- Metatarsalgia is pain and inflammation in the ball of the foot
- Common causes include high heels, high-impact activities, and foot deformities
- Most cases respond to conservative treatment like proper shoes and orthotics
- Ignoring the pain can lead to compensatory injuries elsewhere
What Is Metatarsalgia?
Metatarsalgia (met-uh-tar-SAL-juh) is a general term for pain in the ball of the foot—the area between your arch and toes where the metatarsal bones connect to the toe bones. It's not a specific injury or disease, but a symptom that can have many causes.
If you feel like you're walking on a pebble or have a bruise under the ball of your foot, you may have metatarsalgia. This common condition affects athletes, people who wear high heels, and anyone whose activities put excessive pressure on the forefoot.
Understanding the Anatomy
The ball of your foot contains:
- Metatarsal heads: The rounded ends of the five long bones of your foot
- Fat pad: Cushioning tissue that absorbs impact
- Nerves: Including branches that can become irritated
- Soft tissue: Ligaments, tendons, and joint capsules
When any of these structures becomes irritated, inflamed, or damaged, you experience metatarsalgia.
What Causes Ball of ?
High-Impact Activities
Running, jumping, and other high-impact sports put tremendous pressure on the ball of your foot. Without adequate cushioning or rest, the tissues become inflamed.
Improper Footwear
High heels shift your body weight forward onto the ball of the foot. The higher the heel, the greater the pressure—a 3-inch heel increases forefoot pressure by 76%. Shoes without cushioning (like dress shoes, flats, or worn-out athletic shoes) fail to protect the metatarsal area. Narrow toe boxes squeeze the metatarsals together, causing friction and pressure.Foot Shape and Structure
Some foot types are more prone to metatarsalgia:
- High arches concentrate pressure on the heel and ball of foot
- Long second toe (Morton's toe) shifts extra weight to that metatarsal
- and claw toes change weight distribution
- can affect how pressure spreads across the forefoot
Excess Weight
Extra body weight increases pressure on the ball of the foot with every step.
Age
The fat pad under the ball of the foot thins with age, providing less natural cushioning.
Other Conditions
Metatarsalgia can also be related to:
- Morton's neuroma (nerve irritation)
- Stress fractures of the metatarsals
- Arthritis in the forefoot joints
- Sesamoiditis (inflammation of small bones under the big toe joint)
Symptoms of Metatarsalgia
Common symptoms include:
Pain in the Ball of the Foot
- Sharp, aching, or burning pain
- Worse when standing, walking, running, or flexing the foot
- Better when resting
- May affect one or more metatarsal heads
Sensation Changes
- Feeling like there's a pebble in your shoe
- Numbness or tingling in the toes (may indicate nerve involvement)
- Sensation of walking on a lump
Timing
- Often worse with barefoot walking, especially on hard surfaces
- Increases throughout the day
- May be particularly painful after activity rather than during
When to See a Podiatrist
See a foot specialist if:
- Ball of persists for more than a few days
- Pain affects your daily activities or exercise
- You notice swelling, bruising, or skin changes
- Home treatments aren't helping
- You have diabetes or circulation problems
At Central Florida Foot & Ankle Institute, we'll identify the specific cause of your metatarsalgia and create a targeted treatment plan.
Diagnosis
Physical Examination
We'll examine your foot, locate the exact area of tenderness, and check for structural issues. Squeezing the metatarsals together (the "squeeze test") helps identify nerve-related causes like Morton's neuroma.
Gait Analysis
Watching you walk reveals how pressure is distributed across your feet.
Imaging
X-rays can reveal stress fractures, arthritis, and bone abnormalities. Ultrasound visualizes soft tissue problems, including neuromas. MRI may be ordered for complex cases to see detailed soft tissue structures.
Treatment Options
Conservative Care (Start Here)
Most metatarsalgia responds well to non-surgical treatment:
Rest and activity modification: Reduce high-impact activities. Switch to low-impact exercise like swimming or cycling while healing. Ice: Apply ice for 15-20 minutes several times daily to reduce inflammation. Proper footwear: Choose shoes with:- Wide toe boxes
- Good cushioning
- Low heels (under 2 inches)
- Adequate arch support
See our guide to choosing the right shoes.
Metatarsal pads: These adhesive pads sit just behind the ball of the foot, redistributing pressure away from painful areas. They can be life-changing for some patients. Custom orthotics: Prescription inserts address your specific foot structure and mechanics, providing support and cushioning exactly where needed. Over-the-counter pain relievers: NSAIDs like ibuprofen reduce pain and inflammation.Advanced Treatments
For persistent metatarsalgia:
Corticosteroid injections: Reduce inflammation in specific areas. Physical therapy: Exercises to strengthen foot muscles and improve flexibility. Shockwave therapy: Stimulates healing in chronic cases.Surgical Options
Surgery is rarely needed but may be considered for:
- Metatarsalgia caused by structural deformities (, )
- Morton's neuroma esn't respond to conservative care
- Severe cases that haven't improved after extensive conservative treatment
Procedures may include realigning metatarsal bones, releasing tight ligaments, or removing neuromas.
Prevention Strategies
Choose Shoes Wisely
- Save high heels for special occasions, not daily wear
- Look for cushioned soles and wide toe boxes
- Replace athletic shoes regularly (every 300-500 miles for runners)
- Match shoes to your activities
Maintain a Healthy Weight
Every pound lost reduces pressure on your feet by several pounds of force.
Build Strength and Flexibility
- Toe curls and marble pickups strengthen intrinsic foot muscles
- Calf stretches reduce strain on the forefoot
- Gradually increase exercise intensity to avoid overuse
Use Metatarsal Supports
If you're prone to ball of , metatarsal pads in your shoes can prevent problems before they start.
Address Foot Problems Early
, , and other deformities worsen over time. Early treatment prevents compensatory pain like metatarsalgia.
Get Back on Your Feet
Ball of shouldn't limit your activities. With proper diagnosis and treatment, most people with metatarsalgia find significant relief.
At Central Florida Foot & Ankle Institute, we get to the root cause of your pain and create a treatment plan tailored to your lifestyle. Whether you're an athlete, a professional who spends long hours on your feet, or someone who simply wants to walk without pain, we can help.
📞 Schedule your appointment today and take the first step toward comfortable feet.