What is Metatarsalgia?

Metatarsalgia is a condition that causes pain and inflammation in the ball of the foot—the area just behind the toes where the metatarsal bones bear weight. It’s not a disease itself but a symptom that can result from a variety of underlying issues, including foot structure, overuse, or ill‑fitting shoes. While not usually serious, metatarsalgia can make walking, running, or even standing uncomfortable if left untreated.

Causes

Metatarsalgia develops when excess pressure or stress is placed on the metatarsal bones. Common causes include:

  • High‑impact activities – running, jumping, or sports that stress the forefoot

  • Foot structure – high arches, a long second toe, bunions, or hammertoes

  • Improper footwear – high heels, narrow toe boxes, or worn‑out shoes

  • Excess weight – added pressure on the forefoot

  • Stress fractures – small breaks in the metatarsals that alter weight distribution

  • Other conditions – Morton’s neuroma, arthritis, gout, or Freiberg’s disease

  • Post‑surgical changes – sometimes after bunion or forefoot surgery (iatrogenic metatarsalgia)

Symptoms

Typical symptoms of metatarsalgia include:

  • Sharp, aching, or burning pain in the ball of the foot

  • Pain that worsens with standing, walking, running, or flexing the toes

  • Pain that improves with rest

  • Tingling, numbness, or shooting pain into the toes

  • A sensation of “walking on a pebble” inside the shoe

  • Swelling or tenderness under the metatarsal heads

Diagnosis

Diagnosis usually involves:

  • Physical exam – checking for tenderness, swelling, and foot structure

  • Gait evaluation – observing how weight is distributed when walking

  • Imaging – X‑rays to rule out fractures; MRI or ultrasound if soft tissue or nerve involvement is suspected

  • Medical history – reviewing footwear, activity level, and underlying conditions

Nonsurgical Treatment

Most cases improve with conservative care:

  • RICE protocol – Rest, Ice, Compression, Elevation

  • Footwear changes – supportive shoes with wide toe boxes and cushioning

  • Orthotics or metatarsal pads – to redistribute pressure

  • Stretching and strengthening exercises – for the foot and calf

  • Weight management – to reduce stress on the forefoot

  • Medications – NSAIDs for pain and inflammation

  • Callus care – trimming or padding thickened skin to reduce pressure points

When is Surgery Needed?

Surgery is rarely required but may be considered when:

  • Pain persists despite months of nonsurgical treatment

  • There are structural deformities (bunions, hammertoes, long metatarsals) causing ongoing pressure

  • Stress fractures or joint damage require correction

Surgical options may include:

  • Osteotomy – realigning or shortening a metatarsal bone

  • Debridement – removing inflamed tissue or neuromas

  • Correction of deformities – bunion or hammertoe repair

  • Joint procedures – in advanced arthritis cases