Metatarsalgia

Metatarsalgia is a clinical term for pain and inflammation located under the metatarsal heads, the ball of the foot. It describes forefoot discomfort that can affect one or more toes and may be accompanied by swelling, numbness, or a burning sensation.

Common symptoms include sharp or aching pain under the ball of the foot, worsened by standing, walking, or running, and tenderness upon palpation of the metatarsal heads. Some people report a sensation of stepping on a small object or feeling like the foot has “fallen asleep.” Pain often increases with push-off during gait.

Causes and risk factors include repetitive forefoot pressure from running, jumping, or dancing, ill-fitting or high-heeled footwear, and structural foot variations such as flat feet or high arches. Other contributing factors are a longer second metatarsal, metatarsal length discrepancy, toe deformities (e.g., hammer toes), obesity, and recent increases in activity or trauma to the foot.

Diagnosis is primarily clinical, based on history and examination. Imaging such as X-ray may be used to exclude fractures, arthritis, or other forefoot conditions. Differential diagnoses include stress fracture, Morton's neuroma, capsulitis, and plantar plate injuries.

Management typically begins with conservative measures: wearing adequately fitting shoes with a wide toe box, using metatarsal pads or orthotics, activity modification, ice, rest, and nonsteroidal anti-inflammatory drugs as appropriate. Physical therapy can help with foot mechanics. In persistent or severe cases, corticosteroid injections or surgical options (such as metatarsal osteotomy or relocation/decompression procedures) may be considered. The prognosis is generally favorable with conservative treatment, though recurrence can occur in some individuals.