Metatarsalgia involves pain in the ball of the foot. It stems from problems with the metatarsal bones, which are just behind the toes. These bones connect the toes to the ankles.

There are five metatarsal bones, numbered one to five from the big toe to the small toe. They play an essential role in the bone structure and link to muscles that help control the lower limb and foot.

Many conditions can lead to problems with the metatarsal bones, resulting in metatarsal pain. They include:

  • trauma, leading to fractures or dislocation
  • overuse during high-impact sports
  • degenerative conditions, such as arthritis
  • unusual bone structure present from birth, such as a high foot arch
  • changes to bone structure over time, such as from wearing tight or high-heeled shoes

Home remedies and lifestyle changes can often help, but medical treatment, including surgery, is sometimes necessary.

In this article, learn about treatment options for pain in the ball of the foot, exercises that may help, and why it happens.

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Treatment will mainly focus on easing discomfort and pain. Home remedies and medical treatment can help.

Home remedies

Home remedies for metatarsalgia may include:

  • applying a cool compress for up to 20 minutes every 2–3 hours, wrapping the pack to protect the skin
  • using over-the-counter (OTC) medications, such as paracetamol, to manage pain
  • keeping pressure off the feet by avoiding standing for long periods
  • raising the feet when resting
  • using shock-absorbing insoles or arch supports to relieve pressure when walking
  • putting padding in shoes, such as fleecy web, fleecy foam, felt, or gel covers
  • using metatarsal pads or a metatarsal bar to support the foot and reduce pressure from the metatarsal bones
  • maintaining a moderate body weight to avoid additional pressure

It is also essential to choose appropriate footwear. Tips include:

  • avoiding high-heeled shoes
  • avoiding shoes that are tight or pointed
  • choosing footwear with adequate support and cushioning

Medical treatment and surgery

If home remedies do not help, a doctor will recommend specific treatments depending on the cause of the metatarsal pain.

They may:

  • order lab work if they suspect arthritis or gout
  • recommend physical therapy
  • prescribe mediations
  • refer the person to a specialist who can prescribe steroid injections to reduce pain and swelling
  • refer the person for prescription orthotics to help support the foot
  • manage a fracture, possibly by immobilizing the bone using adhesive straps or a cast
  • recommend surgery, in some cases

Surgery can reshape the bones to straighten a hammertoe or claw toes. Surgery can also relieve or remove a trapped or irritated nerve. The type of surgery will depend on the underlying problem.

Complications

Not treating metatarsalgia or returning too soon to strenuous activity can lead to further complications.

Depending on the cause, possible complications include:

  • pain in other parts of the foot or elsewhere in the body, as the person adapts their gait to manage discomfort
  • the development of callouses
  • neuroma, such as Morton’s neuroma, where the compression of nerves in the front of the foot leads to pain and sometimes numbness

Some exercises can help manage pain in the ball of the foot. However, it is essential to remember that metatarsalgia can result from a wide range of problems. Always check first with a doctor that an exercise is suitable.

Reducing tightness in soft tissues under the foot

  1. Sit on a chair with both feet flat on the floor.
  2. Place a tennis ball under the foot.
  3. Roll the ball back and forth with the foot.
  4. Repeat a least twice a day.

Calf muscle stretch (1)

  1. Sit on the floor with one leg straight and the other knee drawn up to steady you.
  2. Loop a towel or cloth around the center part of the foot.
  3. Holding the towel with both hands, pull the toes to point upward, keeping the heel on the ground.
  4. Add an extra pull to stretch the calf muscle.
  5. Release and relax.

Calf muscle stretch (2)

  1. Stand with both hands on a wall or the back of a chair to steady you.
  2. Put one foot forward, keeping the feet flat on the ground.
  3. Bend the front leg and keep the back one straight.
  4. Hold for 20–30 seconds, then relax and change foot.
  5. Repeat 10 times.

Achilles tendon stretch

  1. Stand straight facing a chair, with hands on the chair for support.
  2. Place the foot to be stretched slightly behind the other foot.
  3. Push the heel of the back foot down while bending the knee.
  4. Relax and swap your feet.
  5. Repeat 10 times.

