Pain in the metatarsus is often caused by injuries, malpositioning of the feet or overloading. Depending on the cause, the therapy of the complaints varies greatly. The type of pain and its exact localization can provide information about the underlying cause. Possible causes are listed below.
Pain midfoot, external
Pain in the metatarsus can preferably occur on the outside of the metatarsus, i.e. in the area of the outer metatarsal bones (Ossa metatarsalis). This is the case, for example, when a patient bends the foot outwards. Especially women who walk on higher heels are at risk of having their feet bent outwards.
This can not only lead to torn ligaments in the area of the ankle joint but also to pain in the outer metatarsus. These are either due to the fact that the bone is compressed or that there is a bruise or small torn ligament of the ligaments of the metatarsal bones. In rare cases, a fracture may also occur, which then leads to severe pain in the outer metatarsus.
The fracture can either be caused by a hard blow to the metatarsal bones or a fatigue fracture caused by too much strain, i.e. a fracture that is caused by permanent overstraining of the metatarsal bones. In this case, the pain in the outer metatarsus is not quite as great as in a “real” fracture caused by external trauma. However, both fractures should be splinted or operated on, depending on their severity.
Inner metatarsal pain
Pain in the area of the inner metatarsus can have many different causes. For one thing, it can simply be that the patient has bumped his foot and now there is pain in the area of the inner metatarsus. Pain in the area of the inner metatarsus is particularly common in women, as many women suffer from the so-called hallux valgus, a deviation of the inner first metatarsal bone, which then leads to a large bony elevation in front of the first big toe and thus causes the big toe to be crooked.
If patients wear shoes that are too tight or heels that are too high, they may press on the bone head of the first metatarsal and cause bruising, which the patient experiences as unpleasant pain in the inner metatarsus. It is therefore important that patients suffering from hallux valgus wear suitable footwear to avoid pain in the inner metatarsus. However, the pain in the inner metatarsus can also be caused by a sprain or bruise.
Mostly the foot swells a little bit in the affected area and is sensitive to pressure. In addition, the bones of the metatarsus can either break due to external force or due to a fatigue fracture, i.e. a fracture caused by prolonged overloading. In addition, there is a very rare disease which also causes severe pain in the inner metatarsus.
In very rare cases, this can lead to a bone infarction of the metatarsal bone. Mostly the first metatarsal bone is affected, i.e. the innermost one, which is why the pain mainly occurs in the inner metatarsal area. This bone infarction is accompanied by the death of the metatarsal bone.
This process is known as aseptic bone necrosis or, according to its discoverer, Köhler-Freiberg’s disease. The slow destruction of the bone initially leads to an inflammatory reaction, so the patient notices a swelling in addition to the pain in the inner metatarsus. The cause is still unknown today, but it is assumed that wearing high shoes and overloading the foot promote bone infarction.
In general, however, the disease is considered very rare and should therefore not be considered first. If there is pain in the area of the metatarsus when running, this may initially be due to overloading. Especially athletes who have previously done less sport and now want to take off, often overload their feet.
This can lead to bruises, small torn ligaments or bruises that cause pain in the midfoot when running because they are then exposed to greater stress. The wrong footwear can also lead to sometimes severe pain in the metatarsus when running. If the shoes put too much strain on the metatarsal bones, they can cause pain. You should therefore make sure you choose the right sports shoes so that they fit the foot and do not cause pain when running.In rare cases, the pain when running can be caused by a fatigue fracture, which is caused by overloading the metatarsal bones. In most cases, the affected areas are also swollen and the pain in the metatarsus gets worse and worse while running, so the patient should see a doctor to have the foot examined.