PODIATRY

Dr. Risa Vinarub

Disorder Affects Bones, Joints At the Soles of the Feet

METATARSALGIA is a general term used to denote a painful foot condition in the metatarsal region of the foot (commonly referred to as the ball of the foot). This is a common foot disorder that can affect the bones and joints at the soles of the feet. The main symptom of metatarsalgia is pain in the ball of the foot. The pain may be sharp, aching or burning.

Symptoms: Pain that gets worse when you stand, walk or run - and improves when you rest; sharp or shooting pain in your toes; numbness or tingling in your toes; pain that worsens when you flex your feet; a feeling in your feet as if you’re walking on pebbles or have a bruise from a stone; and increased pain when you’re walking barefoot, especially on a hard surface.

Causes: Five metatarsal bones run from your arch to your toe joints. The first metatarsal is shorter and thicker than the other four bones, which are usually similar in size. During the push-off phase when you walk, jump or run, your body weight is transferred to your toes and metatarsals. The first and second metatarsal bones take the brunt of this force, which can be as much as 275 percent of your body weight.

Most metatarsal problems develop when the impact load or the mechanics of your foot affect the way your weight is distributed. This can put excess pressure on the metatarsals, leading to inflammation and pain, especially in the metatarsal heads — the rounded ends of the bones that connect with your toe bones.
Sometimes a single factor can lead to metatarsalgia, however, several factors are involved, including:

• Intense training or activity. Runners have the highest incidence of metatarsalgia, primarily because the front of the foot absorbs more force when running than during any other activity — as much as 110 tons of force per mile. But anyone who participates in a high-impact sport is at risk.
• Foot shapes. A high arch can put extra pressure on the metatarsals. So can having a second toe that’s longer than the big toe, which causes more weight than normal to be shifted to the second metatarsal head.
• Hammertoes. This foot problem can develop when high heels or too-small shoes prevent your toes from lying flat. As a result, one of your toes — usually the second — curls downward because of a bend in the middle toe joint. This contraction depresses the metatarsal heads.
• Bunions. This is a swollen, painful bump at the base of your big toe. Sometimes the tendency to develop bunions is inherited, but the problem can also result from wearing high heels or too-small shoes. A bunion can weaken your big toe, putting extra stress on the ball of your foot. Sometimes surgery to correct a bunion can also lead to metatarsalgia.
• Excess weight. Because most of your body weight transfers to your forefoot when you move, even a few extra pounds mean more pressure on your metatarsals. Sometimes losing weight reduces or eliminates symptoms of metatarsalgia.
• Poorly fitting shoes. High heels, which cause more weight to be transferred to the front of the foot, are one of the most common causes of metatarsalgia in women. Shoes with a narrow toe box or athletic shoes that lack support and padding also can contribute to metatarsal problems.
• Stress fractures. Small breaks in the metatarsals or toe bones can be painful and change the way you put weight on your foot.
• Morton’s neuroma. This noncancerous growth of fibrous tissue most often occurs between the third and fourth metatarsal heads. It causes symptoms that are similar to metatarsalgia and can also contribute to metatarsal stress. Morton’s neuroma frequently results from wearing high heels or too-tight shoes that put pressure on your toes. It can also develop after high-impact activities such as jogging and aerobics.
• Aging. As you grow older, the fat pads on the balls of your feet become thinner. This makes the metatarsal bones more susceptible to injury.

Prevention: When you’re serious about sports, your metatarsals may take a beating. To help protect your feet:

• Choose the right shoes. Wearing high heels or too-small shoes can set the stage for a host of foot problems, including metatarsalgia. The same is true of shoes that don’t provide enough support and cushioning. Look for shoes with a wide toe box and a rocker sole, which redistribute weight on the bottom of your foot.
• Consider cushioned insoles, metatarsal pads or arch supports. These products can help prevent the pain of metatarsalgia — as well as relieve the pain when it develops.
• Maintain a healthy weight. Keeping your weight within a healthy range can take a load off your feet.
• If you’re recovering from an injury, don’t try to resume strenuous activity too soon. If you’re not completely healed you may only develop more severe problems and longer layoffs later on.

Dr. Vinarub graduated Cum Laude from the New York College of Podiatric Medicine. She is board certified in foot surgery by the American Board of Podiatric Surgery; Board certified in podiatric orthopedics by the American Board of Podiatric Orthopedics and Medicine; and a Fellow with the American College of Foot and Ankle Surgeons. Dr. Vinarub’s office is located at 1205 N.Courtenay Pkwy. in Merritt Island. To reach her, please call 321-452-5133 or log on to BrevardPodiatryGroup.com

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