Metatarsalgia 101

Metatarsalgia is pain in the midfoot. They usually develop due to stress such as running.

What is metatarsalgia?

Metatarsalgia is when pain occurs in the midfoot. The symptoms appear below the heads of the metatarsal bones (ossa metatarsalia), usually under stress. The term metatarsalgia is composed of the Greek terms “metatarsus” (middle foot) and “algos” (pain). See AbbreviationFinder for abbreviations related to Metatarsalgia.

Metatarsal bones 2 to 5 are affected by the symptoms. Pain in the first metatarsal bone, on the other hand, is treated separately. Females are particularly affected by metatarsalgia, as women often wear high-heeled shoes. As part of the metatarsal complaints, a splayfoot occurs because the metatarsal bones press on the sole of the foot. It is not uncommon for calluses to form below the ball of the foot .

In medicine, a distinction is made between primary and secondary metatarsalgia. In the primary form, the cause of the pain is due to local triggers. Secondary metatarsalgia, on the other hand, is caused by systemic diseases such as arterial circulatory disorders, gout or rheumatism.


In most cases, primary metatarsalgia is caused by excessive strain or poor posture. Claw toes, hammer toes or a crooked toe ( hallux valgus ) promote metatarsal problems. Another role is played by increasing age. Over the years, the protective fat pad under the foot gradually breaks down and can no longer cushion the steps when running.

In the event of incorrect loading or overloading, there is a risk of metatarsalgia. In most cases, metatarsalgia occurs in women who prefer to wear shoes with high heels or shoes that are too tight. This promotes a malformation of the foot, which in turn causes pain in the metatarsal. However, diseases of the foot can also be the cause of metatarsalgia.

This primarily includes tendonitis, in which the tendons that run in the direction of the bones are overloaded, resulting in painful inflammation. Overloading of the ligaments in the metatarsal can also be responsible for metatarsalgia. Another common reason is injuries to the affected area, such as bruises and broken bones.

In rare cases, the symptoms in the metatarsal arise from chronic periosteum inflammation, soft tissue tumors, bone tumors or aseptic bone necrosis. Secondary metatarsalgia is pain in the midfoot that is caused by an underlying condition.

These are usually chronic conditions such as arthrosis, which originates in other areas of the body and spreads to the metatarsus. Other triggers for secondary metatarsalgia are rheumatic diseases or gout.

Symptoms, Ailments & Signs

Metatarsalgia is characterized by pain in the midfoot. The symptoms get worse under stress. In addition, calluses often form in the metatarsal region, which are often perceived as uncomfortable. Metatarsalgia rarely has other symptoms.

If the patient suffers from the secondary form, there is a risk of additional impairments from the triggering disease such as gout or arthrosis. If a bone fracture is the cause of metatarsalgia, there is a risk of redness, swelling, and the formation of a hematoma (bruising). As it progresses, the bruise takes on a yellow-green color.

Diagnosis & disease progression

If there is a suspicion of metatarsalgia, a visit to the doctor is advisable. The doctor first looks at the medical history of the patient. In doing so, he inquires as to what footwear the person concerned is using and whether there may be incorrect posture. Previous broken bones and any previous illnesses such as arthrosis are also important.

After the questioning, the doctor examines the painful foot. Possible deformities can be determined in the process. The doctor also carefully scans the foot. Finger pressure can also cause painful reactions in the foot. It also controls the extent of the protective fat pad.

Occasionally, X-rays may also be required. This is particularly the case when a metatarsal fracture is suspected. In most people, metatarsalgia takes a positive course. The problem can usually be solved by wearing better shoes. However, problems can occur at an advanced stage, often requiring surgical intervention.


In the case of metatarsalgia, those affected primarily suffer from severe pain in their feet. This pain can occur either in the form of rest pain or stress pain and thus significantly reduces the patient’s quality of life. Pain at rest can also lead to sleep disorders and thus to depression and other psychological limitations.

In most cases, those affected also appear irritable and exhausted. Metatarsalgia also has a negative effect on movement and can lead to restrictions in movement and thus in everyday life. It is not uncommon for the affected regions to be restricted and bruising to occur. Furthermore, the course of metatarsalgia depends heavily on the cause of the pain, so that a general prediction is usually not possible.

In most cases, however, the symptoms can be limited relatively well so that no further complications arise. The symptoms can be significantly reduced with the help of painkillers or by resting your feet. Special insoles can also have a positive effect on metatarsalgia and avoid complications. Surgical interventions are only necessary in a few cases. The life expectancy of the patient is not reduced by the metatarsalgia.

When should you go to the doctor?

