Pain Under the Ball of Your Foot? Here’s What You Should Know
Discomfort or aching beneath the ball of your foot can be frustrating, especially when it begins to interfere with daily life or activities you enjoy. If this type of pain sounds familiar, you might be dealing with a condition commonly referred to as metatarsalgia — though several different issues can cause similar symptoms in this area.
These may include:
- Plantar plate injuries: where the ligament under the toe becomes strained or torn
- Morton’s neuroma: a thickening of nerve tissue between the toes
- Sesamoiditis: inflammation of the small bones beneath the big toe joint
- Bursitis: irritation of the fluid-filled sacs that cushion the joints
- Capsulitis: inflammation of the joint capsule, often affecting the second toe
- Tendonitis: overuse or irritation of tendons that stabilise the forefoot
- Synovitis: inflammation of the joint lining, commonly due to repetitive stress
- And of course, Metatarsalgia, a broad term describing general forefoot pain and inflammation
Each condition can present with overlapping symptoms, such as burning, aching, or swelling, which is why accurate diagnosis is key to successful treatment.
What Is Metatarsalgia?
Metatarsalgia is an overuse condition that causes pain and inflammation in the ball of the foot. It’s a general term used to describe forefoot discomfort, often resulting from uneven pressure across the metatarsal bones. This imbalance is frequently linked to foot alignment issues — such as flat, hypermobile feet or high arches — which can overload the structures in the forefoot. Additional contributing factors include poorly fitting footwear, arthritis, bursitis, stress fractures, nerve irritation, and repetitive high-impact activities like running or jumping.
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What are the Symptoms of Metatarsalgia?
The most common symptom of metatarsalgia is discomfort or pain at the front of the foot, typically around the heads of the metatarsal bones (the ball of the foot). The term is often used broadly, as various other forefoot conditions can present with similar symptoms.
Common signs and symptoms include:
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A dull ache or burning sensation in the ball of the foot, which may worsen during activity and persist afterward
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Pain that intensifies with toe flexion, physical activity, or when wearing flexible footwear or walking barefoot
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Sharp, shooting discomfort radiating through the forefoot and sometimes into the toes
What Causes Metatarsalgia?
There are several factors that can contribute to chronic forefoot pain and increased pressure across the ball of the foot. In many cases, this stress builds gradually over time. Potential causes include:
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Participation in high-impact sports or physical activity
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Wearing poorly fitted shoes, such as high heels or narrow footwear
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Having a high-arched (pes cavus) foot with prominent metatarsal heads
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Variations in foot bone structure, including abnormal metatarsal length
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Toe deformities such as claw toes, mallet toes, or hammer toes
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Tight calf muscles or Achilles tendon, affecting gait mechanics
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Abnormal foot biomechanics that lead to uneven pressure in the forefoot
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Degenerative joint changes, such as those caused by arthritis
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Soft tissue injuries, including plantar plate damage, bursitis, Morton’s neuroma, or synovitis
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Loss of protective fat padding under the forefoot, which often occurs with age
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Stress fractures in the metatarsals, such as in Freiberg’s disease
What Are the Treatment Options?
When treating metatarsalgia, achieving an accurate diagnosis is crucial for long-term success. A clear understanding of the underlying cause allows for more targeted treatment — improving the chances of a full and lasting recovery. Because various forefoot conditions can mimic metatarsalgia, a thorough clinical assessment is essential.
In some cases, your podiatrist may recommend imaging such as X-rays or ultrasound to confirm the diagnosis and better understand the structures involved.
The overall aim of treatment and rehabilitation is to restore normal movement, strength, and function in the foot.
Initial management typically includes a combination of the following strategies:
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Stretching and strengthening exercises, designed to reduce strain and rebalance pressure across the forefoot
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Manual therapy and joint mobilisation to restore range of motion and relieve stiffness
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Strapping or taping techniques to support the foot and improve comfort during activity
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Footwear changes or adjustments to relieve tightness and reduce forefoot loading
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Shockwave therapy (ESWT) in cases of chronic inflammation or bursitis
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Custom orthotics, which help redistribute pressure and minimise harmful forces on the forefoot
Depending on the structure of your foot and the specific diagnosis, your podiatrist may include orthotic modifications such as metatarsal pads, domes, first or fifth ray cut-outs, or U-shaped padding. These additions are carefully chosen based on individual needs following a detailed assessment and gait analysis.
