Metatarsalgia (pain in the ball of your foot)

Metatarsalgia refers to pain and inflammation in the ball of your foot. It is often caused by excessive pressure from activities like running, wearing poorly fitted shoes, or foot deformities. While the pain can be uncomfortable, metatarsalgia treatment typically includes simple measures such as rest, ice, proper footwear, and supportive insoles. If your pain persists, you should see a healthcare professional to explore further treatment options.

What is Metatarsalgia?

Metatarsalgia (met-uh-tahr-SAL-juh) is characterised by pain and inflammation in the ball of your foot, or forefoot - the area between your arches and toes. This pain is typically focused under one or more of your metatarsal heads, the five bones at the bases of your toes. 

Common causes include:  

• Foot deformities  
• Medical conditions affecting your foot or ankle  
• Activities like running or jumping  
• Wearing shoes that are too tight or loose.  

While not usually serious, metatarsalgia can impact your daily activities. Treatments often begin with simple steps like rest, ice, and over-the-counter pain relief. Wearing well-fitting footwear with shock-absorbing insoles or arch supports may also help relieve pain and prevent future occurrences.

Symptoms of metatarsalgia  

Typical metatarsalgia symptoms are pain and discomfort in the ball of your foot. They may develop suddenly or over time, and can include:

• Sharp, aching, or burning pain in the ball of your foot.  
• Pain that worsens with activities like standing, running, walking (especially barefoot on hard surfaces) and improves with rest.  
• Numbness, tingling, or shooting pain in your toes.  
• A sensation of having a pebble or small stone in your shoe.  

Metatarsalgia symptoms often vary in intensity and may be accompanied by swelling or inflammation. If they persist, you should consult a healthcare professional for tailored treatment options. 

Causes of metatarsalgia 

Metatarsalgia occurs when excessive pressure or strain on the ball of your foot leads to pain and inflammation. This can happen during high-impact activities like running or jumping, wearing poorly fitted shoes such as high heels or tight footwear, or carrying excess weight that adds stress to your forefoot. Foot conditions like high arches or bunions may also contribute to this issue.

Injury from intense running or exercise

Distance runners and high-impact athletes are at a higher risk of developing metatarsalgia due to the repetitive force placed on the ball of their feet.

When running or engaging in high-impact sports, your forefoot absorbs significant pressure, which can cause pain and inflammation in the metatarsal area. Improper footwear (such as worn shoes, poorly fitting shoes, or those lacking proper support) can further increase your risk. For athletes in these categories, preventive measures like wearing shock-absorbing insoles and well-fitted shoes are recommended to minimise the likelihood of this condition.

Poorly fitting shoes

Poorly fitting shoes can significantly contribute to metatarsalgia by placing undue pressure on the ball of your foot. 

High heels are a common culprit, as they shift weight forward, concentrating stress on your metatarsals. Similarly, shoes with narrow toe boxes can compress your forefoot, while athletic shoes that lack proper support or cushioning fail to absorb impact, increasing your risk of pain and inflammation in the metatarsal area. 

Choosing well-fitted, supportive footwear is essential to prevent this condition.

Foot shape or deformities

Certain foot shapes and deformities can place additional pressure on your metatarsals, leading to ball of foot pain and inflammation. Understanding these factors can help in managing the condition and reducing pain effectively. For example:  

• Foot shapes - high arches can concentrate weight on your metatarsals, while having a second toe longer than your big toe can shift excess pressure onto the second metatarsal head. 
• Foot deformities - such as hammertoes (downward-curling toes) or bunions (swollen, painful bumps at the base of the big toes) alter your weight distribution and increase stress on your forefoot. Wearing poor fitting or weight changing shoes - such as those too small or high heels - can worsen these deformities and exacerbate metatarsalgia symptoms.  

Fractures

Fractures, particularly stress fractures in your metatarsals or toe bones, can contribute to metatarsalgia by altering how weight is distributed across your foot. 

These small bone breaks can cause significant pain and discomfort in the ball of your foot, leading to inflammation and changes in gait to avoid pressure on the affected area. This shift in weight-bearing mechanics often exacerbates stress on your metatarsals, further intensifying symptoms. 

Morton's neuroma

Morton's neuroma, a noncancerous thickening of nerve tissue, typically occurs between the third and fourth metatarsal heads. It can cause symptoms similar to metatarsalgia, such as sharp or burning pain in the ball of your foot, tingling, or numbness.

The nerve irritation associated with Morton's neuroma may also contribute to increased pressure on your metatarsals, exacerbating discomfort and altering weight distribution.

Causes of primary metatarsalgia

Primary metatarsalgia occurs when structural issues with your metatarsals affect their alignment with other parts of your foot. These factors can increase pressure on your metatarsals, contributing to inflammation and pain in the ball of your foot. Causes include:

• Bunions (hallux valgus)  
• Hammertoes  
• Calluses  
• High arches  
• A second toe longer than the big toe.  

Causes of secondary metatarsalgia

Secondary metatarsalgia occurs when health conditions or external factors increase pressure on your forefoot, leading to ball of foot pain and inflammation. Causes may include:

• Inflammatory conditions - rheumatoid arthritis, gout, sesamoiditis, or Morton’s neuroma.  
• Neurological disorders - Charcot-Marie-Tooth disease or Freiberg disease.  
• Metabolic diseases - obesity and diabetes, which affect foot mechanics and pressure distribution.  
• Other health issues - torn ligaments or plantar warts can alter foot function and increase strain.  
• Trauma - repeated impact from running or wearing poorly fitted shoes can exacerbate symptoms.  

