Second Metatarsal Overload Syndrome Treatment

Second Metatarsal Overload Syndrome results from excess stress placed onto the 2nd metatarsal. Orthotics are not the only thing that can help!


Second Metatarsal Overload Syndrome Treatment
Second Metatarsal Overload Syndrome Treatment



Causes of Second Metatarsal Overload Syndrome:

The cause of second metatarsal overload syndrome is simply that too much pressure is placed on the 2nd metatarsal. This can be for any of the following reasons, but it always comes down to one longer than the other. Eventually a callus will form under the 2nd metatarsal head. There will also be constant pain while standing on the ball of the foot.

The pain is typically aggravated while walking running.

Athletes who participate in high impact running in sports, generally develop an inflammatory condition which causes irritation to the second third, fourth or fifth metatarsals.

This is also referred to as a medic her cell just in some cases.

The pain gradually appears over a period of several weeks or months, it does not happen with one bad fall or crack of the bone.

This can frequently be associated with conditions such as Morton’s neuroma, capsulitis, or stress fractures.

Specific causes include:

  • Short 1st metatarsal – Morton’s Toe.
  • Long 2nd metatarsal.
  • Hypermobility of the 1st metatarsal.
  • Prior broken foot.
  • Tight calf muscles.
  • Excessive wearing of heeled shoes.
  • Bunion – that does not make proper contact with the ground for push-off.
  • Flat foot due to another reason.



Symptoms of Second Metatarsal Overload Syndrome:

  • Sharp, aching or burning pain.
  • Pain concentrated around the base of the 2nd toe.
  • Pain that gets worse when you stand, walk or run.
  • Pain that gets better when you are resting.
  • Numbness in your toes.
  • Pain that worsens when you bend your 2nd toe up and down to the extremes.
  • Increased pain walking barefoot, especially on a hard floor.

When to seek treatment:

Not all 2nd toe pain requires seeing a doctor for treatment, especially if you’ve had a long day on your feet. It might be a good idea to try home treatment for a few days. If the pain does continue for an extended period of time and home treatment has not been effective, then it might be time to go seek professional care from your podiatrist.


Podiatrist In Office Evaluation:

  • The first and most basic step is to get an x-ray. This only takes a few minutes and gives very valuable information.
  • The first thing we are looking for is how long the metatarsal is, do you have a bunion, is there a broken bone, or is there any obvious deformities.
  • It is almost impossible to tell if you have Morton’s neuroma based on an x-ray, this is based on clinical exam.
  • Sometimes we may try to order an MRI, but most insurance plans these days don’t cover this right off the bat. As a result we can take an in office ultrasound to make sure that this is what’s going on.
  • Through a physical exam, we will make sure that you do not have an aroma between your toes. We will make sure that none of the toes are dislocated or have a plantar plate rupture. We’ll make sure that you don’t have capsulitis at the site.
  • By pressing with our fingertips along the metatarsal shaft, this would lead us to confirm that what you do have is a stress fracture through the site.


Our basic treatment algorithm includes:

  1. A foot x-ray as the first step.
  2. A full ultrasound in the office as the second step.
  3. An ultrasound as a backup, but insurance can sometimes be difficult in approving these at the beginning.
  4. Very rarely do we need to get a CT scan or a bone scan, especially for younger athletes, this can lead to a higher amount of radiation.



Second Metatarsal Overload Syndrome Treatment:



Treatment during the first day of injury:


  • The first step of any injury would be to apply ice to the site. This is typically done for 20 minutes at a time and can be repeated numerous times throughout the first 24 hours.
  • The idea is to rest ice compress and elevate the site. The more you can do this, generally the better it will feel at the beginning.
  • This is not something that develops with an acute injury, but it is something that starts to gradually get worse if it is not caught early. The key is to accept that you have this overload syndrome and begin taking pressure off it, so it does not get much worse.


What can I wear to prevent this from getting worse?:

  • A good supportive rigid insert.
  • The most common mistake we see is that people simply get a gel pad that does not take any support off the front of their foot. While these do help a little bit, what you really need is a good supportive over-the-counter insert with a metatarsal pad.
  • The second most important thing you can do is get a good supportive running shoe. The ideas that this is not a flexible flimsy type shoe, it must be a good running shoe that you cannot bend in a U-shaped.
  • The ideas to get a great fitting shoe, that does not cause you issues such as crushing your foot or not fitting the above-mentioned insert.


What kind of rehabilitation can I do?:

  • The most important thing you could do is switch up to different forms of exercises.
  • What we usually prefer is stop running, and switch to cycling and swimming if at all possible.
  • You can still do upper body exercises weightlifting rolling. You can do many things that raise your heart rate without damaging your foot further.
  • The key is to accept that you have done some damage, and you must let it heal rather than getting worse.


What kind of stretching can I do?

  • The most common reason people get pressure on the front of their foot is very tight Achilles tendons and hamstrings.
  • Focus on stretching your calf muscles and hamstrings.
  • If these are starting to loosen up, you can even start looking at your lower back and stretching this.


  • Second Metatarsal Overload Syndrome Treatment should be treated by identifying the cause.
  • If you have a bunion for example: correct the flat foot causing the bunion and the bunion itself.
  • If you wear heels: get a good running shoe with inserts.
  • If you have tight calf muscles: perform continuous calf stretches.


How long does it take to heal from second metatarsal overload syndrome?:

  • Doing all the right things, such as where good supportive orthotics, great shoes, resting the foot, and stretching your calf muscles and hamstrings: they can still take 6 to 8 weeks to fully heal this.
  • Some people get better quicker, but you need to keep doing these things for many many weeks.
  • The biggest mistake people do is think that they can do the right stuff for one to two weeks, no! It has to be longer, you have to treat this almost like a broken bone.
  • The biggest key to this is to accept that you have an injury, and you must do all the right stuff to give it time to heal. Have confidence that this is your diagnosis and let it heal up. Don’t turn what should be a 1 to 2 month injury into a 2 to 3 year injury or longer!