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Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball-of-the-foot). This is a common foot disorder that can affect the bones and joints at the ball-of-the-foot. Metatarsalgia (ball-of-foot-pain) is often located under the 2nd, 3rd, and 4th metatarsal heads. It can also affect the first metatarsal head (near the big toe) and the fifth metatarsal head (near the baby toe).


With this common foot condition, one or more of the metatarsal heads become painful and/or inflamed, usually due to excessive pressure over a long period of time. It is common to experience acute, recurrent, or chronic pain with metatarsalgia. Ball-of-foot pain is often caused from improper fitting footwear, most frequently by women's dress shoes and other restrictive footwear. Footwear with a narrow toe box (toe area) forces the ball-of-foot area to be forced into a minimal amount of space. This can inhibit the walking process and lead to extreme discomfort in the forefoot. Other factors can cause excessive pressure in the ball-of-foot area that can result in metatarsalgia. These include shoes with heels that are too high or participating in high impact activities without proper footwear and/or orthotics. Also as we get older, the fat pad in our foot tends to thin out, making us much more susceptible to pain in the ball-of-the-foot.

Treatment and Prevention

The first step in treating metatarsalgia is to determine the cause of the pain. If improper fitting footwear is the cause of the pain, the footwear must be changed. Footwear designed with a high, wide toe box (toe area) and a rocker sole is ideal for treating metatarsalgia. The high, wide toe box allows the foot to spread out while the rocker sole reduces stress on the ball-of-the-foot. Unloading pressure to the ball-of-the-foot can be accomplished with a variety of footcare products. Orthotics designed to relieve ball-of-foot pain usually feature a metatarsal pad. The orthotic is constructed with the pad placed behind the ball-of-the-foot to relieve pressure and redistribute weight from the painful area to more tolerant areas. Other products often recommended include gel metatarsal cushions and metatarsal bandages. When these products are used with proper footwear, you should experience significant relief.

The neuroma is a nerve irritation that occurs in the ball of the foot. Between each of the metatarsal bones in each foot courses a nerve. When this nerve passes between the metatarsal heads at the ball of the foot, they will sometimes become pinched by a shearing force that occurs between the metatarsal bones.  This occurs most often between the third and fourth toes, or between the second and third toes.  When the nerve is pinched, it becomes irritated, swollen and enlarged.  When the nerve swells, it becomes more irritated and painful. Pain often starts as numbness or tingling, sometimes as a burning sensation in the toes. As this cycle progresses, causing more and more pain. Patients often will describe a burning or stabbing type of pain in the ball of the foot.  The pain will sometimes radiate into the toes of the foot. Pinching between the toes while squeezing the front of the foot will usually cause the pain to occur. People will say they get relief from removing their shoes and massaging their foot. 


Treatment involves reducing the shear forces between the metatarsal heads by controlling the amount of pronation the foot goes through. This is accomplished with the use of an orthotic.  Often custom orthotics are superior in this case to over-the counter versions as the forces through the forefoot can be much more accurately controlled. Physiotherapy can help to reduce the inflammation in the area. Occasionally cortisone, or other specialty injections are also used.



Socks scrunched up inside your shoes? Tender to walk on the ball of the foot? This could be a condition called metatarsalgia. Forefoot pain localized to a joint? Maybe bursitis or capsulitis?

Sharp stabbing pain in the foot? Numb, tingling or burning toes when you walk? It could be a neuroma.