Metatarsalgia
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Metatarsalgia means pain in the ball of your foot, on the sole near your toes. It is a symptom with several possible causes, not one single condition. It is common: estimates range from about 10 per cent of people at any one time to up to 80 per cent at some point in life. The pain is often sharp, stabbing, burning or tingling, and can feel like walking on a pebble. It is usually worse when you stand, walk or run. Non-surgical care, such as better-fitting shoes, calf stretches and advice from your podiatrist, is usually enough.
What is it?
Metatarsalgia means pain in the ball of your foot, on the sole near your toes. The pain sits under the metatarsal bones. These are the long bones in the front part of your foot (the forefoot) that join to your toes.
It is best thought of as a symptom, not a single diagnosis. Several different problems can cause it, so finding the cause is part of getting the right treatment.
It is one of the most common things people report when they have foot problems. Estimates of how many people have it vary widely, from about 10 per cent of people at any one time to up to 80 per cent at some point in their lives.
Who does it affect?
It seems to be more common in women. In adults aged 45 and over, the toes and the front of the foot are the most common places for foot and ankle pain. That pain also becomes more common with age in women.
You are more likely to get it if the shape or mechanics of your foot put extra pressure on the ball of your foot. Activity and footwear also play a part. People living with obesity are more likely to have symptoms that last longer.
Signs and symptoms
The pain is often sharp, stabbing, burning or tingling. It sits in the ball of your foot and can spread into your toes. Many people say it feels like walking on a pebble or a lump under the foot.
It gets worse when you put weight on your foot, especially when you stand, walk or run, and it eases with rest. Walking barefoot on hard surfaces can make it worse. The pain often builds up gradually over several weeks, rather than starting suddenly.
You may also notice corns or hard skin, toes that curl up (such as claw toes), or thinning of the natural padding under the ball of your foot.
What causes it?
Most metatarsalgia is a mechanical problem. When you walk, much of the pressure is concentrated under the ends of the metatarsal bones as you push off. If the shape or movement of your foot changes, that pressure can rise.
Things that can raise the pressure include a short first metatarsal (the bone behind your big toe), a long second metatarsal, a high arch and a bunion. Tight calf muscles are also often linked with extra pressure on the ball of the foot, although this may not be the cause.
A sudden increase in activity can cause tiny injuries and inflammation in the area. Footwear matters too, including high heels. Pain can also appear after an injury to the foot or after forefoot surgery. Inflammatory joint disease can cause it as well, and it needs its own treatment plan.
How is it diagnosed?
Your podiatrist will ask when the pain started, what changed in your activity or shoes, and what makes it better or worse. They will examine your foot, especially the sole, and check how well your ankle and toes move. They will check for tight calf muscles and press between the metatarsal bones to see if that brings on the pain. They may also do a digital drawer test, where they gently move a toe up and down to check the plantar plate (a strong band of tissue under a toe joint).
The point in your step when the pain bites can give clues about the cause. X-rays taken while you stand are often used, and they are often enough to find the cause.
Because metatarsalgia is a symptom, your podiatrist will also think about other causes of ball-of-foot pain. These include a pinched nerve (Morton's neuroma), a strained or torn plantar plate, inflamed joint linings or fluid sacs, a stress fracture (a small crack in a bone), loss of blood supply to a bone (avascular necrosis) and inflammatory joint disease. Please don't try to diagnose it yourself. If the cause isn't clear, see your podiatrist or doctor.
Treatment
Non-surgical care is usually enough to get a good result. Your plan should be tailored to you. It isn't yet clear which of the first-line options works best.
Looking after it at home
Start with changes you can make yourself. Cut back the activities that set off the pain, and build walking, running or standing time up gradually. Choose shoes with a wide, deep toe box and a low heel.
Try calf stretches, which may help by reducing the force on the ends of your metatarsal bones. When you do rehabilitation exercises, use a pain scale from 0 to 10 and aim to stay in the green zone (the lowest levels of pain). Sometimes the amber zone is fine if you are comfortable with that level. Stay in these zones both during the exercises and for 48 hours afterwards.
If you have a health problem, an injury, a recent operation or a recent heart attack, or you are pregnant, check with a health professional before starting exercises. Stop if you feel pain or unwell.
If weight is a factor, support to lose weight is strongly encouraged. Your GP or another health professional can help.
Treatment from your podiatrist
Your podiatrist will usually start by explaining what is going on and giving you things you can do yourself. They will often add footwear advice and stretching, and may suggest insoles or pads. They may also carefully remove hard skin or other skin lesions (lesion debridement). It isn't yet clear whether custom-made insoles work for metatarsalgia, so ask what to expect.
