The Runners Guide To Metatarsalgia

Foot Pain From Running

Experiencing a stabbing, burning, or aching pain in your feet, just below the toes? You have come to the right place.

Ball of foot pain when running is a common issue.

But what’s actually causing it? And how to Treat and Prevent it?

9 out of 10, the culprit behind the pain is a condition known as metatarsalgia (in runners and non-runners alike).

If you’re suffering from metatarsalgia, running is often not recommended since the high-impact nature of the sport places a lot of stress on your feet.

This not only makes your symptoms worse but also delays healing.

In today’s post, I’ll share with you the full guide to metatarsalgia, the main symptoms, as well as how to treat and prevent it.

Sounds great?

Let’s lace up and dig in.

Anatomy 101 – Foot & Forefoot

The feet are an amazing piece of design. They were made for walking, jumping, balancing, dancing, climbing, and of course, running.

The feet also endure the load of your whole body, and this weight is further increased when you run.

Let’s dive a little more into the anatomy.

The feet are a household of bones. By number, one foot contains 26 bones—which is nearly a quarter of all the bones in your body. The same limb also contains 33 joints, 19 muscles, 107  ligaments, and so many tendons.

The most tissue-dense area is the forefoot, which is composed of the metatarsal bones, the metatarsophalangeal joints, and all the toes.

The area also houses plenty of tiny muscles, tendons, ligaments, bursa, fascia, blood vessels, and nerve fiber.

The Function

The structures that make up the forefoot function as one unit to perform two primary tasks: weight-bearing and propulsion, both of which require a lot of stability.

Your forefoot is in charge of supporting the entire load of your body during the toe-off, which is the propulsive phase of the running gait.

In fact, you might put as much as three to five times your body weight on every step taken while running, depending on your running speed, biomechanics, type of terrain, and of course, body weight—the heavier your weight, the heavier the load.

For this reason (and some more), it should come as no surprise that forefoot pain is common among runners.

Such pain can limit movement and mobility, making running out of the question.

What Is Metatarsalgia?

Metatarsalgia is the common term used to refer to pain under the heads of the metatarsal bones or what’s often referred to as the ball of the foot.

The condition is an irritation of the structures that surrounds any of the five long bones of the foot. The whole region can become irritated and inflamed.

The most common site for the condition is precisely under the ball of the foot, close to the base of the second toe.

Rather than being a primary diagnosis, metatarsalgia is actually a symptom or secondary diagnosis. It might be caused by a number of various ailments affecting your foot. Your treatment options will depend on what’s causing the pain.

Metatarsalgia is a common overuse injury in runners as well as track and field athletes as well as those who practice high-impact sports such as football and basketball.

The Main Causes OF Metatarsalgia in Runners

The main cause of metatarsalgia comes down to excessive impact when logging the miles.  This can irritate as well as break down any of the structures that make up the forefoot.

Here are the main factors that could contribute to the condition:

  • Calf tightness that pulls on the muscles and tendons
  • Running shoes that lack proper cushion
  • Running shoes that are too old and/or worn-out
  • Limited ankle flexion and range of motion
  • Increasing training load too fast that the muscles and tendons can’t adapt.
  • Feet rolling too much inward while walking and/or running
  • Having excessively high arches or flat feet.
  • Sitting or standing for long periods of time
  • Having hammertoe deformity as well as other feet issues.
  • Previous fracture or sprain

Symptoms of Metatarsalgia While Running

The condition often begins over time. It might start off as mild discomfort that grows gradually to the point that you may find it hard to walk, stand, let alone run.

The main sign of the condition is a stabbing, burning, or aching pain just beneath the toes, at the head of the bone. The pain can be sharp, diffuse, and shooting.

You might feel like you’re walking with a pebble in your shoes and can be felt under one or more of the metatarsal heads, the bony joints on the ball of the foot.

The condition typically afflicts the second toe and sometimes the third or fourth.

And if the nerves within your foot are also damaged, you might also feel numbness, tingling, or burning in some of your toes.

Does Running Make Metatarsalgia Worse?

The answer is a definite yes!

Logging the miles places a drastic amount of stress on the structures that make up your feet. Each time your foot strikes the ground, your forefoot absorbs most of the impact to keep you moving in a forward direction. This can make any symptoms associated with the condition even worse.

