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Metatarsal Joint Pain

By Kendrick Alan Whitney, DPM, Temple University School of Podiatric Medicine

Pain in the joints of the ball of the foot (metatarsophalangeal joints) may originate within the joints themselves.

  • Symptoms include pain and swelling.

  • The diagnosis is based on symptoms and an examination of the foot.

  • Orthoses and special shoes can help relieve pain.

Metatarsal joint pain is a common cause of pain in the ball of the foot (metatarsalgia).

Causes

Metatarsal joint pain commonly results from misalignment of the joint surfaces, which puts pressure on the joint lining and destroys cartilage in the joints.

Metatarsophalangeal joint misalignment can be caused by disorders, such as rheumatoid arthritis, that inflame the joints. In rheumatoid arthritis, hammer toes can develop, which can worsen joint pain and misalignment. Fat tissue, which helps cushion the joints when bearing weight, can be pushed forward under the toes, resulting in a loss of cushioning in the ball of the foot. This loss of cushioning normally occurs as many people age but makes people more susceptible to pain when the ball of the foot is stressed or injured repeatedly (for example, by running or by walking excessively). This loss of cushioning may lead to damage to the nerves of the foot and to the development of calluses and small bursae (fluid-filled sacs).

Metatarsophalangeal joint pain can also result from osteoarthritis or stiffening of the joints of the ball of the foot, often at the big toe joint. Most people with these disorders have an abnormal motion of the foot when bearing weight and walking.

Symptoms

Walking is painful. The skin over the joint may feel mildly warm to the touch, and swelling may be present. Over time, pain and stiffening can be disabling.

Diagnosis

  • A doctor's examination of the foot.

Doctors usually can diagnose metatarsal joint pain based on the person’s symptoms and an examination, but testing is done if an infection or arthritis is suspected.

Treatment

  • Orthoses

Orthoses (devices placed in the shoe) usually provide effective treatment for metatarsal joint pain. Shoes that have thicker soles than normal and rounded heels (called rocker sole modifications) also help reduce pressure and abnormal motion. Occasionally, when these measures are ineffective, surgery is needed.

* This is the Consumer Version. *