Metatarsalgia: Symptoms, Causes, Risks, Complications, Diagnosis and Treatment



Have you ever wondered about how important your feet are?
The feet play a pivotal role in one’s daily life. For years, engineers and experts marveled on the structure of the feet and how they can carry the body’s weight. People rarely appreciate their feet, and as a result, they neglect caring for them.

People will only take a look at their feet if they experience problems, pain or injury.
Often, the feet become overused, and this may lead to a condition called metatarsalgia, which is characterized by pain and inflammation in the ball of the foot.

The ball of the foot becomes inflamed, swollen and painful. Though this condition is not severe, this condition might cause a great deal of discomfort. Also dubbed a stone bruise, metatarsalgia affects the metatarsal heads, where the three middle toes connect and meet with the ball of the foot.

In the United States alone, forefoot injuries including metatarsalgia are very common among athletes who engage in high-impact sports. Metatarsalgia is commonly-seen in athletes who participate in high-impact sports that involve running or jumping. While those who engage in track and field are the ones at the highest risk of acquiring this type of injury, those who perform tennis, baseball, soccer, and football are at risk too.


Metatarsalgia is not an injury but a symptom or a group of symptoms. This includes the following:

  • Pain that becomes worse when you walk, run, stand and flex your feet, particularly when you’re barefoot. On the other hand, the pain goes away with rest.
  • Sharp and burning pain in the ball of the foot
  • Numbness, tingling and shooting pain in the toes
  • Feels like you have a pebble in the shoes

The pain can range from mild to severe and is more noticeable when you stand or move. The areas mostly affected by this condition is the ball of the food just beside the toes and the toes themselves. Though the symptoms slowly progressions, they can sometimes appear abruptly, especially when you engage in exercise or activities that put a strain on the feet.

Metatarsal pain usually occurs gradually with the patient feeling tenderness first. Usually, the second, third and fourth toes are affected. However, there would be times that all these toes would become painful at the same time. In the early stages of the disease,
a separation between two toes can be seen, and it looks like the “V” sign. When you flex or bend the toe, it can reproduce pain and calluses may form under to foot because of too much pressure.


During sports activities, there is a heightened risk that the food can be injured.
As with other overuse injuries, metatarsalgia can be the result of an alteration in the normal biomechanics. Usually, this happens because of an abnormal weight distribution.

Also, excessive and continuous stress can lead to chronic inflammation and irritation of the bone and surrounding tissues such as tendons and ligaments. There is a broad variety of factors that can cause this condition. Sometimes, there is no single cause but several factors that could lead to metatarsalgia.


Having excess weight can take a toll on your feet. This is because most of the body weight transfer to the forefoot when moving, being overweight or obese may mean more pressure on the metatarsals. To eliminate or reduce the symptoms, losing weight would be a great help.

Intense Activity

Engaging in high impact exercise and intense training may affect the feet. Distance runners, for instance, are at a higher risk of metatarsalgia because the front of the foot absorbs massive forces when a person runs.

Badly Fitting Footwear

Using uncomfortable shoes or high-heeled shoes can force the ball of the foot into a small amount of space. This pushes more pressure on the area of the feet, leading to pain and swelling. Moreover, shoes with a narrow toe box or athletics shoes that lack support can aggravate the condition.

Foot Shapes

People with narrow, high-arched or flat feet are at a higher risk of having metatarsalgia.

Stress Fractures

When there are small breaks in the metatarsals, these can cause pain and a change in where you put your weight on the feet.

Stiff Achilles Tendon

This tendon located on the heel of the foot can affect the way you distribute your weight across the foot. This may result in stress on the metatarsal heads.

Morton’s Neuroma

Also dubbed as Morton’s metatarsalgia, the condition affects one of the nerves that are located on the metatarsal bones in the foot, called the plantar digital nerves.

Claw Foot

Also called pes cavus, this condition involves the foot has a very high arch. This arch does not flatten even when you put weight on the feet. This will put extra stress on the ball of the foot.


Having a hammertoe may put stress on the ball of the foot. This is because you have an abnormal position of all three of the joints in the toe. Just like having a claw foot, a hammertoe will put extra stress on the ball of the foot.


People with bunion or hallux valgus have a deformity of the base joint of the big toe. As a result, the toe is angled towards the second toe, leading to excessive stress placed on the metatarsal area.

Freiberg’s Disease

This is a rare disease wherein there is osteonecrosis of the second metatarsal.
This is a genetic disorder seen in teenage girls.

Previous Foot Surgery

When there is a previous surgery or a history of surgery on foot, this may cause metatarsal problems.

Gout Arthritis

Having gout can cause inflammation on the joints of the ball of the foot.
This can lead to metatarsalgia.

4Risk Factors

There are factors that may increase a person’s risk of having metatarsalgia.


People who are older are more vulnerable to this condition because of bone degeneration.


People with diabetes have an increased risk of nerve damage in the feet.
This may lead to metatarsalgia.


Athletes who engage in high impact sports are at a higher risk of developing metatarsalgia.

Obese or Overweight People

Excess weight may take a toll on the bones of the feet.


When the condition is left untreated, this may lead to other discomforts and pain on the other parts of the lower extremities and body. This is because of an altered gait from foot pain.

Moreover, having a foot problem may take a toll on one’s mobility. Athletes may have a hard time coping with the injury, and their sports activities and employees may suffer during working hours, especially the jobs that involve standing for long hours.


There are many ways to diagnose metatarsalgia. First, the doctor may perform a medical history interview and a complete physical examination. Other tests may be recommended:

Blood Test

The doctor may require blood tests to determine underlying causes such as gout, arthritis, and diabetes.


An x-ray of the foot may show the severity of the condition and if there are underlying causes of the condition such as bunions, hammertoes or stress factors.

Bone Scan

A bone scan of the foot may provide a picture of the metatarsal bones, and if there are fractures on these bones.


Acute Phase:

Simple measures can help relieve the symptoms of metatarsalgia, including:

  • Resting the feet and elevating them whenever possible
  • Losing weight, if you’re overweight or obese
  • Wearing comfortable and well-fitted shoes
  • Physiotherapy like exercises to help a stiff ankle
  • Using metatarsal pads and orthotic inserts
  • Simple painkillers – make sure that the medicines were prescribed by your physician. Do not self-medicate.
  • Use an ice pack on the affected area

Recovery Phase:

Physical Therapy

Physical therapy aims to restore the normal biomechanics and relief of pressure in the affected area. Once the pain is reduced or eradicated, the patient may now engage in isometric, isotonic and isokinetic exercises. Passive range of motion exercises may be recommended too.


There are exercise strategies that can relieve the pain caused by metatarsalgia like swimming or cycling instead of high-impact exercises and stretching of the Achilles tendon.

In severe cases, the doctor may recommend using steroid injections to reduce the inflammation and pain. Make sure that you consult with a licensed doctor before getting this medicine. Moreover, surgery is also recommended to reshape the metatarsal bones. Surgery can also help relieve or removed a trapped nerve. If you have a hammertoe, surgery can also straighten it to relieve the pressure on the metatarsal part of the foot.

Maintenance Phase:

During the maintenance phase of treatment, the doctor may recommend physical therapy to help reduce the chances of the inflammation to recur. Also, an orthotic device can be used to maintain normal mechanical function. These devices help distribute the force across the foot, away from the site of the injury.

Moreover, regular consultations are important to prevent the disease from recurring. Seeing the doctor often will also help reduce deformity and long-term problems related to mobility.