The feet

A basic introduction

Some of the symptoms that runners suffer from and ways of treating them:


Metatarsalgia is basically pain in the forefoot. It involves the metatarsal heads; the foot’s equivalent of the knuckles in your hand.

The pain is often described as varying from sharp at times, to more of a dull ache, localised to the ball of the foot. It generally comes on over a period of time and worsens with activity. It can be associated with pins and needles in some of the toes if there is associated nerve irritation of the small nerves which sit between the metatarsal bones.

It occurs when there is excessive distribution of weight on these bones. This can occur due to a number of factors, such as joint stiffness in the foot or ankle; inflexibility in the lower limb leading to altered walking or running pattern, poor running shoes not offering enough support or loss of support from the intrinsic foot muscles (these are found between each of the long metatarsal bones in the forefoot).

Morton’s neuroma

This is a painful condition also felt in the forefoot. A neuroma is the swelling of a nerve, caused by irritation. In this case it is when one of the interdigital nerves, commonly the one between the third and fourth toes, is pinched between the metatarsal bones in the foot. Onset of symptoms is gradual. The pain is often described as a mild pins and needles or electric shock, radiating into the affected adjacent toes. It can be precipitated by tight fitting footwear and by weight bearing activities, eased with rest and avoidance of tight footwear.


It is important that when you seek physiotherapy treatment it should be given by a Chartered Physiotherapist; they will have the letters MCSP after their name. This ensures that you get a practitioner who is qualified to an internationally recognised standard.

Treatment for both Morton’s neuroma and metatarsalgia is covered in this section together, as they may be treated in very similar ways. Following a detailed assessment of the structures involved and the biomechanics of the lower limb, including gait assessment, the physiotherapist may use manual techniques to improve the function of surrounding joints and soft tissue.

Localised anti-inflammatory electrotherapy modalities or acupuncture may help to reduce pain.

Exercise to improve function of the intrinsic and other foot muscles may be needed to regain support of the metatarsals when suffering with metatarsalgia. (They may actually aggravate a neuroma by compressing it, so bear it in mind!)

You can try this exercise by placing your foot flat to the floor and gently try to increase the arch of your foot by squeezing the muscles. Try not to curl your toes up, keep the pads of your toes in contact with the surface. This can be done, perhaps not so effectively, with your shoes on. This means whether you're standing or sitting at work, you can keep them active.

A regime of stretches to maintain, or gain, flexibility of the lower limb muscles may be necessary to improve the gait pattern. These muscles typically include Gastrocnemius, Soleus, Hamstrings and Quadriceps.

Orthotic support may be indicated, to help improve the mechanics of limb. Consultation with a podiatrist or orthotist would then be needed. They would have a detailed look at the gait cycle and the soft tissue and bony structures in the foot and limb, before constructing and supplying you with your orthotic.

Plantar Fasciitis

This is an inflammation of the attachment of the plantar fascia, a ‘bowstring’ arrangement of collagen fibres, running on the underside of the foot from the heel towards the toes. It is a common cause of heel pain.

It plays an important role in maintaining the shape of the medial arch in the foot. It is stretched when the medial arch is flattened and on the ‘take -off’ phase of the gait cycle, when the toes are in contact with the floor and extending. The inflammation occurs at attachment of the fascia to the bone.


Advice should be sought from a recognised medical practitioner. The Physiotherapist may use anti inflammatory electrotherapy modalities, manual techniques, as well as looking at gait and the biomechanics of the limb. A regime of stretches may well be in order, and again referral for orthotics could be indicated.