Forefoot pain / metatarsalgia

Definition

What is metatarsalgia?

Metatarsalgia is a collective term for painful complaints in the area of the ball of the foot - i.e. where the toes meet the metatarsal bones (metatarsals). This area is under a lot of strain when walking and standing, especially when rolling the foot. The pain typically occurs under the so-called heads of the metatarsal bones (metatarsal heads), often in the second and third rays. Those affected often describe a burning, stabbing or dull aching sensation, which intensifies with exertion. Sometimes there is the impression of walking on a small stone. The increased strain on the forefoot can also cause calluses or calluses to form in this area in the long term - a sign of excessive strain.

Causes of forefoot pain

The causes of pain in the ball of the foot are closely linked to modern lifestyles and changing environmental conditions. Our ancestors moved extensively and intensively in order to procure food - be it by hunting, picking berries or farming. These activities usually took place barefoot on natural, uneven ground, which optimally challenged and strengthened the foot and leg muscles. In addition, the soft ground reduced the point load on the feet.
Over the millennia, lifestyles have changed massively. Today, a lack of exercise and a predominantly sedentary lifestyle are widespread, which, among other things, favors the development of splayfoot. When movement does take place, it is usually on hard, flat surfaces such as concrete or asphalt - often in immobile, supportive shoes. These altered conditions affect both the quantity and quality of movement and lead to physical adaptations that can overload the forefoot. The effects of these changes on the development of pain in the ball of the foot (metatarsalgia pain) are described below.

Lack of exercise and a sedentary lifestyle

The modern way of life, which is characterized by a lack of exercise and a sedentary lifestyle, places incorrect strain on the musculoskeletal system. The lack of exercise and sedentary lifestyle lead to physical adaptations that can promote pain in the ball of the foot (metatarsalgia pain). The following changes play a significant role in the development of forefoot pain:

• Weakened muscles

  A sedentary lifestyle and lack of exercise over a long period of time can lead to a significant weakening of the muscles throughout the body - especially in the feet. The foot muscles play a central role in the stability, balance and healthy statics of the arch of the foot. If the load is too low - for example, due to prolonged sitting and too little movement - the small muscles, tendons and ligaments that maintain the transverse and longitudinal arch of the foot atrophy. As a result of this muscular weakness, the transverse arch can drop, which encourages the development of splayfoot. More on this in the following section.
  In addition, weak muscles also have a negative impact on overall posture. Poor posture in the knees, hips or back can lead to changes in the load on the feet via so-called muscular chains and further promote the development of pain in the ball of the foot. This makes it clear that metatarsalgia is not just a localized problem in the foot, but often the result of a general lack of movement and an inactive lifestyle.
  

• Foot malpositions

  As mentioned in the previous section, weakened muscles can lead to foot malpositions. One of the most common misalignments in this context is splayfoot. In this case, the metatarsal bones move apart and the transverse arch of the forefoot lowers. This change leads to an uneven distribution of pressure when standing and walking. Instead of a flat load, the body weight is increasingly shifted to individual metatarsal heads, especially the second and third rays. The result is an overload in this area, which leads to irritation, inflammation of the ball of the foot and pain under the ball of the foot - metatarsalgia.
  At the same time, the longitudinal arch can also drop, which favors the development of a flat foot. The lowering of the transverse and longitudinal arch causes the foot to lose its natural shock-absorbing function. Instead of evenly cushioning the load when walking or standing, the pressure is transferred directly and increasingly to the metatarsal heads.
  In addition, the loss of the arch also makes the entire statics of the foot more unstable. This results in incorrect loading, a changed gait pattern and an increased concentration of pressure on the front areas of the foot. In addition to pain, this can also cause calluses, corns or, in the worst case, inflammatory changes to tendons and joints.
  

