Text by Rod Cedaro (M. App. Sc.) Consultant Exercise Physiologist ACC Accredited Level III Triathlon Coach (DUNCAN)

The human foot is a remarkable piece of engineering design. It is a shock-absorber like no other. When you consider, even running at a moderate pace a 70 kilogram athlete will put something in the vicinity of 126,000 kilograms through each foot every kilometre they run, it really puts things into perspective as to why the foot is vulnerable to injury if something goes astray.

With each stride, the five long bones that run from your arch to your toes, your metatarsals, act as shock-absorbers. As you toe off when running, your body weight is transferred directly onto your metatarsals. If that resultant weight distribution is uneven when it hits the road for whatever reason (e.g. Poor shoe mechanics, tight calves, etc.), the metatarsals can become irritated and inflamed, resulting in the dreaded “metatarsalgia”.

Rod Cedaro metatarsalgia

Many people describe this irritation as feeling like a burning, stabbing, or aching pain at the “head” of the bone, just beneath the toes. Some describe it like feeling that they have a stone stuck in their shoe. It is generally worse on standing, walking and especially running and subsides when you sit or lie and take the load off the region. While the ailment can come on abruptly after working on hard surfaces and running hard in poorly cushioned shoes, it tends to develop over time and effects all foot types equally.

How do you go about preventing metatarsalgia? The answer is often as simple as appropriate shoe choice. Athletes with neutral to flat feet should look for shoes with a wide toe-box and a dome-shaped metatarsal pad, these will protect the metatarsal heads from pounding. If on the other hand you have high arches – which is a foot type known for poor shoe absorption, you may benefit from a shoe that provides extra cushioning that deflects pressure from the bones. While shoes play a considerable roll in lowering the incidence of this ailment, improving your own foot mechanics won’t go astray either! Strengthening the sole of the foot helps to prevent it from flattening, which protects the metatarsals from impact. Strengthening through the plantar muscles will help to control excessive over-pronation which is one of the major causes of metatarsalgia. Try some of the following exercises:

[i] Pick up a marble with your toes, hold for a count of five, and release. Start at the big toe and repeat, working your way down to the little toe. Repeat three times.

[ii] Screw up sheets of newspaper with your toes, hold the movement at the end of the paper screwing for 10 seconds and repeat 10-15 times. If you do develop metatarsalgia, initially give your feet a break – it is an “overuse” injury – so stop the use, comeback to training initially with lowered volume and run on softer surfaces like a golf course to lessen the impact shock. If you do experience pain in the front part of the ball of your foot, get on to it early! Treat such symptoms aggressively with the “RICE” principal (rest, elevation, ice and compression) during the first 24 hours and take anti-inflammatories if need be.

Then see a sports physician if need be and/or a podiatrist if your symptoms persist. At that point you may need to have a callus shaved, a metatarsal pad inserted or appropriate orthotics designed. Untreated this syndrome can become chronic and debilitating leading to joint swelling, bone bruising, chronic stiffness and loss of joint range which can create a vicious cycle. As per any ailment, an ounce of prevention is worth a ton of treatment.

 Rod Cedaro