Metatarsalgia is caused by a wide variety of conditions.

The metatarsals

The metatarsals are five long bones that connect the bones around your ankles to your toe bones.

They support your weight when you are walking, jumping and running, specifically when you are pushing up with your feet.

A lot of pressure is put through the metatarsals, which means they are a common source of pain.

Common causes

Some common causes of metatarsalgia include:

• badly fitting footwear, high-heeled or tight, restrictive shoes or boots – shoes with a narrow toe area or high heels can force the ball of the foot into a small amount of space, which puts more pressure on that area
• being overweight or obese – this can increase the pressure on the foot
• age – older people are more susceptible to metatarsalgia because their feet have more wear and tear, and the fat pad that protects the foot can thin with age, making them more likely to feel pain in the ball of their foot
• bone structure of the foot – narrow, high-arched or flat feet can increase the chance of metatarsalgia as one metatarsal bone may be much longer than the others
• high-impact sports such as running or tennis put extra pressure on the foot
• stress fractures in the foot – these occasionally occur in athletes, runners or walkers and cause pain to come on rapidly

Medical conditions known to cause metatarsalgia

Several medical conditions can cause foot pain, which often changes the way you walk. This in turn places excessive weight on your metatarsals, triggering metatarsalgia.

These conditions include:

• arthritis – pain and swelling of the joints, which can be the result of general wear and tear (osteoarthritis) or your immune system mistakenly attacking the joints (rheumatoid arthritis)
• gout – a condition where crystals form inside the joints, causing them to become very painful and inflamed
• bunions – an abnormal deformity of bone which can occur in the big toe, weakening the toe and placing excessive pressure on the other metatarsals
• bursitis – inflammation and swelling of a bursa, which is a fluid-filled sac under the skin that acts as a cushion between the tendons and bones
• Morton’s neuroma – a common condition in which the nerves inside the feet become compressed, causing a sharp or dull pain between the toes
• diabetes – the high levels of blood sugar associated with diabetes can, over time, cause nerve damage and pain affecting the feet
• hammer toe – when one of your middle toes is bent downwards, which can cause an uneven distribution of weight onto your metatarsals

If you’ve tried the self-care techniques for treating metatarsalgia but your symptoms have not got better, see your GP.

They can arrange a number of tests to check for any underlying problems that may be causing the symptoms.

These may include:

• blood tests – this can be helpful for diagnosing conditions such as gout or rheumatoid arthritis
• X-rays – this can check for any fractures that may have occurred in the bones of your feet
• ultrasound scans – where high-frequency sound waves are used to build up a picture of your foot; ultrasound scans can often be useful in diagnosing bursitis, Morton’s neuroma or joint conditions

Your GP may also refer you to a foot specialist (podiatrist), who will examine your foot and may ask you:

• about your medical history, lifestyle, footwear and hobbies
• where and when the pain occurs
• when the pain started
• how often the pain happens
• whether the pain is getting worse
• whether you have pain anywhere else

They may also analyse your gait (the way you walk) on a treadmill or pressure plate to find areas of high pressure on the foot.

Metatarsalgia is a term for pain that occurs in the front section of the foot.

The pain can range from mild to severe and often gets worse when you stand or do certain activities.

It is sometimes described as a burning or aching sensation. You may also have shooting pains, tingling or numbness in your toes. Some people also experience a sensation that feels like walking on pebbles.

The pain often occurs in the area where the second, third and fourth toes meet the ball of the foot.

When to seek medical advice

As a first port of call, try the self-care techniques listed below.

If the pain doesn’t improve, see your GP, practice nurse or health visitor. If necessary, they can refer you to a health professional who specialises in foot care, such as:

• a podiatrist (also known as a chiropodist)
• a foot and ankle surgeon for further tests or treatment

Alternatively, you could see a podiatrist privately. Private fees can vary depending on where you live and the podiatrist’s experience.

Read more information about seeing a podiatrist.

Treatment

Most cases of metatarsalgia can be treated using self-care techniques such as:

• RICE – this means rest, applying an ice pack, using a bandage to compress the foot, and elevating the foot
• taking painkillers such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to relieve pain
• changing your footwear or avoiding activities that are making your symptoms worse
• using shock-absorbing insoles, which can be fitted inside your shoes to help cushion the pressure when walking – these are available from pharmacies as well as sports shops (runners often use insoles to protect their feet)

Most cases of metatarsalgia respond well to self-care treatment. In rare cases, orthotic supports or surgery may be required to repair underlying damage to the foot.

Read about treating metatarsalgia.

What causes metatarsalgia?

Metatarsalgia occurs for a wide variety of reasons, but is often caused by increased pressure on certain areas. This leads to the soft tissues and bone being damaged.

Common reasons why people experience pain include:

• wearing high heels or tight-fitting shoes
• being overweight or obese (very overweight with a body mass index of 30 or above)
• high-intensity exercise such as running, tennis or squash

Read about the causes of metatarsalgia.

Most cases of metatarsalgia will respond well to a number of self-care techniques. These are discussed below.

RICE

RICE stands for:

• Rest – avoid regular exercise and reduce your daily physical activity. Using crutches or a walking stick may help if you cannot put weight on your foot.
• Ice – apply an ice pack to the affected foot for 10 to 30 minutes. A bag of frozen peas, or something similar, will work well. Wrap the ice pack in a towel to avoid it directly touching your skin and causing ice burn.
• Compression – use elastic compression bandages to limit swelling.
• Elevation – keep the injured foot raised above the level of the heart. This may also help to reduce swelling.

After 48 hours of RICE therapy, stop compression and try moving the injured area. If after this time your symptoms are worse, seek advice from your GP.

Other measures

You can try the following measures to ease the pain of metatarsalgia:

• change your style of shoe to something more roomy and flat-heeled
• avoid activities that make your symptoms worse
• use shock-absorbing insoles – these can be fitted inside your shoes to help cushion the pressure when walking
• take paracetamol and non-steroidal anti-inflammatory (NSAIDs), such as ibuprofen – these can help prevent inflammation and ease pain
• use orthotics (specially fitted insoles) – these are designed to improve foot function, redistribute pressure and protect the ball of the foot
• exercise your ankle and stretch your Achilles tendon (tendon at the back of the ankle)

More severe cases

If the above measures have not helped, see your GP. They may give you further advice or refer you to another healthcare professional.

Simple treatments can include shaving hard areas of skin or steroid injections into your foot joints to reduce the inflammation. Steroid injections may cause some pain and swelling at the site of the injection, but this should pass within a few days.

Read more about corticosteroids.

Surgery

Depending on the cause of your metatarsalgia, you may be referred to an orthopaedic foot and ankle surgeon to consider an operation to treat the underlying condition. Surgery may aim to:

• straighten a hammer toe (where the toe is bent and no longer moves normally)
• reshape or shorten prominent metatarsal bones
• release a trapped nerve or remove an irritated nerve