• Fascia dysfunction

  Fasciae are connective tissue sheaths that surround and connect muscles, tendons and joints. They are crucial for smooth movement and power transmission in the body. However, these fasciae can shorten, harden or stick together if there is a lack of movement, incorrect loading or too little varied movement.
  Fascia dysfunctions can promote metatarsalgia in various ways. Fasciae are a widely ramified network of connective tissue that envelops and stabilizes muscles, bones and organs. They play a central role in mobility, force transmission and the distribution of mechanical forces in the body. Numerous fascial structures run through the foot, in particular the plantar fascia on the sole of the foot, which plays an important role in maintaining the arch of the foot and absorbing shocks.
  A lack of exercise, poor posture or a sedentary lifestyle can lead to adhesions, thickening or tension within these fasciae, which can significantly impair the mechanical properties of the foot. The fasciae lose elasticity, which leads to an uneven distribution of compressive forces when walking or standing. As a result, the forefoot area - especially the metatarsal heads - is subjected to greater stress. This increased pressure load can lead to irritation of the nerves, joints or bursae in this area, which manifests itself in the form of burning, stabbing or load-dependent pain.
  Furthermore, fasciae act as interconnected chains in the body. Disruptions in myofascial tension - for example due to shortening along the fascial chain on the back, which runs from the sole of the foot to the neck - can transfer tension to the foot and lead to compensatory misalignments there. This can, for example, promote the flattening of the transverse arch, which in turn promotes splayfoot formation and thus a typical cause of metatarsalgia.
  

• Joint stiffness

  Joint stiffness, which often occurs as a result of a sedentary lifestyle and a lack of exercise, can significantly contribute to metatarsalgia, i.e. when the balls of the feet hurt. Prolonged sitting and low levels of physical activity lead to reduced blood circulation and supply to the joint structures, which in turn restricts joint mobility. Not only the large joints such as the hips and knees are particularly affected, but also the small joints of the foot, especially the metatarsophalangeal joints and the ankle joint.
  If these joints are restricted in their mobility, the rolling behavior of the foot changes when walking. Instead of a dynamic, even load across the heel, arch and toes, the pressure often shifts unphysiologically to the forefoot - especially to the metatarsal heads. This overloading can lead to friction, micro-injuries and inflammatory reactions in the structures of the ball of the foot, which manifests itself as metatarsalgia. The limited mobility of the toes, especially the big toe, also impairs the normal push-off of the foot when walking and forces the body to make evasive movements, which further increase the pressure in the forefoot area.

Hard, flat floors and stiff, restrictive footwear

Our feet are evolutionarily designed to move on natural, uneven surfaces where the foot muscles, joints and fasciae must constantly actively compensate and adapt. The changed environmental conditions have a considerable influence on the strain on the musculoskeletal system. The hard, flat floors and immobile, supportive shoes change the biomechanics of every single step and are therefore a decisive factor in the development of pain in the ball of the foot. The following changes play a significant role in the development of metatarsalgia pain:

• Force impact

  When walking on natural, yielding surfaces such as grass, sand or moss, the impact energy is gently absorbed and cushioned by the ground. Modern, hard surfaces such as concrete or asphalt, on the other hand, reflect this energy almost completely back into the foot. This significantly increases the peak loads on the foot structures.
  This problem is exacerbated by modern shoes, which are often equipped with stiff, thick soles and supportive insoles. This stiffness considerably restricts the natural mobility of the foot - especially that of the metatarsophalangeal joints and the arch of the foot. If these structures cannot cooperate sufficiently, the body's own shock absorption is restricted. The pressure is then excessively concentrated on the metatarsal heads - precisely the area that typically hurts with metatarsalgia.
  The forefoot has a natural fat pad that serves as a shock-absorbing layer and protects the sensitive structures under the metatarsal heads from excessive strain. This cushion is structured in such a way that it flexibly deforms with every step and thus absorbs the impact when walking or running. Hard, flat floors and inflexible shoes significantly impair this protective function. As they themselves offer no cushioning, impact forces are passed on to the foot unfiltered. The fat pad must therefore permanently compensate for the lack of cushioning and is overstressed. Over time, this can lead to structural wear or displacement of the cushion, which reduces its cushioning effect - further increasing the pressure load on the surrounding tissue.
  In addition, hard floors and stiff shoes not only cause an increased impact force, but also an accelerated transfer of these forces to the foot. As a result, the muscles have less time to react to the load and actively tense up. As a result, the transverse and longitudinal arches cannot be sufficiently stabilized, which further restricts their shock-absorbing function. The result is increased stress on the ball of the foot. In addition, the foot can no longer roll in a controlled manner after heel strike due to the sudden application of force, which further increases the incorrect and excessive load in the forefoot area. More on this in the following section.

