Malpositions
Various defective positions of the foot bones can be the cause of pain in the metatarsus. Women in particular often suffer from hallux valgus, a deviation of the first metatarsal bone, which connects the tarsal and big toe. Surgery is rarely necessary, but in order to prevent pain, the choice of the right footwear (in no case too small, pointed or high shoes) is of great importance. The most common form of hallux valgus is a splayfoot, but all other foot malpositions (flat foot, hollow foot, flat foot, flat foot, buckling foot) can lead to pain in the metatarsus due to a change in the pressure load on the foot and the subsequent irritation of nerves, tendons and ligaments. In many cases, orthopedically prescribed insoles and suitable footwear can provide relief.
Joint diseases
Morton’s neuralgia (neuralgia = nerve pain) or Morton’s neuroma usually affects people with splayfoot and occurs most frequently between the third and fourth metatarsal. The splayfoot position causes compression of the nerves running between the metatarsals, which reactively thicken and rebuild connective tissue (proliferation of nerve tissue = neuroma). This manifests itself as suddenly shooting nerve pain in the metatarsus.
Morton’s neuralgia is first diagnosed by ultrasound and then by MRI of the foot. Often it is sufficient as therapy to correct the splayfoot malposition in order to relieve the compressed nerves. If this therapeutic approach is not successful, the neuromuscular mass can be surgically removed, whereby the aim should be to preserve the nerve.
Pain in the middle foot when running
If pain in the metatarsal region occurs more frequently during walking, this can be a sign of overloading of the structures in the form of minor ligament tears, compression or even fatigue fracture in the metatarsus. This is often observed especially in people who have only recently started jogging, for example, and can be a sign that one has demanded too much of oneself too quickly. Wrong footwear can also cause considerable pain if the pressure and impact forces are distributed unfavorably over the foot.
Especially when the load during running increases rapidly or the running volume is very high, e.g. during marathon preparation, one must also think of a fatigue fracture of the metatarsus. We have written a special topic for this: Fatigue fracture of the metatarsus Pain on the back of the foot can also be caused by running. Stinging pain is often observed in combination with swelling and redness on the back of the foot. You can find out the cause and treatment options under this topic: Pain on the back of the foot