Metatarsalgia – Causes, Symptoms and Treatment Methods

Metatarsalgia is pain in the ball of the foot. Metatarsalgia frequently affects runners and other athletes who participate in high-impact sports. Metatarsalgia often is referred to as a symptom, rather than as a specific disease. 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, or more isolated at the first metatarsal head (near the big toe). Metatarsalgia is a symptom, not a diagnosis. A careful study of ninety-eight patients who had complaints of pain in the fore part of the foot revealed twenty-three distinct diagnoses. These diagnoses were grouped as primary metatarsalgia, secondary metatarsalgia, and pain under the fore part of the foot. Metatarsalgia occurs in the region between the arch and the toes. The medical term for foot pain, metatarsalgia, comes from the name of the bones that are in this part of the foot: the metatarsals. It is usually felt in the sole of the foot and sometimes feel like “walking on pebbles”. Other people feel a more diffuse vague pain, ache or burning. Some people hve trouble around only one or two toes, others have it throughout one or both feet. Occasionally, pain is felt throughout the sole of the foot.

Metatarsalgia can be due to a number of different biomechanical conditions of the foot. And in many cases, the foot is simply predisposed to developing metatarsalgia. It is a diagnostic challenge and a good example of the importance of careful history taking and examination in the foot, as it has many causes and sometimes more than one is present. People with certain foot shapes that create more stress on the metatarsal bones also may have these problems. 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. Metatarsalgia experts indicate that high arches, deformities of the toes, stiff ankles, irritated nerves in the forefeet, bunions, poor circulation to the feet (due to diabetes), gout, arthritis, weight gain, and shoes with too-high heels are also predisposing factors. Metatarsalgia can readily be treated with orthotics to alleviate pressure in the area and ‘create’ a metatarsal arch. It is also important to decrease the pressure on the ball of the foot by lowering heel height and having a flexible ankle joint.

Causes of Metatarsalgia

The common causes and risk favtor’s of Metatarsalgia include the following:

Muscle fatigue.

Avascular necrosis, sesamoiditis.

The foot frequently is injured during sports activities.

Vascular insufficiency.

Poor blood supply to the feet.

Tight toe extensors.

Interdigital neuroma.

Metatarsophalangeal synovitis.

Being overweight.

Neurological problem.

Symptoms of Metatarsalgia

Some sign and symptoms related to Metatarsalgia are as follows:

Pain in the middle of the foot.

A feeling in your feet as if you’re walking on pebbles or have a bruise from a stone.

Sharp or shooting pain in your toes.

Tingling/Numbness in toes.


Increased pain when you’re walking barefoot, especially on a hard surface

Callousing under 2/3/4th toes.

Treatment of Metatarsalgia

Here is list of the methods for treating Metatarsalgia:

Nonsteroidal anti-inflammatory drug such as ibuprofen (Advil, Motrin, others) to help reduce pain and inflammation.

Wearing a more supportive shoe.

Applying an ice pack or package of frozen peas to the affected site several times during the first 24 hours can reduce inflammation and help relieve pain.


Physical Therapy – Ultra sound/ Electrical Stimulation/ Paraffin/Deep Heat/Whirlpool.

Other products often recommended include gel metatarsal cushions and metatarsal bandages.When these products are used with proper footwear, you should experience significant relief.

If inflammation is present (synovitis), a local corticosteroid/anesthetic injection may be useful.

Surgery may be needed if conservative therapy is ineffective.