Foot Pain - Metatarsalgia

Dr. David Erman has helped many patients from and around the East Windsor area who suffer from Foot Pain and Metatarsalgia. These conditions may be caused by underlying medical and physical problems which can lead to mobility issues. Call or schedule a consultation online today for effective care.

Foot Pain Q&A

Q: What causes foot pain?

A: The foot is a complex anatomical structure made up of many joints, ligaments, tendons, and sensitive nerve endings. There are many different diseases, deformities, biomechanical conditions, or injuries that can cause foot pain. But some of the most common complaints about foot pain include:

  • Plantar fasciitis — inflammation of the ligament that runs along the sole of your foot. Because the ligament attaches to the bottom of your heel bone, pain is often felt in your heel as well.
  • Bunions – an inherited condition in which your metatarsal bones are displaced, causing a “bump” at the base of your big toe.
  • Hammertoe - a bending of either one or both joints affecting the second, third, fourth, or little toe.

Q: Does arthritis affect the feet?

A: Arthritis can be a main concern for foot pain, particularly if the patient is diabetic. Many types of arthritis can that affect the joints, muscles, or bones in the feet. This can result in pain, stiffness, and swelling. Some possible arthritis-related problems that affect the feet include:

  • Osteoarthritis - a chronic condition characterized by the breakdown of the cartilage that cushions the ends of the bones where they meet to form joints. In the foot, osteoarthritis most commonly affects the big toe, but it can also affect the midfoot.
  • Rheumatoid arthritis - a chronic inflammatory disease, resulting in joint damage, pain, swelling, inflammation, loss of function and disability. Rheumatoid arthritis commonly affects the small joints of the feet, often causing symptoms in several joints of both feet. This can lead to the development of corns and bunions and the curling and stiffening of the toes into positions such as claw toe or hammer toe. 
  • Gout - a form of arthritis causing excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury.

Q: How is foot pain treated?

A: The first step in treating foot pain is to visit Dr. Erman for a proper evaluation. Dr. Erman has studied the latest technology to deliver optimum service to each patient. Once the underlying cause of your foot pain is diagnosed a treatment plan can be developed to focus on your specific needs.

Metatarsalgia Q & A

Q: What is metatarsalgia?

A: Metatarsalgia is a general term used to describe pain and inflammation in the metatarsal region of the foot, more commonly referred to as the ball-of-the-foot. This is a common foot disorder that can affect the bones and joints at the ball-of-the-foot. Metatarsalgia is often located under the 2nd, 3rd, and 4th metatarsal heads - the rounded ends of the bones that connect to your toe bones, or more isolated at the first metatarsal head near the great toe joint.

Q: What causes metatarsalgia? 

A: Most metatarsal problems develop when something changes in the way one’s foot normally works (mechanics), affecting how one’s weight is distributed. This can put excess pressure on the metatarsals, leading to inflammation and pain, especially in the metatarsal heads.

Sometimes a single factor can lead to metatarsalgia. More often, several factors are involved, including:

  • Intense training or activity: Runners are at risk of metatarsalgia, primarily because the front of your foot absorbs significant force when you run. The first and second metatarsal bones take the brunt of this force. This condition commonly occurs when performing high impact activities especially if one’s shoes are ill fitting or are worn out.
  • Certain 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.
  • Bunion: A bunion can weaken one’s great toe, which may have an effect on the way pressure and weight is distributed across the foot and metatarsal region. Bunion surgery can also lead to metatarsalgia if you don't rest long enough for your foot to heal completely.
  • Hammertoe: This foot condition can develop when high heels or too-small shoes prevent one’s toes from lying flat. As a result, one toe — usually the second — curls downward because of a bend in the middle toe joint. This contraction depresses the metatarsal heads.
  • Excess weight: Because most of one’s body weight transfers to one’s forefoot when moving, extra pounds mean more pressure on one’s metatarsals. Losing weight may reduce or eliminate symptoms of metatarsalgia.
  • Poorly fitting shoes: High heels, which transfer extra weight to the front of one’s foot, are a common cause 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 one put weight on his/her foot.
  • Morton's neuroma: This inflammation of nerve usually occurring between the third and fourth metatarsal heads, 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 one’s toes. It can also develop after high-impact activities such as jogging and aerobics. 

Q: What are the treatments and preventative measures for metatarsalgia?

A: Dr. Erman treats his patients with non-surgical treatments to alleviate symptoms of pain and inflammation. Conservative measures usually relieve the pain of metatarsalgia in the majority of our patients. Initial treatment first consists of determining the cause of the pain. An x-ray of one’s foot will be taken to determine any abnormal position of one or more metatarsals or to rule out a stress fracture or other foot problem. 

If improper fitting footwear is the culprit, the footwear must be changed. Footwear designed with a high, wide toe box and a rocker sole is ideal for treating metatarsalgia. The high, wide toe box allows the foot to spread out while the rocker sole reduces stress on the ball-of-the-foot. Unloading pressure to the ball-of-the-foot can be accomplished with a variety of foot care products including Orthotics designed to relieve ball-of-foot pain usually feature a metatarsal pad. 

Dr. Erman uses cutting edge technology to construct our custom orthotic devices. Many of our orthotics are constructed from a gait scan analysis while you are walking. Using this technology, we can visualize on a computer where you a placing too much pressure on your feet and we can make a custom orthotic to relieve the pressure and redistribute weight from the painful areas of your feet. Depending on the need, orthotics will be rigid or flexible and may include metatarsal pads to offload the metatarsal heads. 


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