What is Metatarsalgia?

Metatarsalgia describes pain and inflammation on the ball of the foot on the sole.

Diagram showing the area of pain experienced with Metatarsalgia

Causes and Risk Factors

Metatarsalgia is caused by too much pressure or loading on one area of the foot.

Risk factors include:

  • A short first metatarsal (bone in the foot near the big toe) compared with the second metatarsal (similar bone near the 2nd toe), so the and toe takes too much load.
  • An imbalance of the tendons to the toes so it forces that area of the bone closer to the ground
  • Repetitive heavy weight bearing such as long distance running or high impact sport
  • A tight achilles tendon
  • Ill-fitting shoes or high heel shoes
  • Increased weight
  • Stress fractures
  • Other lesser toe deformities (lesser toes are toes 2-5)
  • Bunions
  • Torn ligaments in the feet
  • Abnormal foot shape
  • Increased age: the fat pad on the ball of the foot gets thinner over time
  • Rheumatoid arthritis


  • Pain over the ball of the foot, worse with increased weight bearing


A clinical examination will help find the cause of the pain. An x-ray of both feet while standing will also help diagnose the bony problems. If the diagnosis is not clear, a CT scan or MRI scan may be required.


The aim of treatment is to relieve pain by off loading the ball of the foot. This can include:

  • Shoes: Extra padding in shoes also helps by cushioning the painful area during walking, such as sneakers. It also helps if they have a rocker bottom on the sole. Avoiding high heels will also help relieve pain. Also avoiding walking bare foot on hard ground can help decrease the pain and inflammation
  • Orthotics: An orthotic in the shoe can help with a 'cut out' for the painful area of the feet
  • Medications: Paracetamol and or ibuprofen (anti-inflammatory medications) can help with the pain during acute periods of pain
  • Physiotherapy: Stretching the Achilles can sometimes help relieve pressure on the ball of the foot
  • Weight loss: the more weight that is put through foot, the worse the pain and progression can be.
  • Surgery: Depending on the cause of the pain, surgery can help relieve the pain. This can range from soft tissue release to bony foot reconstruction

If you would like an opinion on this condition. please book an appointment with Dr Christy Graff.

Useful Websites

Healthline https://www.healthline.com/health/metatarsalgia