Metatarsalgia (Capsulitis) is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, 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 (ball-of-foot-pain) is often located under the 2nd, 3rd, and 4th metatarsal heads. These joints have a capsule around them to hold in the joint fluid and lubricate the joint for motion. Excessive pressure to the joint can cause inflammation of the joint and capsule. The patient usually relates pain at the joint itself, and states that it sometimes feels like their "sock is bunched up" or it feels like their standing on a "pea".

Cause.
With this condition one or more of the metatarsal heads become painful and/or inflamed, usually due to excessive pressure over a long period of time. It is common to experience acute, recurrent, or chronic pain with this common foot condition. Ball-of-foot pain is often caused from improper fitting footwear, most frequently in women’s dress shoes and other restrictive footwear. Footwear with a narrow toe box (toe area) causes the ball-of-foot area to be forced into a minimal amount of space. This can inhibit the walking process and lead to extreme discomfort in the forefoot. Other factors can cause excessive pressure in the ball-of-foot area that can result in metatarsalgia. These include shoes with heels that are too high or participating in high impact activities without proper footwear and/or orthotics. Also as we get older, the fat pad in our foot tends to thin out, making us much more susceptible to pain in the ball-of-the-foot. Often times, the second metatarsal may be much longer than the others, resulting in excessive pressure on the joint as well.

Treatment and Prevention.
The first step in treating metatarsalgia is to determine the cause of the pain. If improper fitting footwear is the cause of the pain, the footwear must be changed. Footwear designed with a high, wide toe box (toe area) and a rocker sole are 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 footcare products. Orthotics designed to relieve ball-of-foot pain usually feature a metatarsal pad. The orthotic is constructed with the pad placed behind the ball-of-the-foot to relieve pressure, and redistribute weight from the painful area to more tolerant areas. Other products often recommended include gel metatarsal cushions and metatarsal bandages. When these products are used with proper footwear, you should experience significant relief.

Sometimes off-loading of the joint does not eliminate the pain. Surgery may be necessary to alleviate the excessive pressures on the joint. The doctors at Capital Foot & Ankle Centers are well-trained in surgery to correct metatarsalgia.