The symptoms of metatarsalgia include pain under the balls of the feet and swelling and inflammation at the heads of the metatarsal bones. (The metatarsal heads form the balls of our feet.)

Joint tissues, or capsules and ligaments, become increasingly painful during episodes of prolonged walking and weight bearing activities. Gradually and with repetition, fibrotic scar tissue can develop.

What causes metatarsalgia?

There are three different contributing causes of metatarsalgia:

  1. Wearing footwear with a concave surface under the metatarsal heads: In essence, this causes a drop of the heads of the second, third, and fourth metatarsals, significantly increasing the load they bear. The concave supportive surface of the footwear may be a result of footwear design or it may be caused by a breakdown or compression of its midsole or insole material due to long-term use.
  2. Long-term use of footwear or insoles that provide excessive cushioning: This causes the body to stop producing robust soft tissue padding under the metatarsal heads, which creates a highly sensitized area.
  3. Failure of the foot muscles to correctly align the bones of the feet into strong and dynamically adaptable arches: This leads to foot instability and torsional forces on the metatarsal bones.

These causes can present simultaneously and can worsen the severity of the symptoms and difficulty in eliminating the causes.

Excessive Foot movement

For proper function, our feet require the Right Stimulus and the Right Movement.

Right Stimulus consists of the subtle varied stimulus that the soles of our feet receive when we walk, especially when we walk barefoot on natural terrain. With each step, there are subtly different sensations.

These subtle differences in stimulus keep our brain on high alert so that our body’s protective reflexes function properly with optimal muscle function.

When our brain is uncertain about what will happen, it triggers protective reflex muscle activations that support our arches before our feet contact the ground to ensure that our feet and legs can safely manage the forces generated by the activity intensity of our bodies.

As activity-related stimulus intensifies, a progressively higher arch is created. That is why, when they are functioning properly, our arches and toes rise and fall dynamically in response to the varying activity stimulus intensities. This uninhibited dynamic movement is Right Movement.

Right Stimulus and Right Movement prevent the imbalanced muscle function that contributes to collapsing arches and the resulting torsional stresses on the metatarsals.

Right Stimulus
Toe Raise Beach

Conventional footwear impairs optimal foot function in two ways:

First, most conventional footwear dampens Right Stimulus.

This is particularly true for shoes or insoles that support or cushion our feet. They spread the forces evenly across the soles of our feet, creating sensory input that’s muted and repetitive, step after step. Within a short period of time, our brain tunes out the stimulus and stops responding to it.

As a result, our brain doesn’t sufficiently activate the muscles that stabilize our arches and properly align our feet, legs, hips, and lower back, before our feet contact the ground. This “tuned-out” brain response is natural and happens all the time. For example, the same thing happens when we walk into a room and first smell coffee that we no longer notice after only a few minutes.

Second, most conventional footwear, especially footwear that is tightly laced with snug toe boxes or stiff midsoles or outsoles, restricts the Right Movement dynamic raising of the arches and toes that is critical in the creation of a strong stable arch system and healthy linear propulsion with the toe off forces spread across the forefoot.

Right Movement is further impaired by footwear that incorporates a concave supporting surface under the metatarsal heads.

Impaired Right Stimulus and Right Movement increase the strain and damaging stresses on the metatarsals.

Conventional treatment methods for metatarsalgia include:

  • Supportive products such as orthotics
  • Cushioning
  • Ice

While these methods may temporarily alleviate symptoms, they don’t address the poor neuromuscular function that is the cause of the problem. In fact, the more we artificially support or cushion our feet, the weaker and the more dependent we become on these types of products.

These “old school” support and cushioning treatment methods are not recommended in any other area of musculoskeletal medicine as a viable long-term treatment option.

In fact, today’s modern treatment methods for poor neuromuscular function focus on increasing mobility, muscle strength, and proper alignment via Proper Technique exercise, which requires both Right Stimulus and Right Movement. Science has shown that simply challenging the body to “do its job” is the best way to restore and enhance function.

This principle is the foundation for virtually all of today’s sports training/rehabilitation programs.

Recommendations to address the poor neuromuscular function that causes metatarsalgia and prevent it from reoccurring:

  • Walking barefoot on natural terrain as much as possible. This provides the optimal Right Stimulus and allows for the Right Movement required for healthy neuromuscular function.
  • To attain Right Stimulus in your conventional footwear, use BioPods® Stimsoles® and, for best results, use them in loosely laced, soft, flexible footwear that allows your arches and toes to rise easily.
  • Consult with your healthcare practitioner to ask about employing soft tissue mobilization therapies to address the fibrotic scar tissue that may have formed, prior to using BioPods products.

Further, to prevent metatarsalgia:

  • Avoid using excessively cushioned footwear and insoles.
  • Wear footwear that has a flat supporting surface area under the metatarsal heads.
  • Check footwear regularly to ensure that the material under the forefoot area hasn’t compacted to form a concave supporting surface.