Metatarsalgia (pain in the ball of your foot)

Your symptoms for metatarsalgia will generally develop gradually over time, and may improve once you rest your foot and become worse when you stand, walk, or exercise. If you have any of the below issues, it is possible that you might have metatarsalgia.

• Feeling like you're walking on pebbles
• Burning, shooting, or aching pain under the ball of your foot
• Numbness or tingling in your toes
• Warmth and swelling in the affected area

Metatarsalgia occurs for a variety of reasons, all of them relating to changes in your metatarsal bones and its surrounding structures.

Your foot contains small toe nerves that sit between your metatarsal bones. Normally, these nerves pass through freely, but if too much pressure is put on this area, the head of one of your metatarsal bones can press against another, meaning that your nerve can also become compressed and subsequently inflamed, leading to pain in the ball of your foot.

Physical activity

If you regularly participate in a sport that leads to overuse and high levels of pressure on the balls of your feet, such as running or football, you are more at risk of developing metatarsalgia. This is because the constant impact on your metatarsal bones can cause them to become irritated and swollen, leading to less space between them, which may mean that your nerves end up being compressed and you experience pain.

Footwear

Wearing shoes that are too small and/or tight can cause them to squeeze your foot and force the ball of your foot into a small amount of space. You may also have shoes that are too loose, which can make your foot slide back and forth, causing strain on your metatarsal bones. High heel shoes, sneakers, or any other footwear that provides inadequate padding and arch support, may also cause you to put more weight on the ball of your foot and lead to metatarsalgia.

Foot and toe shape

Having high-arched feet is also a risk factor for developing pain in the ball of your foot. This is because your foot is less flexible, leading to a tight Achilles tendon (the tendon that connects your calf to your heel). Such tightness results in increased pressure at the front of your foot as you walk, which can end up causing metatarsalgia.

You may also be at greater risk if your second toe is larger than your big toe. This causes more weight than normal to be shifted to your second metatarsal head, which in turn generates greater pressure on the ball of your foot.

Stress fractures

An impact injury to your foot, such as being stepped on at high speed during a football game, can generate a break in your metatarsals or toe bones. This may lead to the shape of your bones changing, pushing them together and creating more pressure on the ball of your foot as a result. You may also walk differently and therefore change the way you put weight on your foot, which, over time, can cause pain in the bottom of your foot.

Obesity

Being overweight inevitably puts more pressure on the balls of your feet and metatarsal bones, which may lead to metatarsalgia. This is especially the case if you are exercising to lose weight and doing activities like running, dancing, or any other activity that means you put constant strain on the balls of your feet.

Medical conditions

There are a range of joint and foot conditions that increase the chances of you developing metatarsalgia and pain in the ball of your foot. Some of these include:

• Rheumatoid arthritis (causes swollen joints in your foot)
• Diabetes (small nerves in your foot can become irritated)
• Morton's neuroma (growth of tissue around one of the nerves between your metatarsal bones)
• Bunions or hammertoe (both causing your toes to press closer together)
• Gout (build-up of fluid in your foot)

Your consultant will start off by gathering information about the pain in the ball of your foot, such as how it started, how it feels, and how long it's been going on for. They may ask questions about your footwear, what activities you do, how much walking and/or standing you do, along with what seems to improve your symptoms and whether you've had any treatment already. This information may help them differentiate your foot pain from other conditions affecting your foot.

Along with taking a medical history, your consultant might carry out a quick physical examination, feeling for sensitivity on the bottom of your foot and checking for any signs of swelling. You could be asked to carry out some gentle exercises so that your consultant can see when and where your pain shows up.

To confirm their diagnosis, your consultant may then order some imaging tests, as this helps them rule out other issues and see the extent of the inflammation in your metatarsal bones that lead to pain in the ball of your foot. These tests include but are not limited to:

X-ray

Although X-rays don't show any soft tissue damage (muscles, ligaments, tendons, cartilage), they produce detailed images of your bones. This helps your consultant check if you have experienced a fracture, which may be what lies behind your metatarsalgia, or have any bone spurs (bony growths on your bone) that could be causing the compression of nerves that leads to pain in the ball of your foot.