Other tips

Other exercise tips include:

  • opting for low-impact sports, such as swimming or cycling, to boost strength and overall health and manage weight
  • avoid high-impact sports and exercises that put pressure on the feet
  • follow a doctor’s advice on which sports are suitable and how soon it is safe to return to regular exercise

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Metatarsal pain affects the ball of the foot and can:

  • feel like walking on pebbles
  • feel like a burning, shooting, or sharp ache
  • be a general aching under the ball of the foot
  • occur under one or two metatarsal heads only or under all the metatarsal heads
  • range from mild to severe, often worsening when standing, walking, running, or flexing the toes
  • affect one or both feet
  • range from mild to severe
  • involve numbness or tingling in the toes
  • develop slowly or appear suddenly, especially if it results from a fracture or strain on the feet due to increased activity

Other symptoms can vary, depending on the cause:

  • In the case of a sprain or fracture, there may also be swelling and bruising.
  • If bunions are present, the person may notice a hard, bony lump near the big toe.
  • Morton’s neuroma can cause sharp pain, possibly with tingling and numbness.
  • The pain from bursitis or arthritis may be dull and aching, with warmth and swelling.

Metatarsal pain can happen for various reasons, but they all relate to changes in the metatarsal bones and surrounding structures.

In the foot, there are small toe nerves between the metatarsal bones. When the head of one metatarsal bone presses against another, the small nerve can catch between them and become inflamed. This causes metatarsal pain.

Putting weight on the foot can worsen symptoms. With each step, the metatarsal bones rub together, increasing the inflammation of the nerve.

Various factors can increase the risk of metatarsal pain, but weighting the foot is what causes the pain.

Factors that can contribute to metatarsal pain include:

  • footwear that forces toes into a tight space, such as high heels or shoes that are tight around the toes
  • excess body weight, which can put strain on the foot
  • age, as the pad of fat that protects the foot can thin with age
  • running and other high-impact sports or exercises, as the feet absorb large amounts of force
  • the shape of the foot and toes, as having a high arch or a second toe that is longer than the big toe can add to the pressure
  • stress fractures, which are small breaks in the toe bones that can be painful under pressure
  • a stiff ankle, which can add pressure to the metatarsal bones

Some medical conditions that can result in metatarsalgia are:

  • rheumatoid arthritis, with swollen joints in the foot, or gout
  • diabetes, if the small nerves in the foot can become irritated
  • Morton’s neuroma, a growth of fibrous tissue around one of the nerves between the metatarsal heads
  • a buildup of fluid in the foot
  • bunions, a painful, swollen lump at the base of the toe, common in those who wear tight shoes or high heels but also hereditary

Conservative treatment, such as wearing more suitable shoes, often eases the symptoms of metatarsalgia. However, the outlook will depend on the underlying cause of the pain.

According to experts, most fractures heal well provided the bone is immobilized appropriately and the foot gets plenty of rest. Always check with a doctor before resuming activities that can put pressure on the ball of the foot.

If the pain does not improve after 2 weeks, a person should see a doctor.

A family doctor may do an initial assessment, but an orthopedic surgeon or podiatrist — a specialist foot doctor — will often investigate metatarsal pain and diagnose the underlying cause.

A doctor will examine the person’s foot and ask about:

  • their medical history
  • their lifestyle
  • what type of footwear they use
  • their hobbies and activities
  • any recent injuries or trauma

They will also ask:

  • when the pain began
  • how often it occurs and when
  • which areas it affects
  • if it is getting worse
  • if there is pain elsewhere in the body

A person may need to walk on a treadmill or pressure plate so a doctor can assess their gait. This can help identify which parts of the foot are receiving pressure.

The doctor may also recommend tests. Imaging tests, such as an X-ray, MRI, or ultrasound scan, can detect bone fractures and other structural changes. Blood tests can detect bone fractures or rule out possible underlying conditions such as gout, arthritis, or diabetes.

Metatarsal pain occurs under the ball of the foot, just in front of the toes. It can result from structural features a person is born with, an injury, excessive pressure due to high-impact sports, a medical condition, and many other factors.

Home remedies include:

  • resting the foot
  • applying ice
  • performing exercises to stretch the muscles and relax the feet
  • doing low-impact exercise
  • taking over-the-counter drugs to manage pain and inflammation

In some cases, a doctor may recommend stronger pain relief, immobilization of the bones, or surgery.

The outlook will depend on the cause. Often, home remedies and rest are enough to relieve pain, but pain that results from arthritis or another medical condition may need ongoing care.