Shoes with a curved, rocker-shaped sole appear to take pressure off the ball of the foot. How they are made matters, particularly their weight, thickness and the material. Check with your podiatrist before you buy a pair.
Other options
If your pain isn't settling, your podiatrist or GP may refer you for further assessment. This may be sooner if the pain is having a big effect on your life, or the cause isn't clear. If you have had at least 3 to 6 months of thorough non-surgical care without a good response, a referral to a musculoskeletal specialist team can be considered.
Steroid injections are sometimes used. It isn't yet clear how well they work for metatarsalgia. Side effects include infection (rare when the injection is done with a sterile technique), a temporary flare of pain, and high blood sugar in people with diabetes. Injections for Morton's neuroma have not been reported to cause serious side effects.
After an injection, call your local emergency number if you have signs of a severe allergic reaction, such as swelling of your face, lips or tongue, or difficulty breathing. Call as well if you feel very unwell with an infection, for example with a fever, confusion, severe shivering or a fast heartbeat. If you notice spreading redness, warmth, swelling or pus around the injection site, see your GP or another doctor today. If your GP can't see you today, go to an urgent care clinic or an after-hours GP.
Surgery
Surgery is considered after non-surgical care. The operation depends on the problem. It might be removing a neuroma, or in some cases releasing a tight calf muscle. How surgery compares with carrying on with non-surgical care over the long term isn't clear yet.
After forefoot surgery you will need crutches for 6 weeks and a surgical shoe. Before an operation, it is important to manage diabetes (with an HbA1c above 69), blood vessel disease in the legs and a BMI above 35 kg/m². Your surgeon will also check the pulses in your foot.
Surgery can have complications. After one common type of minimally invasive operation on the metatarsal bones, prolonged swelling was the most common problem (30.91 per cent). Other problems were delayed bone healing (14.9 per cent), pain moving to a neighbouring metatarsal (transfer metatarsalgia, 12.73 per cent) and pain that doesn't go away (8.5 per cent). Ask your surgeon about the risks, recovery and what happens if it doesn't help.
Recovery
How long recovery takes isn't clear yet, and it varies from person to person. Many people do well with simple, non-surgical care.
Use your exercise program as a check-in. If your pain increases greatly after exercises, or nothing has changed after six to twelve weeks, contact your GP or podiatrist. People living with obesity are more likely to have symptoms that last longer. It isn't yet clear how often metatarsalgia comes back.
Preventing it
Keep wearing shoes with a wide, deep toe box and a low heel. It isn't yet clear whether footwear or insole changes stop the pain coming back, but they are the first changes recommended. Keeping your calf muscles flexible may help take force off the ball of your foot.
Make changes to your activity, footwear or running style gradually. If the pain started around the time you changed shoes or training, tell your podiatrist. If weight is a factor, support to lose weight can help.
When to see a podiatrist
Book an appointment if
Your ball-of-foot pain hasn't improved after 2 weeks of home care, or nothing has changed after six to twelve weeks of your exercises. Also book if the pain increases greatly after exercises, or if you aren't sure what is causing it. Book an appointment with your podiatrist or GP.
Seek prompt assessment if
you have sudden pain in your foot after an injury or a pop, or signs of infection such as redness, warmth, swelling or a fever. A fracture, a torn tendon or an infection can feel like ball-of-foot pain, so see your GP or another doctor today. If your GP can't see you today, go to an urgent care clinic or an after-hours GP. Go to the nearest emergency department if your foot is at an odd angle after an injury, or a bone has come through the skin. If you have a foot wound or infection and you also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, this could be sepsis: call your local emergency number. See your GP soon if you have tingling or loss of feeling in your foot, if you have diabetes and foot pain, if the pain is getting worse, or if you run or train a lot and the pain keeps building up (a stress fracture needs rest from weight-bearing quickly, so it shouldn't be missed).
Frequently asked questions
Can I keep running or exercising?
Often you can stay active with changes. Cut back the activities that set off the pain, and add distance or time slowly. It isn't yet clear how best to return to running, so ask your podiatrist to help you work out what is right for you.
Is metatarsalgia the same as Morton's neuroma?
No. Metatarsalgia is the name for the pain, and Morton's neuroma is one possible cause. A neuroma gives pain between the metatarsal bones, sometimes like an electric shock, with tingling or burning in typically 3 to 4 toes. It often eases when you take your shoes off. It is most common in middle-aged women. Your podiatrist can tell the two apart.
Are minimalist or barefoot-style shoes a good idea?
Be careful. In runners, moving to minimalist shoes was linked with more injuries, including swelling inside the metatarsal bones (bone marrow oedema) and calf pain. If you want to try them, change over gradually and talk to your podiatrist first.