Pain in the metatarsal area can be due to overloading or overuse of the body. If the symptoms gradually subside during a break and disappear completely after a restful night’s sleep, you don’t need a doctor. In these cases, recovery is often achieved after just a few hours. In the future, the body’s resilience should be taken into account when performing sporting or professional activities as well as in leisure activities. A timely and sufficient rest phase or a restructuring in the fulfillment of necessary tasks can already lead to a permanent freedom from symptoms.

A doctor’s visit is necessary as soon as the pain occurs while performing normal activities or if it no longer subsides. If there is swelling on the foot, adequate rest does not alleviate the symptoms or if discolouration of the skin is noticed, a doctor should be consulted. If the pain increases in intensity or spreads, a doctor is needed. Before taking any pain medication, it is always advisable to consult a doctor. There may be complications or other impairments that must be clarified in advance. If bruising occurs or calluses develop in the affected area, a doctor should be consulted.

Treatment & Therapy

Metatarsalgia can be treated conservatively or surgically. One of the most important conservative measures is for the patient to replace the wrong shoes with shoes that fit. That means he has to do without shoes that are too tight and high heels. It is not uncommon for this measure to be enough to improve the symptoms over the long term, as the foot then recovers on its own.

Insoles in the shoes, which can be precisely adapted to the patient’s foot shape, can also provide support. At the beginning of the treatment, the patient is also given medication to relieve his pain. If the calluses that have developed have a negative effect on the aesthetics of the foot, there is the option of removing them yourself or having a professional podiatrist remove them.

In the case of a pronounced metatarsalgia, however, an operation may be necessary. The metatarsal bones are usually shortened as part of an osteotomy. It is not uncommon for the surgeon to simultaneously shift the heads of several metatarsal bones four to eight millimeters towards the center of the body during the procedure.

Outlook & Forecast

Normally, the prognosis of metatarsalgia is favorable. With this disease, those affected have the opportunity to bring about numerous improvements in their health themselves. In addition to medical care, the cooperation of the patient with this disease is desirable and necessary in everyday life. Otherwise, there will be an increase in health impairments or the symptoms will become chronic.

For a positive development and thus a favorable prognosis, a restructuring should take place in the fulfillment of daily duties. The movement sequences must be optimized and at the same time the body should be sufficiently relieved. Frequently, the fulfillment of professional tasks or leisure activities must be optimized. The patient should learn to react to the signals of his body and bring about changes in good time. In physiotherapy, exercises are trained that bring about a significant improvement in the situation. These training units should also be implemented independently outside of the sessions in order to positively support the healing process and bring about long-term changes.

Without the cooperation of those affected, the improvements are usually only temporary. In some cases, an operation is necessary. This comes with the usual risks. Nevertheless, it is often the only way to achieve permanent relief from the symptoms. Wearing appropriate footwear contributes significantly to a positive outlook and optimization.


To prevent metatarsalgia from occurring in the first place, only suitable footwear should be worn at all times. The use of insoles makes sense for sporting activities. These can be optimally adapted to the shape of the foot.


The aftercare of the metatarsalgia often leads to a change in the usual processes. Accompanying measures can alleviate the symptoms, which has a positive effect on the patient’s quality of life. There are various ways of self-help, which the doctor explains in a direct conversation with the person concerned. The typical swelling in the foot area and often in other parts of the body causes pain.

These can be reduced by taking the appropriate medication. Patients should follow the medical instructions for these drugs exactly to avoid overdosing. Comfortable shoes help against foot pain.

Sporting activities should be limited until the patient has fully recovered and if possible only in consultation with the doctor treating you. With the help of a physiotherapist, an individual exercise program is created that the patients can carry out themselves after detailed instructions. With the exercises, they improve their fitness and feel better as a result. This has a positive effect on the overall well-being and increases the quality of life.

You can do that yourself

Those who suffer from metatarsalgia do not always have to be treated surgically. It is often enough to change shoes. Those affected should avoid wearing shoes that are too tight or high heels. This is usually enough to alleviate the symptoms in the long term and allow the foot to recover.

In addition, insoles can be used that can be precisely adapted to the shape of the foot. Painkillers initially protect against pain in the event of malpositions and other complaints. Calluses that have already formed can be removed with the help of a gentle pumice stone and other tools available at the drugstore. In order to avoid injuries, however, professional foot care should be used in the case of large calluses.

Furthermore, those affected must determine the cause of the metatarsalgia and take the necessary countermeasures. Since the pain in the metatarsus is usually caused by a bad posture or a misalignment of the toes, surgery is often the only option. Therefore, people who are affected by metatarsalgia should definitely speak to their family doctor or an orthopedist. The doctor can suggest other strategies to reduce pain and regain a healthy gait.


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