• Unnatural sequence of movements

  When walking barefoot on natural, flexible ground, the heel can sink in in a controlled manner when touching down. Due to the elasticity of the ground, the load increases slowly and in a controlled manner. This gives the foot muscles enough time to actively stabilize the foot and the transverse and longitudinal arches - which protects the ball of the foot from overloading. When walking on hard, flat ground in combination with immobile, supportive shoes, on the other hand, the ground reaction force acts on the foot in an undamped and abrupt manner, as described in the previous section. Due to the rapidly increasing load, the muscles have hardly any time to react, which leads to insufficient stabilization. As a result, the foot rolls down uncontrollably after heel strike instead of rolling gently and in a coordinated manner. As a result, the sensitive metatarsal heads in the ball of the foot are "beaten" rather than evenly loaded with each step, which can lead to pain in the metatarsal heads and toe pain. At the same time, the transverse and longitudinal arches cannot be sufficiently stabilized, which means that their natural shock-absorbing function is lost.
  The reduced rolling motion over the forefoot not only has a negative effect on pressure distribution over the entire foot, but also inhibits blood circulation and fluid exchange in the area of the ball of the foot. In the long term, this restricted sequence of movements also leads to the breakdown of relevant foot and leg muscles - which is described in more detail in the following section.

• Weakened muscles

  Hard, flat floors and immobile, supportive shoes fundamentally change the natural mechanics of the foot and promote the long-term breakdown of the foot-stabilizing muscles. On natural, uneven surfaces, the foot is constantly challenged to adapt to changing stimuli and unevenness. This activates a large number of small muscles in the foot and lower leg, especially those that support the transverse and longitudinal arches and control the rolling movement. On hard, level ground, however, this stimulus is largely absent. The monotonous surface hardly requires any muscular activity. Inflexible, supportive shoes further exacerbate this situation and lead to further inactivity of the feet. As a result, the deep-lying foot muscles in particular are underchallenged and weakened over time.
  If the muscles that stabilize the transverse arch deteriorate, splayfoot can develop over time. The transverse arch softens, the forefoot becomes wider and the metatarsals sag downwards. This leads to an unphysiologically high pressure load on the central metatarsal heads - usually the second and third rays - which makes the forefoot particularly susceptible to overload complaints. The result is often metatarsalgia, i.e. pain in the area of the ball of the foot. In addition, the natural fat pad under the metatarsal heads is displaced from its position or overstressed due to the altered statics and loss of muscular stability. It gradually loses its cushioning function, which means that the sensitive structures under the metatarsals are no longer adequately protected. The breakdown of the foot lifter muscles - especially the tibialis anterior muscle - also means that the foot is no longer set down in a controlled manner after heel strike, but instead hits the ground. This leads to excessive strain on the forefoot.

Symptoms of forefoot pain

It is important to note that the following are the most common metatarsalgia symptoms. However, the list of symptoms is not complete and exhaustive. Atypical symptoms that are not listed here are also possible. Metatarsalgia symptoms often depend on various factors such as pain sensation, cause of foot sole pain, severity of the condition and physical constitution. In order to obtain a clear diagnosis of metatarsalgia, a doctor should be consulted.

