Pain in the ball of your foot (metatarsalgia) and how to get relief

Most of us don’t realize how many steps we take in a day until we experience foot pain. And when each step hurts, it may feel like you have to put your fitness goals, favorite activities, even your daily tasks on hold.

Pain that occurs in the ball of your foot – the area where your toes meet your arch (also called the forefoot) – is known as metatarsalgia. Named for the metatarsal bones of your foot, metatarsalgia is most commonly an overuse injury related to physical activity. Often, it’s a sign there is too much pressure being applied to your forefoot, leading to inflammation in one or more of the metatarsal bones.

Below, we’ll lead you through the hallmark signs and symptoms of metatarsalgia, how to treat it if you’ve got it, and how to prevent it once and for all.

The main symptom of metatarsalgia is forefoot pain

At the front of your foot, the metatarsal bones fan out and connect to each of the first toe bones (called phalanges). When too much pressure is applied to one or more metatarsal bone for too long, the bone can become painful and inflamed. This is metatarsalgia. Symptoms of metatarsalgia can include:

• Burning, aching or stinging pain concentrated in and around the ball of your foot, which worsens when standing, walking, being barefoot or squatting
• Tingling and loss of sensation in the toe or toes
• Inflammation and swelling in the forefoot area

Metatarsalgia may feel like a rock in your shoe

In addition to forefoot pain, metatarsalgia can cause a distinct sensation in your foot. When you have metatarsalgia, you may feel as if you’re walking around with a pebble or marble in your shoe. It can also feel like you have a deep bruise in your forefoot – metatarsalgia is sometimes called a “stone bruise.”

What does metatarsalgia look like?

The inflammation of metatarsalgia is happening inside your foot, so at first, metatarsalgia will show no apparent signs. If the condition worsens, your forefoot area may start to appear inflamed, swollen or red.

Causes of metatarsalgia fall into three categories

Podiatrists, or doctors specializing in foot and ankle care, categorize the causes of metatarsalgia into three groups: primary, secondary and iatrogenic.

Primary metatarsalgia

If metatarsalgia is originating from a structural abnormality of the foot, then it’s considered primary metatarsalgia. These issues directly affect the metatarsal bones and include:

• Bunions
• High arches
• Hammertoes
• Calluses

Secondary metatarsalgia means your metatarsalgia is caused by other health conditions you have or related to activities you do. Common causes of secondary metatarsalgia can include:

• Morton’s neuroma – This is a thickening of the tissue surrounding the nerves (known as the common digital plantar nerves) that branch out into your toes, causing pain.
• Conditions that make walking painful – Rheumatoid arthritis, gout, diabetes and plantar warts can affect the joints, nerves and soles of our feet, making our normal way of walking (our “gait”) painful. As we adjust our gait to avoid pain, this can put more pressure on the metatarsals.
• Wearing high heels or poorly fitting shoes – Shoes like high heels, narrow styles and flats can squeeze our toes, aggravate high arches and put extra pressure on the forefoot.
• Running, jumping or other high-impact physical activities – There’s nothing wrong with an intense workout, but make sure you have the correct footwear and that you alternate between hard and soft surfaces – by running on grass instead of pavement for a mile or two, for example – to avoid secondary metatarsalgia.
• Stress fractures – Your metatarsalgia may be a sign that one or more of your metatarsals has suffered a stress fracture. Stress fractures are often the result of intense, repeated movements, or a symptom of osteoporosis.

Iatrogenic metatarsalgia

“Iatrogenic” describes an illness, injury or other condition caused by medical intervention. In the case of iatrogenic metatarsalgia, this means it developed as a complication of foot surgery (like bunion surgery) or as a result of broken bones in the foot that healed incorrectly. Iatrogenic metatarsalgia can also be caused by avascular necrosis, when bones in the foot are deprived of blood supply temporarily or permanently, but this is rare.

Treatment for metatarsalgia starts at home

You should be able to self-diagnose metatarsalgia and, depending on the cause of it, treat it relatively well at home with the following:

Select shoes with metatarsal support

Shoes with arch support, forefoot cushioning, a wide toe box and a low heel can alleviate metatarsalgia pain. Consider shopping at a sporting goods store with specialists who can help you select the right shoe for your needs.

Metatarsalgia orthotics (pads and insoles)

Over-the-counter or custom orthotic devices that support high arches and provide more padding in the forefoot area can be added to footwear you already own, and relieve pressure on the metatarsal bones.

Other at-home treatments

• RICE – Rest, ice, compression and elevation can provide immediate pain relief.
• Over-the-counter anti-inflammatories – NSAIDs can be taken as needed, but are not a permanent solution to metatarsalgia.
• Metatarsal exercises – Foot, ankle and calf stretches keep muscles and ligaments that surround the metatarsal bones (and those that contribute to the way we walk) flexible and strong. These exercises and stretches can also relieve pain and prevent metatarsalgia.

How to prevent metatarsalgia

Not all cases of metatarsalgia can be prevented. But many of the ways you treat metatarsalgia are also the ways you can prevent it in the first place – or keep it from coming back. These include:

• Wearing proper footwear
• Filing down calluses
• Maintaining a healthy weight

When to see a doctor for metatarsalgia treatment

Achey feet after a long day of exercise or work can be normal. However, once you put your feet up and rest, maybe even ice them, the pain should go away. If pain in your feet persists, it could be a sign of something more serious, including metatarsalgia. See a podiatrist if:

• Your foot pain lasts for more than two weeks, or it keeps coming back, despite at-home treatments
• Tingling and numbness spreads from your toes to the rest of your foot
• You have diabetes
• The pain is so severe you can’t walk

A podiatrist can give you corticosteroid injections to alleviate inflammation, plus refer you to physical therapy or recommend you for surgery.

Physical therapy

Physical therapy can be an excellent option for treating persistent metatarsalgia without the need for surgery.

A physical therapist can lead you through exercises and stretches that relieve the pressure on the ball of your foot, plus give you strategies for prevention. They can also help you adapt your favorite activities to engage in them without pain.

They may perform interferential electric current therapy (IECT), a procedure in which electrical currents are sent into the tissue of the foot to reduce pain and inflammation.

Surgeries for metatarsalgia

Depending on your unique case, surgical treatment for metatarsalgia is often reserved as a last resort. Surgeries performed for metatarsalgia will seek to correct foot structure abnormalities.

• Metatarsal osteotomy – In this procedure, a foot surgeon cuts the metatarsal bone and repositions it to correct the alignment with the first toe bone.
• Hammertoe repair – Hammertoe describes a toe with the middle joint stuck in a bent position. Because hammertoe can be a cause of metatarsalgia, metatarsalgia can be resolved through the surgical repair of hammertoe. A foot surgeon may lengthen the tendon of the affected toe, or remove and reposition the metatarsal and phalange bones.
• Bunion surgery – A bunion is a growth of bone or tissue most commonly at the first big toe joint, caused by repeated stress or pressure on that area. To repair a bunion, a foot surgeon will remove the growth and realign the bones and ligaments.

Don’t ignore forefoot pain

Taking a walk with your dog, training for a 5k run, or gardening with your grandchild doesn’t have to be accompanied by a nagging sting or ache in your forefoot. Addressing pain in your feet from metatarsalgia can make a huge difference in the enjoyment of your favorite activities – and your overall quality of life.