Metatarsalgia

The term metatarsalgia refers to pain and inflammation in the ball of the foot — specifically the region where the long metatarsal bones meet the toes. This area bears significant weight during walking, running, and standing, and when overloaded, it can become irritated and painful. Individuals often describe a feeling of “walking on pebbles” or sharp ache under the forefoot.

Several factors may contribute to developing metatarsalgia including:

• Overuse or repetitive stress: Activities that involve running, jumping, or prolonged standing place repeated impact on the forefoot, leading to irritation of the metatarsal heads and surrounding tissues.
• Foot mechanics: The shape and function of your foot affect how pressure is distributed. Flat feet, high arches, or overly mobile forefeet can focus more load on the metatarsal heads.
• Improper footwear: Shoes with minimal cushioning under the forefoot, worn-out midsoles, or narrow toe boxes can increase pressure on the ball of the foot. Frequent use of heeled shoes can also shift weight forward.
• Foot structure and alignment: Shortened or stiff Achilles tendons, bunions, hammer toes or prior forefoot injury can change how you strike and push off with your foot, increasing load on the metatarsal region.
• Sudden increases in activity level: a rapid jump in walking or running volume can overwhelm the structures under the forefoot.

By recognizing these triggers, you can take proactive steps to reduce risk and manage symptoms early.

The signs and symptoms of Metatarsalgia may vary depending on the severity and stage of the condition:

• Pain under the ball of the foot that increases during forefoot loading: when walking, running, or pushing off with the toes.
• Pain may be experienced as burning, sharp or aching.
• Pain may be worsened by tight-toed shoes or high heels.
• Pain may improve with rest, but return when activity resumes.
• Sometimes pain is accompanied by numbness or tingling in the toes if nerves are irritated.

Treatment focuses on relieving pain, reducing overload under the forefoot, and improving the support of your foot mechanics. Common treatment options include:

• Footwear - Choose shoes with a well-cushioned forefoot, adequate width in the toe box, and a sole that absorbs impact. Avoid prolonged use of narrow, tight or high-heeled shoes.
• Metatarsal pads or orthotic devices - Custom or over-the-counter inserts can off-load pressure away from the metatarsal heads. A pad placed just behind the metatarsal heads can help redistribute load over a larger area.
• Activity modification - Reduce high-impact forefoot loading (such as sprinting, jumping) and substitute with low-impact options (such as cycling or swimming) while healing.
• Stretching and strengthening - Stretch calves and Achilles to improve ankle mobility and reduce forefoot load. Strengthening intrinsic foot muscles and toes can enhance forefoot stability.
• Rest - Give your forefoot time to recover when symptoms flare.

Preventing metatarsalgia is possible with consistent good habits:

• Always wear shoes that fit properly, offer good cushioning under the forefoot, and have enough room for toe splay.
• Slowly increase activity levels — avoid sudden hikes or runs without a gradual build-up.
• Maintain flexibility in the calves, Achilles tendon and forefoot.
• Strengthen foot muscles regularly to support your gait and reduce focal stress.
• Monitor your body weight and adjust your activity or footwear accordingly as load demands change.

Metatarsalgia doesn’t have to sideline your activity. With the right footwear, targeted support and movement strategies, you can keep moving comfortably and confidently — from standing shifts at work to long walks and runs. If you’re experiencing persistent forefoot pain, reach out for a professional assessment to tailor a plan to your feet and lifestyle.