Metatarsalgia (forefoot): returning to sport step by step

Why it happens

Shoes that are too tight or too flat, increase in volume, jumping and loading the forefoot, hard surfaces.

Coming back in four stages

1. 1

   Short walks on a soft surface with cushioned, wide shoes.

2. 2

   Strengthening of the foot and calf and choice of suitable shoes according to your physiotherapist or podiatrist.

3. 3

   Alternating walking and running on a soft surface, without jumping.

4. 4

   Easy continuous running, then volume and speed in small steps.

Move on to the next stage after 2 sessions in a row with discomfort of 2 out of 10 or less and no pain the next day. Each stage usually lasts 1 to 2 weeks, depending on your healthcare professional’s advice. For the forefoot, walking a few steps barefoot the next day is the test: if the pain under the toes increases, stay at this stage.

Movements to postpone

• sauts from stage 4

Strengthening exercises

• Towel scrunch

  from stage 1 of the plan

  With the foot flat on a towel, gather it under the foot using your toes.

  To start: 3 passes of the whole towel, once a day.

  Variations, mistakes and progression

  Easier

  Dry, light towel, seated.

  Harder

  Put a small weight at the end of the towel, or pick up marbles.

  Common mistakes

  • Moving the whole foot instead of just the toes.
  • Pushing through a cramp: stop and relax.

  Moving on

  When it is easy: keep it as a warm-up and focus on heel raises.

• Short-foot exercise

  from stage 1 of the plan

  Seated or standing, draw the ball of the foot towards the heel without curling the toes, as if doming the arch. Hold 5 seconds.

  To start: 10 contractions of 5 seconds, twice a day.

  Variations, mistakes and progression

  Easier

  Seated, foot resting without body weight.

  Harder

  Standing on one foot, then balancing while keeping the arch lifted.

  Common mistakes

  • Curling the toes instead of shortening the foot.
  • Lifting the heel.

  Moving on

  When you can keep the arch lifted for 10 seconds standing on one foot.

• Heel raises

  from stage 2 of the plan

  Standing, rise on both feet and lower slowly over 3 seconds. Keep the knee straight, then bent to work the other part of the calf.

  To start: 3 sets of 12, 3 seconds down, every other day.

  Variations, mistakes and progression

  Easier

  Seated on a chair, a light weight on your knees.

  Harder

  Heels over the edge of a step, to go lower.

  Common mistakes

  • Bouncing at the bottom instead of controlling the way down.
  • Rising higher on one side than the other.

  Moving on

  When 3 × 15 is easy with no discomfort the next day: move on to single-leg raises.

• Single-leg balance

  from stage 2 of the plan

  Stand 30 seconds on one foot, knee slightly bent. Then with eyes closed, then on a cushion or unstable surface.

  To start: 3 holds of 30 seconds per leg, every day.

  Variations, mistakes and progression

  Easier

  One hand on a chair, or the tip of the free foot on the floor.

  Harder

  Eyes closed, then on a cushion, then throwing a ball against a wall.

  Common mistakes

  • Knee straight and locked.
  • Looking at your feet instead of a point ahead.

  Moving on

  When you can hold 30 seconds without putting the other foot down, as on the healthy side.

• Single-leg heel raises

  from stage 4 of the plan

  Same movement on one foot, lowering over 3 seconds, a light hand on a wall if needed. Add a loaded backpack very gradually.

  To start: 3 sets of 8 to 10 per leg, 3 seconds down, every other day.

  Variations, mistakes and progression

  Easier

  Rise on both feet and lower on one.

  Harder

  On a step with the heel over the edge, then with a loaded backpack.

  Common mistakes

  • Leaning too much on the wall.
  • Bending the knee to cheat on height.

  Moving on

  When you can do 20 to 25 raises in a row on the injured leg, roughly as many as on the other.

The doses are starting points. Stay at 2 out of 10 discomfort at most, during and the next day; otherwise switch to the easier version or go back to the previous exercise.

Rehab’s advice

Wide, cushioned shoes, soft surfaces. No jumping or sprinting on the forefoot at first.

What the Rehab plan does for this injury

The plan starts at 35% of your previous training volume and builds up to 85%, with a consolidation week every three weeks. If your discomfort reaches 5 out of 10, it stops and refers you to your doctor or physiotherapist.

In which sport?

• DanceWear soft shoes and avoid prolonged demi-pointe at first.