What is it?
The metatarsal heads carry much of your weight during push-off. Pain develops when one or more of them is overloaded, or when a nearby structure — a ligament, nerve, or joint — is injured.
What causes it?
- High heels and thin-soled shoes
- Bunions or hammertoes shifting load
- A long second metatarsal
- Loss of the fat pad with age
- High-impact activity
- Plantar plate injury, neuroma, or stress fracture
What does it feel like?
- Aching or sharp pain under the ball of the foot
- Pain that worsens barefoot on hard floors
- Calluses under one or more metatarsal heads
How is it diagnosed?
A careful exam to locate the exact source of pain, X-rays to check alignment and rule out stress fractures, and ultrasound when a nerve or ligament problem is suspected.
When should you see a podiatrist?
- Ball-of-foot pain lasting more than two weeks
- Swelling or bruising on the top of the foot
- A toe that is changing position
Nonsurgical treatment
- Cushioned, supportive shoes
- With a rocker sole if needed.
- Metatarsal pads and orthotics
- Redistribute pressure.
- Callus care
- Reduces focal pressure.
- Treatment of the underlying cause
- Such as a neuroma or plantar plate injury.
When is surgery considered?
Surgery is directed at the underlying cause — for example, a metatarsal that is too long or a deformity shifting weight — when conservative care has not helped.
Procedures may include shortening or elevating a metatarsal, repairing the plantar plate, or correcting an associated bunion or hammertoe.
Related procedures
What is recovery like?
Varies with the procedure; most forefoot surgery allows protected walking in a surgical shoe.
Frequently asked questions
Can shoes alone fix metatarsalgia?
Often they make a large difference, especially combined with a metatarsal pad. Persistent pain needs a specific diagnosis.