Can A Chiropractor Help Fix Metatarsalgia (Forefoot Pain)?
“Why does the ball of my foot hurt?”
At Ascent Chiropractic we see new patients with back pain, neck pain, headaches, and shoulder, knee and ankle injuries walk into our office literally every day. But then we’ll get a surge of some relatively uncommon condition. And due to the dramatic change in seasons and everyone subsequently breaking out their summer footwear, we’re suddenly seeing a lot of patients coming through our doors with metatarsalgia – or pain in the ball of the foot.
90% of the time metatarsalgia is caused by faulty foot biomechanics, where the ligaments and connective tissue that are supposed to be supporting your metatarsal arch aren’t doing their job. Pain in the ball of the foot can also be caused by conditions such as stress fractures or a Morton’s neuroma – a benign but painful condition that happens when the tissue around a nerve that leads to a toe thickens from irritation or compression. But in the majority of cases it’s the integrity of your metatarsal arch that’s to blame for forefoot pain. Which is good news, because that’s fixable.
Now not all foot problems need treatment. Sometimes your feet simply ache after a long day of standing or an intense workout. But if your foot pain doesn’t go away in a day or so, it’s best not to ignore it – schedule an appointment at Ascent to see what’s actually causing the problem.
The 3 Arches of Your Foot
Our feet are the foundation for our bodies, including the pelvis and spine: they provide balance, propel us, absorb impact and adapt to walking stresses. The feet provide the necessary stability to perform daily activities and are reliant upon a structure comprised of 3 bony arches: the medial longitudinal arch, the lateral longitudinal arch and the anterior transverse (or metatarsal) arch.
Each arch consists of several bones bound together by tough, elastic ligaments. These strong connective tissues ensure that the arches are flexible and movable, yet able to tolerate both sustained stress and sudden, high forces. Together, these 3 arches form an extremely strong, supportive ‘plantar vault’ that distributes the weight of the entire body.
The structural design of a 3-arched plantar vault is very good at supporting weight and carrying high loads, while remaining flexible. During normal standing the load of the body is balanced over the center of the foot, in front of the ankle. This places the greatest amount of load at the apex of the 3 arches. This force is then distributed along the ‘buttresses’ of the arches to the heel (which bears 50%-60% of body weight) and the metatarsal heads (which bear 40%-50% of body weight).
If any one of these 3 arches is compromised, the entire plantar vault loses its structural integrity. Metatarsal arch problems specifically will develop when the transverse ligaments are put under excessive stress – either from high loads for sudden, brief periods, or from more moderate but repetitive stresses over longer periods.
So what am I doing that’s causing the problem?
Repetitive activities, like running, hiking and cycling, directly expose the metatarsal arch to constant impact. High-heeled shoes also stress the transverse ligaments, because a raised heel channels the majority of pressure from walking directly into the metatarsal arch. And being overweight can overload the transverse ligaments and affect your gait. But whatever the cause, the bottom line is that metatarsalgia is usually due to chronic over-stretching of these supportive ligaments and the resulting collapse of the metatarsal arch.
There’s two stages to fixing metatarsalgia: 1.) relief of the acute pain and inflammation, and 2.) long-term correction of the problem.
So to start, put a hold on any activities that aggravate the pain, at least temporarily. Avoid shoes with a tight toe and/or forefoot region (or adjust the lacing pattern), and shelve any heels that are higher than 1½ inches.
Most of my patients with metatarsalgia find that using a Pro-Tec metatarsal drop pad on their insoles just behind the metatarsal heads helps reduce weight-bearing pressure on the inflamed joints. These two tips, plus NSAID pain relievers and topical ice as needed, are usually enough for short-term relief until you can get in to see a professional.
But to truly fix the problem long-term, we need to correct the positioning of the metatarsals and allow the transverse ligament to heal. Unfortunately, that’s not usually something you can DIY.
For most patients, we’ll start with Graston Technique® – a form of instrument-assisted soft tissue mobilization (also known as scraping) – to break up scar tissue and fascial adhesions and encourage the healing process.
After we’ve got the soft tissue pliable enough to work with, we’ll adjust the metatarsal heads that are “dropped” back to their correct arched position. Patients with metatarsalgia often have other joints in the foot that aren’t working properly as well, so the entire foot really needs to be evaluated.
Next we’ll use RockTape to support the metatarsal arch and transverse ligament in their corrected position. While taping is only temporary, it lets the ligaments and tendons in the foot to adapt to their new position instead of just allowing the metatarsal arch to collapse again. It’s a re-education process; we’re trying to keep the metatarsals in their correct position long enough for the soft tissues to get used to a new normal.
Finally, once we’ve achieved stability of the foot biomechanics, most patients will need custom stabilizing orthotics to provide long-term support for the transverse arch. Flexible orthotics are the most beneficial, especially for people who must be on their feet for many hours each day. Orthotics should be custom-built to support to all three arches of the foot individually, as well as provide cushioning and shock absorption.
At Ascent Chiropractic we use Foot Levelers because their foot scanning technology is leaps and bounds more advanced than the methods used by literally every other orthotic company on the market. The better the scan, the better the orthotic fits your foot – which translates to less stress on the metatarsal arch.
The Ascent Chiropractic Difference
There’s a reason so many patients choose us – we’re experts in the biomechanics of everything from your head to your toes. So if you’ve been self-diagnosing, living in the pharmacy aisle, or dismissed by doctors who aren’t interested in actually figuring out what the problem is, it’s time to get the answers you deserve. Ready to get started? Make an appointment at Ascent Chiropractic by calling 262-345-4166 or using our online scheduling app.