• Pain under the metatarsal heads: Sharp, dull or burning pain directly under the ball of the foot, usually in the area of the second or third toe.
• Pressure pain when walking or standing: The pain intensifies under pressure, especially when rolling over the forefoot.
• Splayfoot formation: A lowering of the transverse arch leads to a widening of the forefoot and increased pressure on the metatarsal heads, which can result in painful feet.
• Feeling of a "stone" in the shoe: Those affected often feel as if there is a foreign body in the shoe - typical of overloaded metatarsal heads.
• Burning soles or tingling in the forefoot: Nerve irritation caused by overloading or pressure can lead to neuropathic complaints such as "burning soles" or "formication".
• Numbness in the toes: Chronic pressure on nerves can lead to numbness, especially in the middle toes.
• Increased pain when walking barefoot on hard ground: without cushioning, the pressure on the aching feet increases significantly.
• Pain when wearing tight or hard shoes: Shoes with little forefoot freedom or stiff soles increase the pressure load.
• Metatarsalgia at rest: Metatarsalgia at rest can also be caused by inflammation, nerve irritation or stress fractures. Pain at rest should be investigated by a doctor as it may indicate more serious causes.
• Painful calluses or callus formation on the ball of the foot: Reactive thickening of the skin due to chronic overloading of individual pressure points.
• Increasing pain during the course of the day: The discomfort increases with the duration of exertion and fatigue of the muscles.
• Toe deformities (e.g. claw toes): Malpositions occur due to changes in load conditions or muscular imbalance.
• Pain during sporting activity: running, jumping or fast rolling often significantly exacerbate the symptoms. Those affected often complain of foot pain at the bottom of the forefoot.
• Restriction of movement in the forefoot area: Pain leads to relieving posture or reduced toe mobility.
• Pain radiating to other areas of the foot (e.g. toe pain): Due to incorrect loading or compensation patterns, adjacent structures can also react painfully.
• Morning stiffness in the forefoot: After periods of rest, especially in the morning, the forefoot feels stiff - structures irritated by overloading need time to "break in".
• Inability to walk or stand for longer distances: Pain occurs even with moderate exertion, which can significantly limit the distance you can walk.
• Local warming or swelling: Metatarsal bone inflammation or metatarsal head inflammation can become noticeable through overheating or slight swelling. Those affected often complain of swelling around the ball of the foot with forefoot pain.
• Loss of the natural rolling motion: Due to pain or muscular imbalance, physiological rolling over the forefoot is disturbed or compensated for.
• Avoidance posture or altered gait pattern: In order to avoid pain, those affected often develop an avoidance pattern when walking, which can lead to further discomfort (e.g. in the knee, hip or back).

Conventional therapies - What helps with forefoot pain

There are several approaches to treating metatarsalgia or forefoot pain. Some metatarsalgia therapies are listed below. The list of therapies for forefoot pain is not exhaustive. Various measures can also be combined to treat metatarsalgia. A medical consultation is recommended to determine the appropriate metatarsalgia treatment.

• Insoles (e.g. with a pad): In the case of metatarsalgia, insoles can relieve the sensitive metatarsal heads through targeted pressure redistribution.
• Physiotherapy: Physiotherapy can help with metatarsalgia by strengthening the foot muscles, stretching shortened structures and gait training to relieve foot and toe pain.
• Cushioning (e.g. gel cushions): Relieve acute pain through shock absorption.
• Cold therapy or anti-inflammatory medication: For pain relief in acute irritation.
• Weight reduction (for overweight people): Reduces the mechanical load on the forefoot.
• Activity modification: Temporarily avoid strenuous activities such as prolonged walking on hard surfaces or jogging to prevent overloading.
• Manual therapy / mobilization: To improve the mobility of the ankles and reduce blockages.
• Taping / Kinesiotape: Supports the foot statics, provides targeted relief for the forefoot and can relieve pain in the short term.
• Barefoot training: Promotes the muscles of the foot and improves foot awareness.
• Foot exercises for splayfoot: For metatarsalgia, foot exercises to strengthen the foot muscles are helpful in order to support the transverse arch with strong muscles.
• Electrotherapy / ultrasound: To relieve pain and promote blood circulation.
• Shock wave therapy: Used in some cases to treat chronic pain, e.g. persistent plantar fasciitis or tendon insertion irritation in the forefoot area.
• Cortisone injections: For severe inflammation in the foot (e.g. Morton's neuroma).
• Orthopaedic adjustments to footwear: In the case of metatarsalgia, butterfly rollers or general rolling aids on the shoe are an option to reduce pain in the forefoot.
• Metatarsalgia surgery: For structural problems if conservative measures are not sufficient or effective. Metatarsalgia surgery should therefore be at the end of the treatment process.

Unfortunately, these measures often do not lead to a long-term reduction in pain in the ball of the foot, as the causes of metatarsalgia are not eliminated. The aim of any metatarsalgia treatment should therefore be to eliminate the causes. As described above, the lack of exercise, sedentary lifestyle, hard, flat floors and immobile, supportive shoes should be addressed. The kybun mode of action proves to be a suitable therapy for pain in the ball of the foot, which can eliminate the causes mentioned.

kybun mode of action - What helps with forefoot pain

Kybun products aim to eliminate the harmful effects of hard, flat floors and immobile, supportive shoes and actively tackle the lack of exercise and sedentary lifestyle. The elastic, springy properties of kybun products relieve pressure on the feet on the one hand and activate them on the other. The relief ensures that the pain in the ball of the foot is reduced as a first step. Activation is intended to tackle the causes of metatarsalgia pain so that the complaints become a thing of the past in the long term. This makes kybun shoes ideal for pain in the forefoot, as they help to treat metatarsalgia through the following modes of action:

