Metatarsalgia refers to severe pain or a cramp at the ball of your foot in the anterior portions between the talus and the phalanges, including the five metatarsal bones. Conditions associated with metatarsalgia include nerve pain between the toes, and metatarsophalangeal articulation pain. The condition is also referred to as Morton's disease.

The condition may result from injury to nerves between the toes resulting in the loss of the fat pad protecting those nerves; repeated trauma; improper footwear; or disease of metatarsophalangeal articulations, resulting from misalignment of the joint surfaces.

The condition is characterized by pain over the ball of the foot. When the condition is due to injury to the nerves within the toes, the signs and symptoms may include a sudden onset of pain along one or more nerves of the foot which radiates to the ball of the foot or the toes. The signs and symptoms of a benign interdigital neuroma begin with a mild ache or discomfort in the ball of the foot in the area of the 4th metatarsal head. Occasionally, a burning sensation or tingling is felt, and a feeling that there may be a pea inside the ball of the foot is experienced. The symptoms may be more pronounced when wearing different types of shoes. When the condition progresses, there may be constant burning that radiates to the tip of the toes. While walking, relief from the symptoms may be sought by removing the shoes. When the condition is due to metatarsophalangeal articulation the signs and symptoms may include tenderness of the dorsal and plantar surfaces of the toes and synovitis. Burning, and numbness and tingling are usually absent.

Diagnostic measures for the condition include: x-rays, which may show degenerative joint disease; a comprehensive history; and palpation of the spaces within the toes elicit pain when a neuroma is present. Tests may also be used to rule out rheumatic disease (see Diagnostic Code: 5002 Arthritis rheumatoid).

When the condition is due to interdigital pain, treatment may include proper shoes and insoles. Drug therapy with local anesthesia may be used. If a neuroma is present, the treatment may include injections of long-acting corticosteroids with a local anesthetic. A cast and a fabricated orthotic device may be used. Surgery for excision of the neuroma may be needed if conservative treatment is ineffective. When the condition is due to metatarsophalangeal articulation, treatment involves the use of an orthotic device, and injections of a local anesthetic to relieve pain.

Residuals may include repeated injections of long-acting corticosteriod therapy with a local anesthetic over long periods of time. Injections may be given 2 months apart.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• The DC provides for an evaluation of 10 percent regardless of whether the condition is unilateral or bilateral.

• When multiple foot disabilities are present, but the etiology of the symptoms cannot be separated, assign a single disability evaluation for the predominant symptoms. If the etiology of the symptoms can be delineated, separate disability evaluation may be assigned under multiple DCs for foot disabilities provided that the principles of 38 CFR 4.14 have not been violated.

• Since metatarsalgia refers to pain in the forefoot while plantar fasciitis (DC 5269) is associated with pain in the heel, the symptoms should generally not overlap and separate evaluations may be assigned unless assessment of the evidence reveals that separate evaluation would be in violation of the pyramiding rules at 38 CFR 4.14.

• None.