What is metatarsalgia?

Metatarsalgia is a painful inflammation in the ball of your foot. The ball of your foot is the area between your toes and your arch. Metatarsalgia is named for the five metatarsal bones in the midsection of your feet that connect to your toes.

Metatarsalgia commonly occurs from overuse injuries in sports that involve running and jumping. It can also result from shoes that don’t fit, foot abnormalities, or arthritis and other diseases.

The pain of metatarsalgia usually begins gradually over time. It may improve when you rest your foot and get worse when you stand, walk, or exercise. Your foot may feel like:

  • you’re walking with a marble or pebbles in your shoe
  • you have a sharp burning or shooting pain in the ball of your foot
  • your toes are numb or tingling

You may also notice that your pain gets worse when you:

  • stand
  • run
  • walk barefoot
  • participate in a high-impact sports activity

The most frequent cause of metatarsalgia is participating in sports activities that put pressure on the metatarsal bones at the front of your foot. These activities often lead to overuse of the area. Running, for example, involves putting constant force on the ball of your foot. The abnormal stress on your foot can increase inflammation in the metatarsal area. It can also irritate the tendons, ligaments, and cartilage around the bone.

Other causes include:

  • Shoes that don’t fit right: Your shoes may be too tight, squeezing your foot. Or your shoes may be too loose, making your foot slide back and forth.
  • High heels or sneakers without adequate padding and arch support: These shoes can cause you to put more weight on the ball of your foot.
  • Foot abnormalities: High arches, a second toe that is longer than your big toe, calluses on the bottom of your foot, bunions, and hammer toe can contribute to metatarsalgia.
  • Extra weight: Being overweight or obese puts more pressure on your feet and metatarsal area.
  • Some diseases: Bursitis, arthritis, gout, Morton’s neuroma, and small stress fractures in your toes and metatarsal bones can increase the stress on the ball of your foot.

People who play high-impact sports that involve running and jumping have a greater risk of metatarsalgia. Also at greater risk are athletes who wear shoes with spikes or shoes without good support.

Other people who have a greater risk of metatarsalgia include:

  • older people
  • women who wear high heels
  • people who wear ill-fitting shoes
  • people who have inflammatory arthritis or foot deformities
  • people who are overweight or obese

If your pain in the metatarsal area persists for a few days after resting your feet or changing your footwear, it’s best to see a doctor.

Your doctor will examine your foot and ask you to walk so they can observe your gait. They will also ask you questions about your activities and when the pain started. If your doctor suspects other causes of the pain, you may have other tests. These may include:

  • an X-ray to rule out a stress fracture
  • a blood test to check for uric acid, which is an indication of gout
  • an ultrasound test to look at soft tissue problems like bursitis or neuromas, which may contribute to metatarsalgia
  • magnetic resonance imaging (MRI) to look for evidence of arthritis and possible injuries

Treatment for metatarsalgia depends on the cause and severity of your pain. Usually, conservative measures like staying off of your feet, changing your footwear, and using an orthotic pad in your shoe will relieve the pain.

At-home remedies include:

  • resting your foot
  • icing your foot a few times per day, 20 minutes at a time
  • elevating your foot after activity
  • taking an over-the-counter pain reliever to help with pain and inflammation
  • losing weight if you’re overweight

You may also be able to ease pain and prevent recurrence by replacing your shoes with a well-fitting pair with good support. You should also avoid wearing high-heeled shoes. A break from high-impact sports or exercise routines should also help. For exercise, try swimming or cycling, which are low impact.

Your doctor may recommend you work with a physical therapist. They can give you range-of-motion exercises and exercises that strengthen surrounding muscles. The therapist can also help correct your gait, if necessary.

An occupational therapist may also be able to help. They can fit you with custom orthotics, such as a metatarsal pad or arch support. One small study found that custom-made sandals with a metatarsal pad had the best results in increasing walking time and distance without pain.

If your pain persists after trying conservative treatment measures, you may be a candidate for surgery to realign your metatarsal bones.

If left untreated, pain can cause you to alter your gait, which may affect your hips, lower back, and legs.

Most metatarsalgia eases with conservative measures and properly fitting footwear. Early diagnosis and treatment usually gives you a good prognosis. In some cases, you may need surgery to treat the underlying cause of the pain.