Forefoot Pain (Metatarsalgia) and Lesser toe deformities


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At a Glance

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What is metatarsalgia? 

Metatarsalgia is pain in the ball of the foot. It is usually felt in the sole of the foot and sometimes feels like "walking on pebbles". Other people feel a more diffuse vague pain, ache or burning. Some people have trouble around only one or two toes, others have it throughout one or both feet.

  • It is most commonly found in people who:
  • Have a bunion or arthritis in the big toe since this can weaken the big toe and throw extra stress onto the ball of the foot.
  • Have had an operation on the big toe, such as a bunion correction.
  • Are overweight.
  • Wear high-heeled shoes.
  • Have certain foot shapes such as a high-arched "cavus" foot in which the bones in the front of the foot (metatarsals) point down into the sole to an excessive extent.
  • Have a longer than normal metatarsal bone which takes extra pressure.
  • Have clawed or hammer toes which press the metatarsals down towards the ground.
  • Have a stiff ankle which cannot be drawn up to right angles with the leg but points the foot down to the ground.

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How can I improve the pain from metatarsalgia? 

Many cases of metatarsalgia just happen and cannot be prevented. But if you are affected, try to take the pressure off your feet as far as possible and:

  • Rest with your feet up after periods of standing or walking.
  • Keep your weight at the right level for your height and build.
  • Wear comfortable shoes with a small heel and plenty of room for your feet.
  • Exercise your ankle and stretch your Achilles tendon.
  • Take simple pain-killers.
  • Use a metatarsal insole or pad bought from a pharmacist or shop.

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What are lesser toe deformities? 

The toes which are not your big toes are known as the lesser toes. They become deformed when more pressure is exerted on them than their joints can resist. When the muscles that control the toes become unbalanced, so that one set pulls harder than others, this causes the toes to bend further. In some people the tissues in the lower part of the joint at the base of the toe (metatarso-phalangeal joint) becomes weak, allowing the base of the toe to drift upwards which further unbalances it.

The deformity that results depends upon which joints are affected and the toe may either be called a:

  • Hammer toe.
  • Claw toe.
  • Mallet toe.

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What problems to lesser toe deformities cause? 

The main problem is that they tend to rub on shoes, either on top of the toe or at the tip, or both. This rubbing may simply be uncomfortable, or the skin may be rubbed raw. If the MTP joint is bent upwards, particularly if it is stiff, the toe may press down and cause pain in the ball of the foot. This is known as metatarsalgia which was previously discussed overleaf.

Bent toes may also rub on one another or on the big toe, especially if the big toe is bent towards the second toe (hallux valgus or bunion).

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What can I do about the lesser toe deformities? 

The simplest thing to do is buy shoes which have enough room in the toe area for your toes to fit comfortably. High heels should be avoided since they tend to force the toes down into the tip of the shoe. Small pads on the top or end of the toe may improve the discomfort.

If your toes are interfering with your daily activities and the problem is not helped by the simple measures outlined above, it may be best to have an operation to straighten the toes. Your GP can refer you to an orthopaedic foot and ankle surgeon who will listen to your problems and examine you. Depending on the shape of your toes and how stiff they are, they will advise you on the best method for straightening your toes which may include:

  • Freeing up the joints.
  • Transferring one of the tendons which curl your toes to the top of the toe.
  • Removing bone from one or more joints and then possibly fusing the joint straight.

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Is surgery for lesser toe deformities successful? 

Over 90% of toe operations correct the problem for which they were done. However a number of problems can occur:

  • Recurrence of the deformity.
  • The toe may be swollen for several months, or in a few cases permanently
  • Stretching of the nerve in the toe can cause tingling, numbness or over-sensitivity in the toe - this usually gets better after a few weeks, but can be permanent.

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