Metatarsalgia and Morton’s neuroma

Metatarsalgia and Morton’s neuroma refer to complaints in the anterior and middle area of the foot caused by overload or incorrect placement.

There is pain and inflammation in the anterior region of the sole of the foot.

It is important to control the shape of the feet and observe their further development over time, especially if foot problems have already occurred in the family.

With special exercises, the feet can be strengthened.
This includes, for example, picking up small objects with your toes, such as pens or marbles.

Shoes must be worn in the right size, they must not cause cramps and do not constrict the toes; Women should avoid very high heels, with which they practically walk on tiptoe, which causes chronic metatarsalgia.

Athletes who run and jump a lot are particularly at risk of developing forefoot pain.
In track and field athletes, the front foot is exposed to increased traumatic forces, while other athletes such as tennis, football, baseball and football players often have to deal with forefoot discomfort, including metatarsalgia caused by mechanical stress.


Morton’s neuralgia

Metatarsalgia should not be confused with Morton’s neuralgia (also called Morton’s neuroma), which consists in the degeneration of plantar nerves. It is a benign condition that causes pain between the second, third and fourth metatarsal bones.

Morton’s neuralgia causes constant discomfort, even at night, whereas in metatarsalgia the pain occurs only when moving.

Causes of metatarsalgia

Each foot has five metatarsal bones that lie between the root of the foot and the toes.

The first metatarsal bone is shorter but wider than the other four, which are usually about the same size.

During the rolling process when walking, running or jumping, body weight is transferred to the toes and metatarsal bones. Mainly the first two metatarsal bones are loaded.
Most problems of metatarsal bones arise when the natural functioning of the foot (mechanical component) is disturbed and the weight distribution on the foot is affected.
This can be done

lead to excessive stress on the metatarsal bones and cause inflammation and pain in the metatarsal heads, i.e. the rounded bone ends connected to the toes.

Sometimes metatarsalgia is triggered by a single cause. However, in most cases, it is a combination of various factors, including:

Intense training sessions or activities: Runners and athletes with high jumping and running performance are among the risk groups, especially if wrong or worn shoes are worn because the front area of the foot is subjected to considerable force.

Certain malpositions of the foot: A hollow foot can lead to additional stress on the metatarsal bones. If the second toe is longer than the big toe, more weight than usual is shifted to the second metatarsal head when walking.

Symptoms of metatarsalgia in acute phase

Hammer toes: This foot problem can occur when heels are worn that are too high or the shoes are too tight, the toes are squeezed and do not lie flat next to each other. As a result, one toe, usually the second, bends downwards due to a joint deviation of the third toe. As a result of contracture, the metatarsal heads become depressed.

Bunion or crooked toe (hallux valgus): This complaint consists of a swollen and painful bulge at the level of the big toe joint. The tendency to valgus deformity of the big toe can be hereditary, but too tight shoes or high heels are also among the possible causes.

Women are affected much more often than men. Hallux valgus can weaken the big toe and thus put the front part of the foot under increased tension. Surgery to correct this deformity can cause metatarsalgia if the feet are not spared enough to heal completely.

Overweight: A large part of the body weight is transferred to the forefoot when walking, every kilo too much creates an increased pressure on the metatarsal bones. Weight loss can help alleviate or eliminate the symptoms of metatarsalgia.

Wrong shoes: High heels shift the weight to the front part of the foot and are often the cause of metatarsalgia in women. Pointed shoes or sneakers with insufficient padding favor problems on the metatarsal bones.

Stress fractures: Small lesions on the metatarsal or toes can be painful, whereupon the foot may be unusually placed and thus differently burdened by body weight.

Morton’s neuroma: Typically, the growth of benign fibrous tissue around the nerve occurs between the third and fourth metatarsal heads.
The neuroma causes symptoms that are very similar to those of metatarsalgia and can also put the metatarsal bones under tension. It is often caused by high heels or tight shoes that squeeze the toes. It can also develop after sports activities that produce repetitive microtrauma, such as aerobics and jogging.

Metatarsalgia causes pain in the front of the foot, which increases when standing, walking and running.
Rarely, this disease occurs bilaterally.
Some patients describe it as walking on stones.
Others feel a diffuse pain.
The painful stitches can occur on one or both feet. Sometimes only one or two heads of the metatarsal bones are affected, in other cases all heads.
Metatarsalgia usually develops slowly within several weeks, rarely occurring suddenly. The affected area of the foot is sensitive to pressure.

The symptoms of metatarsalgia:

  • Stabbing pain or a burning sensation in the front part of the foot, just below the toes.
  • Pain around the second, third or fourth toe, rarely near the big toe.
  • The stitches increase when getting up, walking and running and become less when the foot is relieved, i.e. when sitting and lying down.
  • Acute and stabbing pain in the toes.
  • Numbness or tingling in the toes.
  • Increased pain when bending the feet.
  • A feeling like a stone in the shoe.
  • Increased pain when walking barefoot, especially on hard ground.

Sometimes the symptoms appear suddenly, especially after intensification of training sessions or after forefoot stressing activities, but usually the symptoms develop over a longer period of time.

