Metatarsalgia

Pain underneath the ball of the foot can be due to a variety of causes, one of these is due to excess pressure from the heads of the metatarsal bones. This can also lead to painful callus (corns) underneath the ball of the foot. Patients often describe “walking on a marble”. It can be worse with frequent wearing of high-heel shoes, being overweight and some neurological conditions such as Morton’s neuroma.

Figure 1: painful corns (callus) due to metatarsalgia

This often coexists with other foot conditions such as bunions or hallux rigidus. Some of the risk factors include: long metatarsal bones (relative to the big toe) and tightness in the calf muscles.

Figure 2: Long second-fourth metatarsals relative to the first metatarsal

Treatment options:

Non operative treatment

  • Modification of shoes including

    • insoles with cutouts to make room for the metatarsal bones

    • dome inserts to take pressure off the painful joints

  • Injections

Operative treatment

  • The primary goal is to relieve the excess pressure on the metatarsal heads

Figure 3: foot anatomy showing painful 2nd metatarsal head

Surgeries performed for metatarsalgia include:

  • Gastrocnemius recession (calf muscle release)

  • Bony corrections (osteotomies)

    • Minimally invasive (DMMO)

    • Open (Weil osteotomy)

These are often performed in conjunction with other foot procedures.