For this reason (and we’re going to see later), the first step toward a quick recovery from metatarsalgia is to take time off of training as long as you have symptoms. Otherwise, the road to recovery will be slow and full of terrors—and you don’t want that.

How To Treat Metatarsalgia

The best way to speed up recovery is to take action quickly and uncover the actual cause(s) that led to the irritation and pain.

Next, start treating it at the onset of pain.

Here’s what to do

The Rice Method

Your aim is to restore a normal range of motion while soothing pain, reducing swelling, and ensuring proper function.

Begin with the R.I.C.E method, in which you:

  • Rest the injured limb

Take time off any activities that cause pain. As the pain fades, you can gradually taper up while paying attention to your symptoms.

  • Ice the affected area

Typically the sooner, the better—for 15 to 20 minutes, three times a day. Avoid placing the ice in direct contact with your skin. Instead, use a barrier between the ice and your skin.

  • Compress the area

Use a simple ACE wrap around the affected limb to help with the swelling and pain. Begin at the toes and work up the foot. Avoid wrapping too tightly.

  • Elevate the injured foot

Use a pillow to place the affected limb above the level of your chest to help limit swelling and speed up recovery.

What’s more?

For more relief, try stretching your calf muscles. As I previously stated, having tight calf muscles may place more pressure on the forefoot. I’d also recommend a foam roller for a deeper release.

Use A Pad

Padding might be needed temporarily, but it’s worth it.

Metatarsal pads consist of slightly triangular, small pads that can be placed behind the injured site to soothe pain and speed up healing, especially in the early phases of treatment.

The exact location of your pain will help you choose what kind of padding device to use.

Proper shoes

Take a look at your running shoes. Shoes with enough cushion around the ball of the foot—remember, this is the area where the metatarsal heads are found close to the base of the toes—can help a lot.

Consult Your Doctor

Your doctor may suggest an ultrasound?, X-ray, or a bone scan to get at the root cause of the pain, especially if the underlying cause isn’t instantly obvious.

In most cases, you might need an injection to the affected site to reduce inflammation, but of course, it won’t solve the problem. In severe cases, surgery might be needed to fix the damage.

The Return To Running

Take up running again once you’re completely healed and can run on the affected foot pain-free.

Shoot for a gradual return. Taking things up pre-injury levels would risk a flare-up. And you don’t want that.

How To Prevent Metatarsalgia

The best way to prevent metatarsalgia —as well as any other overuse injury—is to address the risk factors that are to blame for the condition (some of which I’ve already shared above).

Use Proper Shoes

Preventing metatarsalgia—as well as some other overuse injuries—is often a matter of choosing the right footwear.

To soothe pain, go for shoes with a toe box wide enough for the toes to comfortably spread out.

If you’ve flat feet, choose a pair of shoes with enough cushioning in the midfoot. Have a high arch? Get some shock-absorbing support for your arch.

What’s more?

Pay attention to your casual shoes, too, e.g., shoes with narrow tox box, high heels, etc. These can also affect your feet.

Try Tape or Orthotics

Can’t seem to find enough support in your running shoes?

If you’re having trouble finding proper shoe support but are in need of quick relief, try taping or shoe inserts such as orthotics, metatarsal pads, or insoles. Sometimes orthotics come together with the pads, so choose as needed.

Strengthen Your Feet

Another thing to protect you against metatarsalgia is to strengthen the muscles of your lower legs.

When you do so, you’ll help add more support and stability to your feet when with weight-bearing. You’ll also help restore your body’s ability to support your arch and limit the strain on your feet while running.

Any weakness or dysfunction in the foot and ankle muscles can place undue strain on the tissues and ligament of the foot, including your plantar fascia.

What’s more?

Strengthening the bottom of your foot may also prevent it from flattening excessively, which reduces the impact on your metatarsals.

Stretch Regularly

Tight muscles place undue stress on the midfoot with running, which may cause—or contribute—to metatarsalgia. T

The tightness can also cause bunions. Not nice at all.

Make it a habit to regularly stretch your calves and any other muscles that impact your running biomechanics.

Stretch before and after running if you have a history of leg or ankle issues.

The key areas to focus on for quick healing include the toes, ankles, Achilles tendons, and calf muscles.

Here are some of the best exercises that will help you do that.

  • Calf-stretch
  • Achilles tendon – Stretch
  • Toe towel-scrunches
  • Ankle Extension
  • Ankle Flex