relief. My first recommendation is to put in your shoe a simple green, Spenco insole (made with neoprene). It never bottoms out like many other materials, it's light and the simple insole is thin enough to fit in most shoes. It also has a nicer give to it that the more dense blue insoles also on the market. Neoprene Spenco insoles just keep on working and only need replacing when the fabric on top wears away. spenco.com
A foot with a low arch or strained arch from bearing excessive weight can be helped by an orthotic.
An orthotic that stops just behind the ball of the foot provides little cushion to the ball itself. A full length orthotic with a neoprene-type extension under the ball will provide extra comfort.
There are many brands of prefabricated orthotics that can be a starting point to aiding arch support. I recommend the softer type for arches that are mildly low.
Spenco has several types and can be purchased at sporting goods stores. spenco.com Pricier ones are also available, many of which have built corrections and can be bought from Orthopodiatric fabricators.
Custom orthotics can be made by either foam box method or neutral casting.
Neutral casting is the most accurate for feet in need of considerable correction. (See clip M4) Most custom made orthotics are made from a hard plastic or cork and leather. This more rigid orthotic is necessary for very flat feet especially in obese people, but there are other lighter materials available like puff, plastizote, pealite, nickleplast that can offer more softness for a foot that requires less control. Remember, a normal arch should fall a little then return to its raised position. A very rigid orthotic on a sensitive foot of a fairly small individual may create more discomfort in the arch and over-control a foot. A high arched foot may need more material under the arch rather than rigid control. See Arches.
Metatarsal pads can be added to any insole or orthotic usually behind the balls in the area that needs pressure relief. (See figure M5) The metatarsal pad will distribute the weight more broadly beneath the transverse arch, thus relieving the pinpoint pressure on the ball of the foot. A rocker bar glued to the bottom of the outside shoe sole, placed behind the balls, is also a way to provide pressure relief on the balls. (See figure M6)
For diabetic patients who are prone to ulceration and skin breakdown under the toes, an extra-depth shoe will accommodate a custom molded, 1/2 - 1 inch plastizote insole which will provide considerable cushion and pressure relief.
Extra depth shoes can be purchased from Orthotic fabricators. If more relief is needed a rocker bar can be added.
Morton's Neuroma
Pain and or numbness felt in the lateral side of the foot and caused by walking but not relieved by rest is likely to be pain in the nerve that passes between the toes. It can be a twinge that occurs occasionally or a constant pain. It is thought that the nerve that runs between either 3rd and 4th, or 4th and 5th toe, is nipped or squeezed causing swelling, numbness and pain. (See M7, M8) If you squeeze your forefoot together you may be able to reproduce it. (See Clip M9)
Assess the possible causes of this problem to see if you can relieve it yourself.
Are you in a frequent crouching/kneeling position with the ball of your foot flexed?
Are you wearing high-heeled shoes that put considerable pressure on the ball of your foot.
Are you wearing shoes that are too narrow in the front of the foot?
Are you wearing shoes that are supportive enough? Have you tried wearing arch supports?
If your pain is only occasional you may be able to avoid further painful nipping of the nerve. If your pain is more frequent or longstanding then you probably have more swelling of the nerve. You may try oral anti-inflammatories and adjust your foot habits and avoid excessive walking. If symptoms persist then an injection of an analgesic can help. Ultimately, irretractable pain requires surgery where the swollen nerve is cut out so that there is nothing to pinch.
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The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Movementwise makes no representation or warranty regarding the accuracy, reliability, completeness, currentness, or timeliness of the content, text or graphics. Links to other sites are provided for information only - they do not constitute endorsements of those other sites. Any duplication or distribution of the information contained herein is strictly prohibited. Copyright 2006-2011
MovementWise Christine Inserra P.T.
Certified Teacher of the Alexander Technique & Feldenkrais Method
Physical Therapy serving Chicago and the Greater Chicagoland Area
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