• Optimized pressure distribution

  People with pain in the ball of the foot often complain of pressure points when walking and standing. Particularly on hard surfaces or in shoes with stiff soles, the discomfort in the forefoot increases. Metatarsalgia pain is also exacerbated when rolling over the forefoot, as the pressure on the sensitive joint heads increases.
  When wearing kybun shoes, the entire sole of the foot is encased in an elastic, springy material. The feet sink gently into the flexible sole, which leads to an even distribution of pressure. This significantly reduces localized pressure peaks in the forefoot area - especially on the sensitive metatarsal heads and the nerves that run along them. The result is noticeable and immediate relief, which leads to rapid relief of pain in the ball of the foot.

• Activation of the foot muscles through elastic-springy properties

  The elastic, springy properties of kybun products create targeted instability when walking and standing, which encourages the body to perform constant, subtle balancing movements. This permanent muscular activity occurs unconsciously and activates the deep-lying foot and leg muscles in particular. Regular exercise strengthens these muscles and supports their natural function. Strong foot muscles play a central role in the cushioning and support function of the foot. They stabilize the transverse and longitudinal arches, relieve pressure on the ankles and ensure that the forces generated when walking are distributed more evenly over the entire sole of the foot. Especially in the forefoot area, where pain is often caused by selective overloading of the metatarsal heads and surrounding nerves, this improved force distribution leads to noticeable pressure relief.
  Standing and walking on kybun materials also creates a physiological basic tension in the foot and leg muscles. This muscle tension not only stabilizes the arch of the foot, but also prevents the forefoot from folding uncontrollably after heel strike. This protects sensitive structures such as nerve endings and joint heads from incorrect and excessive strain. More on this in the following section.

Balance and EMG

The ability to maintain balance was measured with a force plate by moving the body's center of gravity from front to back (ant-post) and sideways (med-lat) when standing. At the same time, muscular activity was recorded using electromyography (EMG).

• Natural foot roll thanks to muscle activation and roll-off function

  With a healthy, physiological rolling movement - from the heel to the midfoot to the metatarsophalangeal joint - all foot structures are evenly loaded. This promotes a balanced distribution of force over the entire sole of the foot and relieves pressure on the sensitive forefoot area in particular.
  The elastic, springy properties of kybun shoes allow the heel to sink gently into the sole when stepping. This means that the load on the body only increases gradually, giving the foot and leg muscles the time they need to activate in good time. This early muscle pre-tensioning stabilizes the foot during the further rolling process and ensures that the midfoot and forefoot are placed in a controlled and gentle manner. This protects the natural fat pad under the forefoot and the sensitive metatarsal heads from incorrect and excessive strain.
  
  In addition, the slightly rounded sole shape of kybun shoes supports the natural forward movement of the foot and promotes harmonious, dynamic rolling - a key prerequisite for pain-free walking and lasting relief for the forefoot.

• Reduction of the force impact of hard, flat floors through damping effect

  When the heel strikes the ground in kybun shoes, the elastic, springy material of the sole is compressed, reducing the ground reaction force and transferring it to the body with a delay. The cushioning property reduces the peak loads that would otherwise act directly on the structures of the musculoskeletal system. The time delay in the application of force enables early muscular activation so that the muscle groups involved, particularly those responsible for stabilizing the transverse and longitudinal arches, can preload in good time. This optimizes the efficient execution of the support and cushioning functions of the arch of the foot. This mechanism also contributes to the prevention of a fallen arches by placing the forefoot in a controlled and precise manner. By improving muscular activity, incorrect and excessive strain on the sensitive nerve endings and metatarsal heads is prevented, which protects the forefoot and associated structures in particular from damaging pressure peaks.
  The elastic, springy sole also enables the kinetic energy generated when stepping to be stored for a short time, which is then released for forward movement and active rolling in the further course of the movement cycle. This functional rolling motion is described in detail in the previous section and represents a further advantage.
  During the rolling phase, the cushioning properties of the sole continue to have an effect in that the ground reaction forces are not transferred directly and selectively to the forefoot, but are gently cushioned and evenly distributed. This process helps to reduce the load on the ball of the foot and promotes a more physiological movement.