MRI

Using powerful magnetic waves, an MRI scan produces detailed images of the soft tissue in your foot and allows your consultant to check for a number of conditions that may be leading to you experiencing pain in the ball of your foot. Some issues that an MRI might pick up include:

• Arthritis
• Traumatic disorders
• Conditions affecting your circulation
• Foot tendinopathies (inflammation of your tendons)
• Neuroarthropathies (destructive disease of your bone structure and joints)

If the pain in the ball of your foot is not too severe, or has only recently started, and you've not received any kind of treatment already, your consultant will most likely start off by suggesting a range of conservative treatments. It could be that this is enough to relieve your metatarsalgia symptoms. These treatments include:

Rest

The first thing your consultant will suggest is protecting your foot from further injury by not stressing it any further. Elevate your foot after standing and/or walking, and avoid doing the activities that led to the problem in the first place, along with applying ice packs to the affected area for around 20 minutes several times a day. Combined with anti-inflammatory medications like ibuprofen and naproxen, this may be enough to bring down the swelling in your metatarsal bones and relieve you of any painful symptoms.

Orthotics or changing footwear

Your consultant may also suggest that you avoid shoes that are too tight or loose, as well as limiting how often you wear high heels. Take care to wear shoes with plenty of support that are suited to the activities you do. You may be advised to wear orthotics - custom-made pads that are placed in your shoes and help to distribute weight more evenly across your foot, putting less pressure on the ball of your foot. If these measures don't make a difference, your consultant could recommend arch supports to reduce the stress on your metatarsal bones and improve the overall function of your foot.

Physiotherapy

Certain gentle calf stretches can help with pain in the ball of your foot. If you stand in a walking position with your affected leg straight behind you and the other bent in front of you, you can - using support from a wall or chair - lean your body forwards and down until you feel your calf being stretched. Hold this for 20 or 30 seconds, or for as long as your discomfort allows, ahead of stretching the other leg.

In cases where your metatarsalgia is severe, and more conservative treatments have failed to improve the pain in the ball of your foot, your consultant may recommend surgery. This can be done under either general anaesthetic (where you'll be asleep for the entire time) or local anaesthetic (where your foot will be numbed with an injection; you'll stay awake during the procedure). Your anaesthetist will speak to you about these options before your surgery. This is an outpatient procedure, meaning you'll be able to go home on the same day as your surgery.

Depending on the severity of your metatarsalgia, your surgeon may choose from one of two surgical options:

Osteotomy

Your surgeon makes an incision on the top of your foot between your metatarsal bones. They will then make a cut into your metatarsal bone - just enough so that it can slide back enough to relax the joint and relieve the pressure under your foot. The exact amount of bone that your surgeon needs to remove in order to facilitate this smoother movement will depend on the exact severity of your condition. Having done this, your surgeon will then fix your metatarsal bone in its new place using one or two tiny screws, ahead of closing the incision and covering it with a dressing.

Joint fusion

In this procedure, which is used both for metatarsalgia and hammertoe, your surgeon makes an incision at the top of your foot, allowing them to cut the surfaces of the joints at the base of your smaller toes. If your toes are not straight, your surgeon will also use special surgical instruments to release the tendon at the top of your foot. They shall then place a K-wire (a smooth stainless-steel wire used to keep your toes straight) through the bone and out of the tip of your toe, which ensures that your toe joints fuse together and stay straight. Bringing your toes into this new fused position should relieve the pressure on the ball of your foot.

Some complications with surgery for metatarsalgia are possible, but these are extremely rare. Your consultant will speak to you about any risks beforehand and give you the space to ask any questions that may be on your mind.

General complications of any operation

• Pain
• Bleeding
• Infection in the surgical wound
• Unsightly scarring
• Blood clots
• Difficulty passing urine
• Chest infection
• Heart attack or stroke

Specific complications of surgery for metatarsalgia

• Stiffness in your foot
• Nerve damage (numbness and/or tingling at the site of your wound or in your foot)
• Pulmonary embolism (when a blood clot gets stuck in an artery in the lung, blocking blood flow to part of the lung)
• Return of your symptoms and need for further surgery

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations to suit your routine
• The freedom to choose which hospital and consultant fits your needs
• Personalised, consultant-led treatment plans tailored to your specific requirements 
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private cosy ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about treatment for pain in the ball of your foot, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Metatarsalgia, Cleveland Clinic
2. What are metatarsalgia and metatarsal pain?, Medical News Today
3. Weil osteotomy, East Sussex Healthcare
4. Metatarsalgia, Blackpool Teaching Hospitals
5. Metatarsalgia foot pain, Tyneside Integrated Musculoskeletal Service
6. Metatarsalgia, Mayo Clinic