Metatarsalgia

Overview

Metatarsalgia is a general term for pain and inflammation in the ball of the foot, the padded area just behind the toes where the long foot bones (metatarsals) meet the toes. It is a symptom rather than a single disease and can have several underlying causes.

The condition is common in active people and in those who wear shoes that concentrate pressure on the forefoot. It is usually not serious and tends to improve with rest, footwear changes, and other simple measures, but persistent pain should be checked to identify and treat the underlying cause.

Symptoms

Symptoms center on the ball of the foot and may include:

• Aching, burning, or sharp pain in the ball of the foot
• Pain that worsens when standing, walking, or running, and eases with rest
• A feeling of having a pebble or lump in the shoe
• Tingling or numbness in the toes
• Pain that increases when flexing the foot or walking barefoot on hard surfaces

The pain often builds gradually over time rather than appearing suddenly. It may affect one spot or spread across the whole ball of the foot, and it can involve one or both feet. Some people find that the discomfort eases when they take their shoes off or rest, only to return when they resume standing or walking. Paying attention to when the pain is worst can help identify contributing factors such as specific shoes or activities.

Causes

Metatarsalgia develops when too much pressure is placed on the ball of the foot. Contributing causes include:

• High-impact activities such as running and jumping
• Shoes that are too tight, lack cushioning, or have high heels
• Foot shapes such as high arches or a long second toe
• Excess body weight
• Other foot problems such as bunions, hammertoes, or a nearby nerve growth (Morton neuroma)
• Stress fractures or thinning of the natural fat pad with age

Risk Factors

• Participation in high-impact sports
• Wearing high heels or poorly fitting shoes
• Foot deformities such as bunions or hammertoes
• Excess body weight
• Increasing age
• Other foot conditions affecting the forefoot

Diagnosis

Diagnosis is mainly clinical, based on the location of pain and an examination of the foot.

• Physical exam: pressing on the ball of the foot to locate the pain and checking foot shape and mechanics
• Gait assessment: watching how you walk and how pressure is distributed
• Imaging: X-rays to look for stress fractures or alignment problems, and sometimes ultrasound or MRI to check for a nerve growth or other soft-tissue cause

Treatment

Most cases respond well to conservative care that reduces pressure on the forefoot.

• Rest and ice: reducing high-impact activity and icing the area to ease pain and swelling
• Better footwear: well-fitting, cushioned, low-heeled shoes with a roomy toe area
• Inserts and pads: metatarsal pads or orthotic insoles to redistribute pressure away from the ball of the foot
• Pain relief: over-the-counter pain relievers as needed
• Treating the cause: addressing related problems such as bunions or a Morton neuroma

If pain persists despite these steps, physical therapy or, rarely, surgery may be considered for an underlying structural problem. Most people improve over several weeks once pressure on the forefoot is reduced. The key is to identify and address what is overloading the ball of the foot, whether that is footwear, activity level, body weight, or a structural issue, rather than simply masking the pain.

Prevention

• Choose supportive, well-cushioned shoes with a wide toe box
• Limit time in high heels and tight shoes
• Use metatarsal pads or insoles if you are prone to forefoot pain
• Increase exercise intensity gradually
• Maintain a healthy weight

When to See a Doctor

See a doctor if ball-of-foot pain lasts more than a few weeks despite rest and supportive shoes, or if it limits your daily activities. Also seek care for:

• Severe pain that came on suddenly, which could suggest a stress fracture
• Redness, warmth, or swelling that might indicate infection
• Persistent numbness or tingling in the toes
• Pain in someone with diabetes or poor circulation, which needs prompt attention

Related Topics

Frequently Asked Questions

References

1. American Academy of Orthopaedic Surgeons (AAOS).
2. Mayo Clinic. Metatarsalgia.
3. MedlinePlus, U.S. National Library of Medicine. Foot pain.
4. American College of Foot and Ankle Surgeons.