Great Balls of Fire in My Aching Feet


    I was in my last year of medical school, spending a lot of time on my feet working at the hospital when I noticed my poor feet were just killing me. The pain was on the balls of my feet. Pain increased exponentially whenever I was standing for any length of time.

     Foot massages from my honey, taking ibuprofen, and wearing over-the-counter inserts
weren’t helping. So I went to the student health service where they booked an appointment for me with a young sports medicine doctor. As it turns out, however, she had no idea what was wrong with my feet. She told me to try icing them. I had no luck with that either. Temporarily, I found that wearing cushioned shoes and avoiding being on my feet kept the pain under control. The problem was that good cushioned shoes translated to wearing ugly running shoes. This looked silly with nice outfits. Also, sitting down frequently was not conducive to the nature of hospital work. A few months later I was working at an Orthopedic physician’s office who happened to have a Podiatrist on his staff. As soon as I mentioned my foot problem to the Podiatrist, he identified it as metatarsalgia (me-ta-tar-SAL-ja). I checked several of my medical textbooks and sure enough, only a handful of them mentioned this condition. It seemed as though plantar fasciitis, a different problem that affects the arch was well-identified since it is often seen by primary care physicians and Orthopedic surgeons. However, after comparing foot information in medical texts to that in podiatry texts, it seemed the information on plantar fasciitis eclipsed many of the other painful conditions in the feet.

    Flash-forward several years later to when I took up bellydancing. My feet held up well unless I practiced a lot of pivoting and turning. These movements necessitated being on the balls of my feet, and metatarsalgia reared its ugly metatarsal head. Literally, the pain of metatarsalgia is located at “heads” of the metatarsals or most distant portions of the mid-bones of the foot. The pain is usually most pronounced under the 1st metatarsal head (the one belonging to the great toe) but pain can occur under the other heads as well. The pain is due to inflammation as a result of excessive pressure over time. Poorly fitting shoe-wear, especially in the toe-box or wearing high-heels or poorly cushioned shoes can all factor in. As we grow older, collagen and the good fat that pads our feet tends to wear thin, making the foot more susceptible to painful conditions. (Really, couldn’t we just lose it elsewhere?) Lastly, it is very common to experiences acute, recurrent, or chronic pain with metatarsalgia.

    Treatment for metatarsalgia first lies in identifying the cause. If it’s the fit of shoe-wear, then a wider toe-box, better cushioning, and even a sole with a rocker-like bottom may remedy the situation. The next step is to find a method of unloading pressure. Over-the-counter orthotics have grown very sophisticated from even a few years ago. One can find metatarsal pads that are placed behind the ball of the foot and adhere to the shoe. Other products include orthotics with a built-in pad or an arch support that is high enough to have the same pressure-relieving effect of the pad. There are also gel metatarsal cushions and metatarsal bandages. Although bellydancing is commonly danced barefoot, a few brave souls dance in high heels. I have tried this on rare occasions and keep the time I wear the high heels to an absolute minimum. I’ve found that high heels manufactured for dancers, such as jazz dancers are the best. These have a steel component in the sole that minimize bend and torque along the sole. Other choices of footwear include ballet slippers or lyrical-style leather-and-elastic sandals. I sometimes wear the latter and find they these work well to reduce friction and minimize pain. Not all foot pain is plantar fasciitis and if you have persistent pain in your feet, you shouldn’t have to live in constant discomfort. I therefore encourage you to see a podiatrist or other qualified foot expert.