The recovery timeline will vary depending on the severity and cause, but most people begin to see gradual improvement as treatment progresses.
In the rare event that conservative care does not provide relief, surgical options may be considered. However, surgery is typically only explored after all non-surgical treatments have been tried.
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How Is Metatarsalgia Prevented?
The role of a podiatrist goes far beyond treating immediate foot pain — it’s about maintaining long-term foot health. Regular check-ups allow your podiatrist to monitor your feet, legs, footwear, and any orthotic devices to help prevent more serious issues from developing. Early detection of problems such as abnormal gait, poor foot posture, reduced circulation, or neurological concerns can significantly reduce the risk of long-term complications.
When it comes to conditions like metatarsalgia, your podiatrist plays a key role in both diagnosis and treatment, along with managing many other foot and leg conditions.
A gait analysis is an essential part of a comprehensive biomechanical assessment. It helps evaluate how your feet and legs move during walking and running. This type of assessment provides valuable insight into joint function, muscle strength, and how the lower limbs interact with the rest of the body. An annual review is recommended to ensure mobility, alignment, and function are being maintained.
Properly fitted footwear is also critical in preventing forefoot pain, including metatarsalgia. Poor-fitting shoes are a major contributor to foot and ankle issues. Footwear should always be tried on and assessed for comfort, fit, and support before purchase.
Preventing future injury — or re-injury — means addressing the root cause of abnormal loading and reducing any excess stress on the forefoot. This is where custom orthotics can be especially beneficial. Designed to improve foot posture and redistribute pressure, orthotics are prescribed based on precise measurements and findings from your podiatrist’s biomechanical assessment.
What Happens if Metatarsalgia is Left Untreated?
If metatarsalgia is not treated, the condition can worsen over time and may become chronic. As the body tries to compensate — often through limping or shifting weight away from the painful area — additional strain can be placed on other joints and muscles. This altered gait can lead to secondary pain in areas like the opposite foot, knees, hips, or even the lower back, complicating recovery.
By identifying the issue early and implementing targeted treatment, these compensatory problems can often be prevented, leading to better long-term outcomes.
In summary, podiatrists play a key role in effectively managing and resolving metatarsalgia by offering the following care and support:
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Accurate diagnosis: A podiatrist will perform a comprehensive assessment of your feet, including a review of your medical history, symptoms, and physical examination to confirm the diagnosis and rule out other causes of forefoot pain.
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Footwear advice: Guidance is provided on selecting shoes that offer proper cushioning, support, and sufficient toe room. In some cases, orthotic inserts or custom orthotics may be recommended to redistribute pressure and relieve pain.
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Padding and strapping: Targeted padding or strapping techniques may be applied to reduce friction, offload pressure, and support healing of the affected area.
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Custom orthotics: Orthotic devices can address underlying biomechanical issues contributing to excess pressure in the forefoot. These help optimise alignment and evenly distribute load across the foot.
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Stretching and strengthening programs: Specific exercises may be prescribed to improve muscle strength and flexibility in the feet and lower legs, enhancing foot mechanics and reducing stress on the metatarsals.
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Activity modification: Podiatrists may recommend changes to daily activities or training routines to avoid aggravating symptoms — such as reducing high-impact exercise or limiting time spent in unsupportive footwear.
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Corticosteroid injection guidance: While rarely required, corticosteroid injections may be considered in persistent cases to help reduce inflammation and manage pain, particularly where conservative measures are insufficient.
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Surgical referral: If all non-invasive treatments fail and pain remains severe, surgery may be considered to address structural problems or repair damaged tissue. This is generally a last resort after exhausting conservative options.
Ultimately, a podiatrist provides personalised, evidence-based care to help relieve pain, restore function, and support long-term foot health for those living with metatarsalgia.
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