Causes of Iatrogenic metatarsalgia

Latrogenic metatarsalgia is a type of metatarsal pain caused by complications from forefoot surgery. 

For example, bunion surgery may alter the mechanics of your big toe, leading to increased pressure on your metatarsals and subsequent pain. 

Other surgical complications, such as fractures that fail to heal properly or avascular necrosis (loss of blood supply to bone tissue), can also contribute to this condition. While rare, these outcomes can occur and may require additional treatment or management.

Risk factors of metatarsalgia

Certain factors can increase your risk of developing metatarsalgia. Recognising these factors can help in taking preventive steps to reduce the risk of metatarsalgia. They include:

• High-impact activities - participating in sports or activities like running and jumping that put repeated pressure on the forefoot.  
• Improper footwear - wearing high heels, poorly fitting shoes, or shoes with spikes, such as cleats, can increase stress on the metatarsals.  
• Excess weight - being overweight or obese places additional pressure on the ball of the foot.  
• Foot problems - conditions like hammertoes, calluses, or other foot deformities can alter weight distribution.  
• Inflammatory conditions - health issues such as rheumatoid arthritis or gout that cause inflammation in the joints.  

Metatarsalgia treatment 

Patients often come to us hoping to get immediate relief for metatarsalgia. Metatarsalgia treatment typically begins with conservative, non-invasive methods aimed at relieving pain and reducing pressure on your foot. Healthcare providers often recommend these approaches first to see if symptoms improve without the need surgery. 

Here are some common treatment options that may be explored.

RICE method for metatarsalgia

The RICE method (Rest, Ice, Compression, and Elevation) helps manage metatarsalgia by reducing pain and inflammation. Rest allows recovery, ice minimises swelling, compression supports your foot, and elevation reduces discomfort by improving blood flow.

Pain medications

Over-the-counter medications like acetaminophen (Tylenol®) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil®) and naproxen sodium (Aleve®) are commonly used to manage metatarsalgia. These medications help reduce pain and inflammation in the ball of your foot, providing relief for mild to moderate symptoms.

Exercises for metatarsalgia 

Metatarsalgia exercises and stretches can play a key role in relieving this ball of foot pain and preventing future issues by improving flexibility, reducing tension, and strengthening the foot. 

Common recommendations include:

• Toe stretches - gently pulling your toes back to stretch the tendons and muscles in the ball of your foot.  
• Calf stretches - stretching the calf muscles to reduce strain on your foot and improve overall alignment.  
• Toe scrunches - picking up small objects or scrunching a towel with your toes to strengthen foot muscles.  
• Heel raises - lifting your heels while keeping your toes on the ground to build strength in your arch and reduce pressure on your metatarsals.  
• Balance exercises - standing on one foot or using a foam pad to improve stability and foot control.  
• Marble pickups - use your toes to pick up marbles from the floor and place them in a container to enhance foot dexterity.
• Resistance band abductions - use a resistance band to stretch and strengthen your foot muscles.

Metatarsalgia shoe inserts and footwear

A change in footwear or the use of supportive inserts can help alleviate pressure on your metatarsals and reduce pain. Switching to athletic or rocker-soled shoes provides better cushioning and shock absorption, easing strain on the ball of your foot.

Additionally, using soft insoles or metatarsal pads can distribute weight more evenly, offering extra support and minimising discomfort during daily activities. These simple adjustments are often effective in managing metatarsalgia.

Metatarsalgia surgery

If conservative metatarsalgia treatments fail to relieve your ball of foot pain, your doctor may recommend foot surgery to address the underlying cause of your pain.

Surgical options can include procedures to release tight ligaments, remove inflamed tissue, or correct structural issues like bunions or hammertoes. These interventions aim to reduce pressure on your metatarsals and restore foot function.

How to ease pain in the ball of your foot at home

To help manage metatarsalgia pain, try these effective self-care tips:

• Rest and elevate - minimise stress on your foot by resting and raising it after activity.  
• Apply ice - use an ice pack (or frozen peas in a towel) on the painful area for 20 minutes every 2 to 3 hours.  
• Wear proper shoes - opt for shoes with enough space, a low heel, and a soft sole to support your foot.  
• Use Insoles or pads - insert soft insoles or metatarsal pads in your shoes for added cushioning.  
• Regular metatarsalgia exercises - gentle foot and ankle stretches can improve flexibility and alleviate tension.  
• Lose excess weight - shedding extra pounds reduces pressure on your feet.  
• Take painkillers - use over-the-counter medications like paracetamol or ibuprofen (gel or tablets) for pain relief.  

Metatarsalgia diagnosis

To diagnose metatarsalgia, a doctor typically uses several methods to identify the source of pain. These may include: 

• Physical examination - your doctor will inspect your foot while you stand and sit, assessing areas of tenderness, swelling, or alignment issues.  
• Lifestyle and activity assessment - questions about your daily habits, footwear choices, and physical activity levels will help pinpoint potential contributing factors.  
• Imaging tests - an X-ray may be ordered to detect or rule out stress fractures, arthritis, or other structural foot problems that could mimic metatarsalgia symptoms.  

When to see a doctor about metatarsalgia 

While some foot discomfort may resolve on its own, it's important to seek medical advice if you experience any of the following red flags:

• Persistent pain lasting more than two weeks, even after home treatment.  
• Pain in the ball of your foot that worsens or keeps returning.  
• Foot pain severe enough to interfere with normal daily activities.  
• Tingling, numbness, or loss of sensation in your foot.  
• Foot pain accompanied by swelling, redness, or fever, indicating possible infection.  
• If you have diabetes, as foot problems can be more serious and require immediate attention.