Did you ever have one of those really active days - running, hiking, jumping, maybe just standing for a really long time on your feet - and the balls of your feet ached like crazy? Well my friend, you were probably suffering from the dreaded Metatarsalgia.

Metatarsalgia isn't as serious as it sounds. It simply refers to minor pain and inflammation of fatigued and overused metatarsal bones (the long bones in your feet). The pain appears in the area where the metatarsals join your toe bones, otherwise known as the ball of your foot - the area of your sole behind your toes (not just behind the big toe). The pain usually begins as a mild ache and worsens over a period of months.

Usually, metatarsalgia is caused by ill-fitting shoes combined with lots of activity. Most cases of metatarsalgia aren't serious, and rest, ice and over the counter pain medicine will resolve the pain.

But if left untreated, the classic cascade effect may kick in: The balls of your feet hurt, so you unconsciously shift weight to other parts of your feet, which eventually causes pain in those areas, which again causes you to shift your weight. Since your legs, ankles and feet are drifting farther out of alignment, the joints above your feet start feeling the impact and you suddenly have pain in your knees, back, or hips. And it all began with minor, treatable pain in your feet.

Prolonged metatarsalgia which doesn't resolve in 10 days should always be reported to your podiatrist, as it can be a symptom of other, more serious conditions.

Symptoms of Metatarsalgia include

• Sharp, aching or burning pain at the head of the metatarsals, in the ball of your foot, just below and underneath the toes
• Pain that becomes worse when you're on your feet, especially when running, walking or flexing
• Pain decreases as you rest
• Sharp or shooting pain, numbness, or tingling in your toes
• A feeling of having a pebble in your shoe

Contributing factors to Metatarsalgia

Intense training. Most runners are accustomed to occasional bouts of metatarsalgia, as the front of the foot absorbs significant shock when running. But this can be true of anyone who plays a high impact sport, especially basketball, soccer, tennis, football, or track and field events. It's sometimes a sign that your athletic shoes are worn out and need to be replaced.

The shape of your foot. If you have a high arch, extra pressure is placed on the metatarsals, increasing the chance of pain from overuse. If your second toe is longer than your big toe, more weight than normal is shifted to the 2nd metatarsal head, and that may cause pain as well.

A muscle imbalance. Tight toe extensors or weak toe flexors don't properly support the metatarsal bones and may cause fatigue and pain from overuse. A too-tight tight achilles tendon may be a contributor as well.

Stiff ankles, perhaps the result of a previous injury or arthritis, don't support the foot correctly, placing too much pressure on the forefoot.

Excessive pronation - the side-to-side movement of your foot - may contribute.

Foot deformities such as flat feet, bunions, gout, arthritis and  hammertoe can cause metatarsalgia. Many patients with bunions complain of pain in the balls of their feet.

Carrying too many pounds. Your forefoot carries most of your body weight when you walk of run. Extra pounds means extra pressure on the metatarsals. Additionally, as we age, the fat pad in the foot tends to thin out, reducing its cushioning effect. A weight management plan may reduce your symptoms.

Poorly fitting shoes and high heels. That's right, ladies. While high heels make you look great, they're murder on your feet (like I had to tell you that). High heel shoes are a very common cause of metatarsalgia in women, as they transfer your body weight to the front of the foot, working against how the foot is designed to carry your weight.  Athletic shoes which don't support your feet correctly are also guilty of causing metatarsalgia.

Stress fractures in the metatarsals or in the toe bones change the way you walk, which may result in metatarsalgia.

Morton's Neuroma, a growth of fibrous tissue around the nerve between your 3rd and 4th metatarsal heads causes symptoms similar to metatarsalgia.

Your podiatrist may recommend one or more of these treatments for Metatarsalgia

• Rest and complete non-weight bearing for at least 24 hours
• Ice
• Over the counter pain medicine such as advil or aleve
• Cortisone injection in the sore area to relieve pain and inflammation
• Pressure bandage on the sore area
• Ultrasound therapy
• Custom orthotic devices to support and realign your feet
• Metatarsal pads
• Change in footwear (usually to good quality athletic shoes with proper support or flat shoes with a wide toe box)
• When pain has subsided, stretching and strengthening exercises for your feet, supervised by a physical therapist
• Alternate forms of activity may be recommended such as swimming or bicycling
• Weight management if you're overweight