Metatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball of the foot). This is a common foot disorder. Metatarsalgia is often located under the 2nd, 3rd, and 4th metatarsal heads, or more isolated at the first metatarsal head (near the big toe). We usually refer to a metatarsalgia when most of the metatarsal heads is affected. Typically a patient will complain of pain in the ball of the foot, (metatarsalgia) many times without any history of trauma. The foot will hurt when walking, aggravated when walking barefoot. Of course, at times calluses can be the source of metatarsalgia, but more often than not the pain is coming from a level deeper than the skin.


With this common foot condition, one or more of the metatarsal heads become painful and/or inflamed, usually due to excessive pressure over a long period of time. It is common to experience acute, recurrent, or chronic pain with metatarsalgia. Ball of foot pain is often caused by unadjusted footwear, most frequently by women’s dress shoes. Footwear with a narrow toe box (toe area) forces the ball of foot area to be stuck into minimal space. This can inhibit the walking process and lead to extreme discomfort in the forefoot.

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. Also as we get older, the fat pad in our foot tends to thin out, making us much more susceptible to pain in the ball-of-the-foot.

Treatment and Prevention

The first step in treating metatarsalgia is to determine the cause of the pain. If unadjusted footwear is the cause of the pain, it must be changed.  High, wide toe box (toe area) and a rocker sole is ideal for treating metatarsalgia. It allows the foot to spread out while the rocker sole reduces stress on the ball-of-the-foot.

Unloading pressure to the ball of the foot can be accomplished with a variety of footcare products. Orthotics designed to relieve ball of foot pain usually feature a metatarsal pad. Orthotics can help by redistributing weight equally in the forefoot.

The custom made orthotic must take into account the many foot conditions that can cause the metatarsalgia and the podiatrist trained to cast and prescribe the best orthotic for your condition.