What it is
Metatarsalgia is pain under the forefoot (metatarsal heads) and includes a range of causes that increase plantar pressure beneath the forefoot. It may be localised to one metatarsal head or more diffuse across the ball of the foot.
Common causes / risk factors
- Mechanical overload from high activity, ill-fitting or high-heeled shoes, altered foot biomechanics (long second metatarsal, tight calf/achilles), toe deformities (hammer toes), and fat pad atrophy.
- Systemic causes (inflammatory arthropathies) or neuropathy should also be considered in the appropriate clinical context.
Symptoms
- Sharp, aching or burning pain under the ball of the foot, worse on weight bearing and with forefoot activities. Some patients report numbness or shooting pain if nerve irritation exists.
Evidence-based treatments
- Conservative care: footwear modification, metatarsal pads or off-loading orthoses, activity modification, and targeted strengthening/stretching.
- Custom orthoses can redistribute plantar pressures and have evidence supporting their use for symptomatic relief in many patients. Surgical options (metatarsal osteotomy, soft tissue procedures) are reserved for refractory mechanical causes.
How Clear Step Podiatry can help
- Full forefoot assessment (gait, pressure analysis where appropriate, footwear & biomechanical exam).
- Immediate measures: footwear advice, metatarsal pads, padding and temporary off-loading.
- Custom orthotic design and manufacturing when indicated, targeted rehab and referral for surgical opinion when conservative care fails.