• Protection against fascia dysfunction thanks to physiological movement sequences

  The fascia - the connective tissue that surrounds the muscles, tendons and organs - plays a central role in power transmission, mobility and stability throughout the entire musculoskeletal system, especially in the foot area.
  Unphysiological gait patterns, incorrect static loading or overly hard ground reaction lead to overloading and "sticking" of the fascial structures, especially the plantar fascia, which runs from the heel bone to the metatarsal heads. These fascial dysfunctions lead to reduced gliding ability in the tissue, which can cause local irritation, chronic increases in tension and associated pain in the forefoot area.
  The elastic, springy shoe soles from kybun counteract this process by generating gentle, controlled cushioning with every step, thus enabling a natural, harmonious rolling movement of the foot. The targeted reduction of impact forces and the even distribution of the pressure load protect fascial structures and prevent overloading. At the same time, the active, muscle- and fascia-friendly movement promotes circulation in the connective tissue, which contributes to better supply and regeneration of the fasciae.
  

• Improved circulation through increased movement activity

  The use of elastic, springy shoe soles significantly increases natural movement activity when walking, as they promote a more dynamic, springy gait and thus continuously stimulate the muscles in the foot and lower leg area. This increased muscle activity has a direct effect on the blood circulation of the tissues involved - especially in the forefoot area, which many people have insufficient blood supply due to static incorrect loading, lack of movement or permanently hard surfaces.
  The improved blood circulation leads to an optimized supply of oxygen and nutrients to the local structures. At the same time, the removal of metabolic waste products, which can cause irritation and pain in the tissue, becomes significantly more efficient. This can actively counteract inflammatory processes, fascial adhesions and muscular tension in the forefoot area. Tissue that is better supplied with blood is more resilient, more capable of regeneration and less sensitive to pain.
  

• Promoting physical activity and reducing sedentary behavior

  The elastic, springy kybun products increase the pleasure of movement, as their unique material relieves the forefoot when walking and standing. Regular, varied movement activates and strengthens the foot and leg muscles. The associated benefits have already been explained. Sitting less and walking more also ensures better blood circulation and more elastic fascia. The positive effects of this have also been described.

Application tips for forefoot pain

Before you wear kybun shoes for the first time, you should consider a few tips on how to use them. Correct use of the shoes can help to relieve pain in the ball of the foot. Metatarsalgia pain can also be treated with targeted therapy, which is explained in the next section.

• At the beginning, only wear the kybun shoes for as long as your body allows. Take breaks if the pain in the ball of the foot increases or if your musculoskeletal system becomes tired. Metatarsalgia treatment takes time. The activating properties of kybun products train the muscles, which can lead to so-called initial reactions, especially at the beginning.
  
• Press your heel slowly and in a controlled manner into the elastic, springy material so that you can feel your heel sink in and tense your foot and leg muscles. A deliberate and controlled heel strike prevents the midfoot and forefoot from folding uncontrollably and thus protects the balls of the feet from excessive strain. At the beginning, make sure that the midfoot and forefoot are lowered slowly and that you do not roll too much over the forefoot. This is particularly important if you have severe pain in the forefoot.
  
• Take small, controlled steps at the beginning to get used to walking in kybun shoes and to take the strain off your forefoot. Increase the range of motion of your feet over time, if possible. Try to roll over the metatarsophalangeal joint in a controlled manner.
  
• Try the following exercises to boost the effectiveness of kybun shoes and increase the likelihood of recovery. These are intended as a complementary therapy for metatarsalgia and should be part of the treatment for pain in the ball of the foot.
  

Helpful exercises for forefoot pain

To enhance the effectiveness of kybun shoes and increase the likelihood of recovery from forefoot pain, we recommend performing the following exercises. The selection of exercises is not exhaustive and can be supplemented by other metatarsalgia exercises. The basic rule for all exercises is that the pain must not become more severe. If one of the metatarsalgia exercises increases the pain, it must be discontinued. Soothing and relieving "pain" outside of the pain point (e.g. in the calf) is desirable.
The metatarsalgia exercises are divided into the following areas: "Correct walking in kybun shoes", "Muscle length training", "Fascia rolling" and "Strengthening". Ideally, the different areas should be used as complementary therapy for metatarsalgia.

