Metatarsalgia: The Weight in Your Toes

Remember back to the good old days of summer where it was brutally hot? Working in the kitchens is like moving around outdoors in the direct sunlight. It’s sweltering hot. It’s a scorcher. And it is never-ending. The inner bowels of the kitchen with all of the ovens on type of hot. You are on your feet all day and that is a lot of pressure on a small area. Combine that with closed toe rubber soled shoes, your inner core temperature at an all-time high, the ambient temperature above 90 and you’ve got a nice combination of factors waiting for fluid to pool in the feet and for your foot bones to get really sore.

If you’re a woman, you might also like to wear shoes that force even more pressure and weight onto the front of the foot. This area is called the ball of your foot and bears the weight of your entire body plus gravity. It is a mobile area with 5 bones that have bulbous endings that can dissipate weight-bearing forces. The joints are also mobile enough so that your toes remain in an extended (backward bent) position and can bend even further in order to propel yourself forward during walking. A combination of stability and mobility that allow you to move from station to station.

Welcome to metatarsalgia. A painful and inflammatory condition of the ball of the foot that is caused by ill-fitting shoes, shoes that force the weight of your body into the ball of the foot, or repetitive activities that involve pressure in the front of the foot eg running the stairs on the toes. Additional causes can be excess weight, tight calves, high arches, tight toe flexors, weak toe extensors and hammertoe deformities. It is an injury that many people associate with women wearing heels but it can occur in anyone who spends a lot of time on their feet.

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Symptoms of metatarsalgia include pain and inflammation under the ball of the foot, worst with any toe-off or push-off of your foot. Pain can be described as sharp, aching, burning or shooting. Pain can come on gradually but can also occur suddenly and is exacerbated by any weight bearing activities.

Evaluation by your healthcare practitioner will involve a subjective and physical exam to find out when the pain occurred and how. Your physical therapist will perform a detailed evaluation and start treatment immediately. If any additional tests are required, your physical therapist will refer you to a podiatrist. These tests include xrays to rule out bone breaks and ultrasound to help diagnose additional soft tissue injuries in the foot.

Physical therapy helps to educate you to avoid aggravating activities, positions and footwear. Treatment includes rest and ice with use of a pressure bandage initially. Modalities such as ultrasound, soft tissue mobilization, and gentle joint mobilizations can help reduce pain, swelling and inflammation. Stretching and strengthening activities are reintroduced carefully once the area has stabilized and pain has reduced. Additional components of your treatment include well supportive shoes which can help during the healing process.
The balls of your feet do a lot of work. They are necessary for propulsion during gait and to support our weight if we decide to wear high heels (to all my female colleagues). Occasional proactive massages help to keep the foot muscles loose and reduce tension that can build up in the lower leg and foot. So remember to treat the little body parts with care.  You need good and healthy feet the second you swing your legs out of bed to get you dressed and ready for your upcoming shift.

Karena Wu is owner and Clinical Director of ActiveCare Physical Therapy. She is a native of Los Angeles, California and has a Bachelor of Science in Biology from the University of California at Riverside. She has been practicing Physical Therapy for 15 years in New York City after she graduated from the Program In Physical Therapy at Columbia University. She has advanced training in manual therapies, specifically in Maitland Joint Mobilization and Myofascial Release. Karena is certified as a Strength and Conditioning Specialist, Kinesiology Tape Practitioner and Pilates Instructor. She is also LSVT BIG, FMS and SFMA Level 1 Certified.  Karena is used as a healthcare expert on CBS, NBC, NY1, PIX11, Verizon Fios, Fox News and Dr. Oz. She is the Director of Education for SpiderTech Kinesiology Tape and is on the Medical Board of the Association of Volleyball Professionals.

To learn more about ActiveCare Physical Therapy, please visit or call 212.777.4374.