To all of you with metatarsalgia, in the words of a famous campaigner, I feel your pain. Earlier this month I made the mistake of walking several miles in badly cushioned dress shoes (don’t ask, but it was at a foot surgery seminar in Las Vegas) resulting in significant pain on the ball of my foot.

The word metatarsalgia has come to refer to pain on the ball of the foot, usually behind the second toe. Sometimes, as with mine, it is accompanied with swelling and a feeling of a painful lump. It was so bad that I felt I must have developed a stress fracture. At an ultrasound workshop later in the seminar week, I looked at the joint and saw that I actually tore the joint capsule of the joint where my toe meets the foot. It is the one next to the bunion joint, for you amateur anatomists.

Now for the anatomy lesson. All of our joints, whether knee, hip, elbow or our metatarsophalangeal joints, are held together by strong fibery adhesions called a joint capsule. The inside lining of the capsule contains cells that produce lubricating joint fluid. The fluid is called synovial fluid, and the cells that produce the fluid are synovial cells. When a joint is injured the synovial cells often multiply, forming a visible swelling. It is meant to be some kind of protective action, but the actual result is pain, especially if you happen to walk on it.

This is a very common injury. It is nearly always caused by too much pressure on the area in too short a time (by definition, an overuse injury). Aggravating factors are shoes with too little cushion for the activities being done; working or playing on a hard, unforgiving floor surface; weight; and maturity, because the natural fat pad on the bottom of the foot thins with age. We rarely see this injury in young, lean adults who wear athletic shoes for working out. Overweight people age 50 and up who wear high-heeled shoes are a prime target.

Anatomically long second metatarsals, a bunion joint that shirks its weight-bearing duty and a tight Achilles’ tendon can also be contributing factors. Hammertoes, if present, place backward pressure on the ball of the foot, and a damaged ball of the foot can contribute to the metatarsalgia in a devilish feedback loop.

Without doubt the best first aid for this common condition is to use a cushioned shoe, like an athletic trainer, 100 percent of the time for a few weeks. Anti-inflammatories can be helpful, but cushioning the foot is chief. If the pain is significant or if it lasts more than a few weeks, you should see a foot doctor. If this condition persists for a long time the deformity can cause the second toe to move up away from the floor and, frequently, to be too friendly with the big toe, sometimes even crossing over it.

After we X-ray the foot to see the quality and alignment of the toe, we will examine the joint capsule, sometimes with the ultrasound, to see if it is intact. We will also make sure you don’t have the always confusing neuroma (swollen nerve) or other causes of ball-of-the foot pain.

For treatment, we can use oral and injected anti-inflammatory medications to reduce the swelling and pain. We will certainly do something to take weight off the painful metatarsal, either with pads, shoe modification or orthotics. A well-made orthotic can do wonders to reduce the swelling of this joint both for the acute condition and to prevent long-term damage.

We can make devices that fit in dress shoes, although you and your doctor will likely have a “come-to-the-deity” moment when discussing higher heeled shoes.

When the joint and toe go all haywire, we have surgical solutions for this condition, too, but they often do not work out as well as we both want.

This is a case where prevention is many times more effective than a surgical cure, so don’t ignore metatarsalgia. And remember the shoes. If you ever have to walk a mile in someone’s shoes, even your own, make sure they are well padded.

Dr. Michael Zapf, along with his associates Drs. Darren Payne and Steve Benson, are board certified podiatrists with offices in Agoura Hills and Thousand Oaks. For more information, call their office at (818) 707-3668 or visit www.conejofeet.com.