Running: Metatarsalgia

By Dr. Donald A. Ozello DC

Las Vegas Informer

Learn and implement intelligent running strategies to prevent the occurrence of overuse injuries and to recovery faster from an injury. Running is a repetitive weight bearing form of exercise which places a large demand on the feet. Overuse injuries in the feet are common among runners.

Metatarsalgia is a running injury with a high incident rate. Metatarsalgia is pain and inflammation located on the bottom of the foot near the toes. It is common in activities which require repetitive impact. Utilize sound training principles to combat the performance limiting condition known as metatarsalgia.

Anatomy: The metatarsal bones are located in the forefoot. Five metatarsal bones exist in each foot, connecting the toes to the midfoot. The metatarsal bones are numbered one through five from big toe to small toe. The heads of the metatarsal bones are at the ends of the bones closest to the toes. The transverse arch of the foot runs from the head of the first metatarsal to the head of the fifth metatarsal.

Symptoms: Pain is located on the bottom of the foot directly underneath the head of a metatarsal bone. Most commonly at either the second, third or fourth metatarsal head.

In most cases, the symptoms begin in an insidious manner. The pain is usually described as sharp, stabbing, burning, achy pain. Patients commonly state, “It feels like a pebble jabbing into my foot.” Symptoms are aggravated by walking, standing, jumping and running, especially sprinting. Rest and taking weight off the foot usually decreases the symptoms.

Intrinsic Sources: Several anatomical and biomechanical sources are precursors to metatarsalgia including: Collapsed transverse arch, overpronation, poor foot biomechanics, subluxated foot bones and weak foot muscles, especially the toe flexors.

Extrinsic Sources: Metatarsalgia is an overuse injury. Too much training combined with inadequate rest between runs is the foremost extrinsic source of pain. Other sources include improper foot wear, limited warm-up, insufficient cool down and lack of cross training.

Prevention: Metatarsalgia is preventable and manageable with smart training practices. Develop a training schedule that contains intensity increases in small increments, rest days and cross training.

Wear proper fitting and supporting shoes. Utilize custom fit orthotics if needed. Perform a thorough warm-up to prepare your body for activity. Execute a quality cool down that includes dynamic and static stretches to decrease muscle tension.

Do active recovery on your rest days to promote healing. Include chiropractic care, massage, reflexology, foam rolling, active and passive stretching, sleep and sound nutrition strategies.

Strengthen your feet muscles to build a solid base. Powerful feet muscles propel us forward and help lower the possibility of overuse injuries.

Consistently perform foot strengthening exercise as part of your training. Strengthen the toe flexors and the muscles that support the arches of the feet with specific and functional foot strengthening exercises. Execute specific foot strengthening exercises such as the towel toe grab, the short foot exercise, toe curling, toe splaying and alphabet writing to develop strong feet. Add pool running, sand running, Pilates, plyometrics and barefoot running as functional multi-joint exercises to increase foot strength.

Self- Management: Take immediate action if symptoms of metatarsalgia begin. Modify your training by decreasing distance, sprinting and hill work. Compensate for the reduced mileage with swimming or cycling.

Apply ice to the painful area for fifteen minutes. Place a towel between the ice pack and skin to avoid skin irritation.

Chiropractic Care: Seek chiropractic care for professional evaluation and treatment. The consultation and examination determine the diagnosis and course of treatment. Several conditions common in the same area, such as a stress fracture and Morton’s neuroma, must be ruled out. Imaging such as x-rays & MRI may be necessary to rule out a stress fracture. 

Once a diagnosis of metatarsalgia is determined, chiropractic treatment to the spine and lower extremities restores proper skeletal motion and optimizes nerve flow. Chiropractic adjustments to the lumbar spine improves nerve flow from the spinal cord to the feet. Chiropractic adjustments to the feet, especially the metatarsal bones restores correct skeletal motion. The improved skeletal motion and unimpeded nerve flow decreases symptoms, maximizes healing and increases function.

Conclusion: Train smart, use preventive measures, take immediate action and seek chiropractic care to combat metatarsalgia. Strengthen your feet and provide your body the recovery time and assistance it requires to prevent metatarsalgia. Modify your running schedule and utilize self-treatment immediately if symptoms begin. Receive chiropractic treatment to restore proper biomechanics and maximize healing. Use these strategies to combat metatarsalgia and perform at your optimal capacity.

Dr_Donald_A_Ozello_thumb_medium150_Dr. Donald A. Ozello DC

Dr. Donald A. Ozello DC is the owner and treating doctor at Championship Chiropractic. 8871 W. Flamingo Rd, Suite #202, Las Vegas, NV 89147.  His web address is He can be contacted at (702) 286-9040 and

Dr. Donald A. Ozello’s mission is to educate and inspire others to live healthier, fitter, more functional lives.

Dr. Donald A. Ozello DC is the author of the book “Running: Maximize Performance & Minimize Injuries: A Chiropractor’s Guide to Minimizing the Potential for Running Injuries.” He writes a weekly health, fitness and nutrition column for The Las Vegas Informer. He is published in OnFitness and He has educational health, fitness and nutritional videos on Informer TV, and YouTube.

Dr. Donald A. Ozello DC proudly handles Standard Process Supplements and Foot Levelers Orthotics.

Dr. Donald A. Ozello DC is an award-winning public speaker. He has spoken to numerous groups on the importance of health, fitness, exercise, ergonomics, nutrition and injury prevention.

Dr. Donald A. Ozello DC is a fitness enthusiast. Functional kettlebell training, running and bike riding are his favorite types of exercise.

Before pursuing his career in Chiropractic, Dr. Donald A. Ozello DC served in the United States Navy aboard the USS Bremerton, SSN 698.

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