Why physiotherapy is important in diagnosing and treating foot pain


Why physiotherapy is important in diagnosing and treating foot pain

Your foot is an important and complex area of the body that contains 26 bones, 33 joints and over 100 muscles and ligaments.

The foot can be split into 3 sections, the forefoot, the midfoot and the hindfoot.

  1. The forefoot: Made up of phalanges — your toes (three phalanges in each toe, two only in the big toe) — and five metatarsal bones (the long bones in your foot). The big toe is the shortest and thickest and is designed this way to allow many tendons to attach onto it. This feature helps with force production and allows the big toe to withstand significant loads in weight bearing.
  2. The midfoot: Contains five tarsal bones: five cuneiform, navicular and cuboid — and they connect the hindfoot to the forefoot and form the arches of your feet that help generate force and shock absorption; and
  3. The hindfoot: The talus (ankle bone) and the calcaneus (heel bone) join together to allow for rotation at the ankle

The forefoot is the most common location for foot pain in adults and it’s easy to see why with all those musculoskeletal structures. During running and jumping, loads on the forefoot can surpass four to five times your body weight as well, putting extreme pressure on a small zone.

The following factors also contribute to excessive pressure over the forefoot, increasing your risk of developing forefoot pain:

  • Tight-fitting shoes or high heels
  • High-arched feet
  • Increased level of activity
  • Over-pronation
  • Tight Achilles tendon
  • Weak toe muscles (flexors)
  • Tight toe muscles (extensors)
  • Being overweight
  • Protruding metatarsal heads

“It feels like I have a stone in my shoe”

Is one of the most common complaints from patients with metatarsal pain, but there is a long list of common injuries of the forefoot. Those with Metatarsalgia experience pain and tenderness underneath the forefoot, which can extend into the toes.


Metatarsalgia is the general umbrella term for forefoot pain beneath the ball of the foot, or the area just before the toes. The pain may be located beneath the second, third and fourth metatarsal heads, or may be more isolated at the first metatarsal head behind the big toe.

Bunions, hammertoes, short metatarsal bones, collapsing arches, high-arched feet, stress fractures, hallux limitus, arthritis, plantar plate rupture, capsulitis, intermetatarsal bursitis are all possible causes of metatarsalgia – highlighting the need for an expert physio to diagnose the underlying cause.

There are 2 main categories of Metatarsalgia; primary and secondary.[1]

Primary Metatarsalgia refers to pain that develops due to abnormalities of an individual’s foot biomechanics or anatomy, for example: high arched feet or having clawed toes.

Whereas secondary Metatarsalgia arises as a by-product of conditions such as diabetes, rheumatoid arthritis, gout, neurological or vascular disease.

Primary Metatarsalgia is much more common, with most cases having a biomechanical cause.

Metatarsalgia commonly develops as a result of poor gait biomechanics, abnormal foot anatomy, or congenital abnormalities affecting the foot or ankle.[2]

Older patients are at greater risk of developing metatarsalgia, and women are affected more often than men. Athletes in sports like distance running whose forefeet repetitively sustain large impact forces are also at increased risk.

How does physiotherapy treat forefoot conditions?

Depending on the diagnosis, your physio may use a range of methods to help treat your forefoot pain. During the initial stages of metatarsalgia, it is important to restrict usage of your foot and to use ice to help decrease foot swelling and inflammation. The initial treatment for metatarsalgia

The majority of problems seen by physiotherapists arise from non-traumatic causes that include congenital, structural, and medical conditions. For these atraumatic conditions, your physio will begin with a thorough evaluation of the forefoot and surrounding area.

Physiotherapy Treatments include:

  • Education
  • orthoses & corrective shoes
  • stretching of specific lower limb muscles
  • small foot strengthening exercises

For an in-depth foot and ankle assessment by one of our skilled physiotherapists, book a consultation today.

[1] Espinosa N, Maceira E, Myerson MS. Current concept review: metatarsalgia. Foot Ankle Int. 2008 Aug;29(8):871-9. doi: 10.3113/FAI.2008.0000. Review. PubMed PMID: 18752791.

[2] Espinosa N, Brodsky JW, Maceira E. Metatarsalgia. J Am Acad Orthop Surg. 2010 Aug;18(8):474-85. doi: 10.5435/00124635-201008000-00004. PMID: 20675640.