Walking correctly in kybun shoes
The quality of each individual step is crucial in metatarsalgia treatment in order to reduce pain and eliminate incorrect and excessive strain. The kybun shoes therefore offer an ideal therapy when the balls of the feet hurt.

Controlled heel strike

• Press the heel slowly and in a controlled manner into the elastic, springy material to pre-tension the foot and calf muscles.
• Lower the midfoot and forefoot slowly and in a controlled manner so that the forefoot is physiologically loaded.
• Take small steps at the beginning so that you do not have to roll too much over the forefoot.

Controlled rolling

• Easy rolling in the forefoot without actively pushing off over the forefoot with a lot of force. Active rolling increases the pressure on the forefoot and puts additional strain on the sensitive metatarsal heads.
• Test the possible range of motion when rolling in the forefoot without causing or increasing pain in the ball of the foot.
• If possible, increase the range of motion and switch to active rolling.

Muscle length training
Muscle length training is important in the treatment of metatarsalgia, as this is often caused by shortening and tension in the foot and leg muscles. Targeted stretching exercises can actively address the shortening and tension and are therefore an ideal therapy when the balls of the feet hurt.

Foot sole

• Take the foot in both hands.
• Actively pull the forefoot towards the shin to stretch the sole of the foot.
• Hold the exercise for 3 x 30 seconds.
• perform 1 - 2 × daily

Calf muscles

• Starting position in a lunge.
• The back heel is in contact with the ground and should not be lifted.
• Slowly bend your front knee forwards until you feel a pull in your calf.
• 3 x 30 seconds per side.
• perform 1 - 2 × daily.

Fascia roller
Fascia training with the fascia roller is important in the treatment of pain in the ball of the foot, as the development and symptoms are often caused by shortening and tension in the posterior chain (including the sole of the foot and calf muscles). By regularly rolling out the shortened and tense myofascial chain, the fascia roll can be used as an active metatarsalgia therapy.

Foot sole

• Actively roll out the sole of the foot with a fascia roller or ball from the heels to just before the metatarsal heads. Deliberately leave out the ball of the foot in case of severe pain.
• Perform the exercise slowly and in a controlled manner.
• Adjust pressure to personal feeling, but go up to the tolerable pain threshold.
• Roll out any localised adhesions or hold the position at this point.
• 3 minutes per foot.
• perform 1 - 2 × daily.

Calf muscles

• One leg bent and the other leg on the fascia roll. Increase the pressure by placing the legs on both sides. Further increase by placing the legs on top of each other.
• If you experience pain in the wrist, the exercise can also be performed on the forearms.
• Actively roll out the calf above the heel to just below the hollow of the knee.
• Perform the exercise slowly and in a controlled manner.
• Adjust pressure to personal feeling, but go up to the tolerable pain threshold.
• Roll out any localised adhesions or hold the position at this point.
• At least 3 minutes per foot.
• perform 1 - 2 × daily.

Strengthening

Targeted strength training for the feet is crucial so that the arch of the foot and muscles can fulfill their function as natural shock absorbers and optimally cushion any forces that occur. Regular muscle training is particularly important for splayfoot in order to protect the forefoot from overloading and incorrect loading. Strengthened foot muscles prevent the transverse arch from dropping and thus reduce the pressure on the sensitive metatarsal heads. Targeted strength training is therefore an effective measure for treating metatarsalgia.

Foot muscles Longitudinal arch

• Lay a towel or similar flat on the floor.
• Place the foot at the beginning of the towel.
• Grasp the towel with your toes and pull it towards your foot by flexing your toes.
• 3 sets of 8 - 12 repetitions per foot.
• Perform 2 - 3 × weekly.

Big toe lifts and toe raises

• Place your feet hip-width apart on the floor.
• Big toe lift: The big toe is actively lifted and slowly lowered again. All toes except the big toe remain on the floor. Do not lift the inner edge of the foot.
• Toe lift: Here, only the big toe remains on the floor. All other toes are actively lifted and slowly lowered again. Do not lift the outer edge of the foot.
• It is important that the balls of the feet and heels do not lose contact with the ground.
• To simplify the exercise, it can be performed alternately with one foot only.
• 3 sets of 8 - 12 repetitions per foot.
• Perform 2 - 3 × weekly.