ConditionBones, joints & muscles
Metatarsalgia (Ball of Foot Pain)
Metatarsalgia is pain and inflammation in the ball of the foot, the area under the heads of the metatarsal bones just behind the toes. It is usually caused by too much pressure on this area, from high-impact activity, high heels or thin-soled shoes, excess weight, or foot shapes such as high arches, bunions or hammer toes. It feels like a burning or aching pain, or like walking on a pebble, and is worse when standing or walking. Supportive shoes, metatarsal pads and rest relieve most cases.
Also called: Ball-of-foot pain, forefoot pain, metatarsal pain
At a glance
- What it is
- Pain under the ball of the foot, usually at the second to fourth metatarsal heads.
- Feels like
- Burning, aching or sharp pain, or a pebble in the shoe, worse on standing and walking.
- Common causes
- Running and jumping, high heels, thin-soled shoes, excess weight, high arches, bunions, hammer toes.
- Conditions to rule out
- Morton's neuroma, stress fracture, Freiberg's disease, gout, plantar plate tear.
- Treatment
- Rest, ice, supportive cushioned shoes, metatarsal pads, stretching and weight management.
- Recovery
- Usually weeks to a few months with the right footwear.
When to get help
See a doctor within a day or two
- Sudden, severe forefoot pain with swelling and bruising after injury or a big increase in running (possible fracture)
- A hot, red, swollen, very painful joint at the base of a toe (possible gout or infection)
- Foot pain with redness, warmth and fever, especially with diabetes
Book a routine appointment
- Ball-of-foot pain lasting more than 2 weeks despite rest and better shoes
- Numbness, tingling or a burning sensation between the toes (possible Morton's neuroma)
- A toe that is drifting, lifting off the ground or developing a gap from its neighbor (possible plantar plate tear)
- Foot pain with diabetes or numb feet
Usually safe to manage at home
- Mild aching in the ball of the foot after a long walk or new shoes, improving with rest and cushioning
What causes metatarsalgia
The metatarsal heads bear a large share of body weight when you push off during walking and running. When pressure is too high, or the fat pad underneath is thinned, the area becomes inflamed and painful.
Common causes
- High-impact activities: running, jumping and court sports
- Footwear: high heels shift weight onto the forefoot; narrow toe boxes and thin soles concentrate pressure
- Excess body weight
- Foot shape: - high arches - a second toe longer than the big toe, or a long second metatarsal - tight calf muscles or Achilles tendon
- Toe deformities: bunions, hammer toes and claw toes push the metatarsal heads down
- Fat pad thinning with age
- Inflammatory arthritis such as rheumatoid arthritis
- Previous foot surgery that changed weight distribution
Symptoms
- Pain in the ball of the foot, often under the second, third or fourth toes
- Burning, aching or sharp pain
- Feeling like walking on a stone or a folded sock
- Worse with standing, walking, running or walking barefoot on hard floors
- Better with rest
- Sometimes numbness or tingling in the toes
- Calluses under the painful area
Conditions with similar symptoms
| Condition | Distinguishing features |
|---|---|
| Morton's neuroma | Burning, tingling or numbness between the third and fourth toes, clicking when squeezing the forefoot |
| Stress fracture | Pinpoint tenderness on the top of a metatarsal, swelling, after increased activity |
| Freiberg's disease | Collapse of the second metatarsal head, mostly in adolescent girls and young women |
| Plantar plate tear | Pain under the second toe joint, toe drifting or lifting |
| Sesamoiditis | Pain under the big toe joint |
| Gout | Sudden, intensely painful, red, swollen big toe joint |
| Tarsal tunnel syndrome | Burning and numbness across the sole |
Diagnosis
A doctor or podiatrist will examine the foot standing and walking, press on each metatarsal head and the spaces between them, and check for calluses, deformities and calf tightness. Tests may include:
- X-rays to look for fractures, arthritis, Freiberg's disease and foot alignment
- Ultrasound or MRI for Morton's neuroma, plantar plate tears or stress fractures not visible on X-ray
- Blood tests if gout or inflammatory arthritis is suspected
Treatment
Self-care
- Rest from high-impact activity, switching to swimming or cycling for a while
- Ice the area for 15 to 20 minutes a few times a day
- Pain relief: acetaminophen (paracetamol) or ibuprofen at label doses
- Lose weight if needed
Footwear and insoles
- Choose shoes with a wide toe box, cushioned sole and low heel
- Metatarsal pads placed just behind (not under) the painful area spread pressure away from the metatarsal heads
- Rocker-sole shoes reduce forefoot pressure during push-off
- Custom orthotics for foot shape problems
- Avoid walking barefoot on hard surfaces
Exercises
- Calf stretches: lean against a wall with the back leg straight, hold 30 seconds, repeat 3 times on each side
- Toe curls and towel scrunches to strengthen small foot muscles
- Toe spreads and picking up marbles with the toes
- Plantar fascia stretches by pulling the toes back
Medical treatment
- Physical therapy for gait and strength
- Corticosteroid injection for some causes such as Morton's neuroma, used cautiously
- Treating gout or inflammatory arthritis
Surgery
Rarely needed. Options include correcting toe deformities, repairing a plantar plate tear, or shortening a metatarsal (osteotomy) when conservative treatment fails.
Prevention
- Wear supportive, well-cushioned shoes for activity, and replace running shoes regularly
- Limit high heels
- Build up running distance gradually
- Maintain a healthy weight
- Stretch the calves regularly
Frequently asked questions
What is metatarsalgia?
Metatarsalgia is pain and inflammation in the ball of the foot, under the heads of the metatarsal bones. It usually results from excess pressure from activity, footwear, body weight or foot shape, and feels like burning, aching or walking on a pebble.
What causes pain in the ball of the foot when walking?
Common causes are metatarsalgia from overload or poor footwear, Morton's neuroma, stress fractures, bunions and hammer toes, and arthritis. Thinning of the fat pad with age also increases pressure on the area.
How long does metatarsalgia take to heal?
Most cases improve within a few weeks to a few months with rest, supportive shoes and metatarsal pads. Healing takes longer if the underlying cause, such as footwear, foot shape or high-impact training, is not addressed.
What is the best treatment for metatarsalgia?
The most effective measures are resting from high-impact activity, wearing cushioned shoes with a wide toe box and low heel, using metatarsal pads or orthotics, stretching tight calves, and losing weight if needed.
Can metatarsalgia be a stress fracture?
Ball-of-foot pain can be from a stress fracture, especially after a sudden increase in running or walking. Pinpoint tenderness on a bone, swelling and pain that persists at rest suggest a fracture, which needs an X-ray or MRI.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Orthopaedic Surgeons (OrthoInfo): Metatarsalgia
- American College of Foot and Ankle Surgeons: Metatarsalgia
- American Podiatric Medical Association: Forefoot pain
- NHS: Ball of foot pain
- American Academy of Family Physicians: Evaluation and treatment of forefoot pain