The forefoot absorbs as much as 110 tons of cumulative force per mile during running, which makes your metatarsals, the five long bones that run from your arch to your toes, one impressive set of shock absorbers. When you push off the ground, your body weight is transferred to your metatarsals. If the weight distribution across the foot is uneven when it hits the road (because of your foot's mechanics, a tight Achilles tendon, or calluses), the metatarsals can become irritated and inflamed, resulting in metatarsalgia, according to John Cianca, M.D., associate professor of physical medicine and rehabilitation at Baylor College of Medicine in Houston.
If you develop metatarsalgia, you'll feel a burning, stabbing, or aching pain at the "head" of the bone, just beneath the toes. It usually affects the second toe, and often the third or fourth. "People complain that it feels like there's a stone in their shoe," says Dr. Cianca. It's worse when you stand, walk, or run, and better when you take a load off (especially if you're at all overweight). It's an equal-opportunity injury, affecting the flat-footed, the high-arched, and all soles in between. Symptoms can occur suddenly: after running barefoot on the beach, walking on a hard tile floor, or sprinting on pavement in worn-out shoes. But it usually builds over a few months.
Preventing metatarsalgia is often as simple as wearing the right shoes. If you have a flat or neutral foot, look for a shoe with a wide toebox and a dome-shaped metatarsal pad, which protects the metatarsals from pounding. Runners with high arches may benefit from a shock-absorbing insole that provides a platform for the foot and extra cushioning that deflects pressure from the bones. Visit a running specialty store for help outfitting your foot.
Improving your own support system doesn't hurt, either. Strengthening the bottom of the foot prevents it from flattening excessively, which protects the metatarsals from impact. Strengthening the "plantar sling" muscles, which run on either side of the calf, helps control overpronation, one of the most common causes of metatarsalgia. (See below for exercises that accomplish both.)
If you develop metatarsalgia, give your feet a break. Reduce your mileage, run on softer surfaces, or temporarily switch to a low-impact activity. Treat acute symptoms with ice during the first 24 hours and take anti-inflammatories as needed. See your doctor or a podiatrist if your symptoms don't improve in 10 days. You may need a callus shaved, a different insert or metatarsal pad, or orthotics. "Metatarsalgia can lead to joint swelling, bone bruising, chronic stiffness, and lost range of motion," warns Dr. Cianca. "So it's best to start treatment sooner than later."
Exercises that will help prevent metatarsalgia
Plantar Sling Strengthener:
Anchor an exercise band tied in a loop to a desk leg. Place the arch of your right foot in the loop. Working against resistance, pull the band away from your center 10 times. Replace your right foot with your left, and pull toward your center. Turn around, face the opposite direction, and repeat: left foot pulls away, right foot pulls in. Progress to 30 reps per side.
Arch strengtheners:
[A] Pick up a marble with your toes, hold for a count of five, and release. Start at the big toe and repeat, working your way down to the little toe. Repeat three times.
[B] Place a washcloth on a smooth surface and scrunch it up with your toes. Hold for a count of five, then release. Repeat 10 to 15 times.