Morton’s neuralgia has other, typical symptoms that are explained elsewhere.

Diagnosis of metatarsalgia

In the case of metatarsalgia, the doctor must find out the cause of pain.
For this purpose, the patient is questioned in detail and the foot is thoroughly examined.
The doctor may also advise a technical examination.

Technical investigations

Blood test: to control diabetes, arthritis and gout.
X-ray examination of the foot: indicates joint and bone problems of the foot. Bone scintigraphy of the foot: if stress fracture of a metatarsal bone is suspected.

Further examinations: for a more detailed examination, the doctor will occasionally schedule additional examinations, such as magnetic resonance imaging of the foot.

How is metatarsalgia treated?

The following measures can alleviate the symptoms:

  • Cool the affected area with ice several times a day for about 15-20 minutes.
    The ice must be wrapped in a cloth to protect the skin; Ice must never come into direct contact with the skin.
  • Anti-inflammatory drugs such as alrheumum (ketoprofen) can be taken.
  • Stressful sports and exercises that put the foot under tension should be avoided. You can also switch to a more foot-friendly sport, such as swimming or cycling.
  • The feet should be relieved of body weight as often as possible, i.e. put up or support them outside working hours (e.g. footstool).
  • Ultrasound treatment under water can relieve the symptoms.
  • Perform physiotherapy exercises for the ankle joint and stretch the Achilles tendon. A gentle massage at the top and bottom of the foot can relieve pain.
  • Use insoles that optimally distribute the forces acting on the foot.
  • In pharmacies and medical supply stores, there are special metatarsal bandages with pads, which relieve the metatarsus.
  • It can also be used cushioning insoles or butterfly rollers that relieve the feet when walking.
  • The doctor may recommend support bandages for the arch of the foot if the insoles have not achieved any effect.
    There are different sizes that are commercially available or can be made to measure.
  • Replace the old shoes with appropriate footwear.

In more severe cases, the following treatment options are also available:

  • Cortisone infiltrations to relieve pain and swelling.
    After the injection, pain and swelling at the injection site may become noticeable, but they disappear after a few days.
  • Surgical intervention may be necessary if the other treatment methods are unsuccessful; The following surgical procedures are available here:
  • Alignment of metatarsal bones.
  • Liberation or removal of a pinched or irritated nerve.
  • Straightening of the hammer toes, i.e. the deformation at the middle toe joint of the second, third or fourth toe, which keeps the toe in a permanent bending position.

Maintenance therapy and prevention

The following measures greatly contribute to reducing the risk of metatarsalgia:

  • Comfortable shoes – do not wear too tight shoes or shoes with very high heels; a rounded toe is ideal. The shoe must also provide sufficient support and act as a shock absorber.
  • Insoles or pads prevent the pain or relieve it if it has already occurred.
  • Body weight – Thin people are significantly less likely to develop metatarsalgia; you should maintain an appropriate body weight to prevent other foot complaints, such as plantar fasciitis.
  • Recovery periods – After an injury, the doctor’s recommendations regarding sporting and professional rest periods must be followed.

Conservation phase

When the inflammation has subsided, wearing insoles is usually the only recommendation given to maintain the normal biomechanical function of the foot. With these aids, the body weight can be kept away from the painful area. Patients should perform the self-mobilization exercises recommended by the doctor and physiotherapist, including stretching exercises.

In severe cases, surgical correction of the metatarsal bone position may be necessary to compensate for the weight load.

If conservative treatment has not led to the desired success, surgery may be considered.

Which doctor is responsible?
The patient can see an orthopedist or foot specialist if the pain does not get better or even worse.

Anti-inflammatory drugs, such as ibuprofen, can bring relief; however, they are rarely a permanent solution.

Control (aftercare)

Sports and competition ability

When normal sports activities can be resumed depends on the type of ailment and the particular sport.
Metatarsalgia is considered to be overcome when mobility, resistance, aerobic abilities and proprioception, which are essential for any sport, are fully restored.

With the start of sporting activities, the athlete again exposes himself to the same traumatic circumstances that led to the pain in the forefoot. Therefore, the foot must first be completely healed and symptom-free in order to be exposed again to the stress and trauma that this sport brings with it.

The right choice for running, football and indoor shoes is the key to preventing relapses.


If you train on hard surfaces, you need shoes with a good suspension.
Silicone pads and shock-absorbing insoles are useful for athletes who run and jump heavily, especially on hard ground.

The aim of prevention is to avoid abnormal tension and pressure.
Insoles, metatarsal pads and calluses are used to balance and cushion the weight load.
Sometimes the foot problems are not caused by pathology, but are caused by incorrect footwear.
The correct position of the foot in the shoe depends on the size of the shoes and their shape, also because the two feet are practically never exactly the same.


The prognosis is usually good if the treatment measures recommended by the doctor are followed.


Athletes who drastically increase their training volume run the risk of developing inflammation on the forefoot.
Therefore, training duration and training intensity should be increased gradually; if you have foot pain, you are not allowed to walk.

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