Metatarsalgia Explained: Why the Ball of Your Foot Hurts and How to Relieve It
Metatarsalgia: Why the Ball of Your Foot Hurts—and What Actually Helps
If it feels like you’re walking on a rock, dealing with burning pain, or battling constant soreness in the ball of your foot, you may be suffering from metatarsalgia.
Here’s the truth: I've seen many people ignore this and waste money and time buying insoles and shoes that do not help. But unless you understand why your pain is happening, treatment becomes a guessing game—and pain doesn’t improve when you guess.
What Exactly Is Metatarsalgia?
Metatarsalgia is the medical term for pain at the ball of the foot where the long metatarsal bones ( metatarsal heads) meet the toe bones (proximal phalanges). This area absorbs 2–3 times your body weight during walking, making it highly vulnerable to stress and inflammation.
Most metatarsalgia falls into one of three categories:
- Structural or biomechanical issues
- Nerve-related conditions
- Arthritic or inflammatory joint disease
1. Structural & Biomechanical Causes (Most Common)
A major review found that up to 90% of metatarsalgia comes from biomechanics. People with high arches, tight calves/ achilles tendon or equinus, bunions, hammer toes, or long/dropped metatarsals are especially prone to forefoot overload.
Dropped/long metatarsals and hammer toes contribute to formation of calluses at the ball of the foot which is a very common cause I see daily for ball of the foot pain. Please check out my YouTube episode on how to DIY customize OTC spenco orthotics to offload calluses.
Tight Achilles ( Equinus) and Forefoot Pressure
When calf muscles/ achilles tendon is tight, the ankle can’t bend upward enough.
The ankle needs to bend upward 10-20 degrees for proper gait.
Less than this, we podiatrists call this equinus and it wrecks havoc on the foot and causes a lot of foot pathology. One big problem it causes is forefoot overload which can lead to metatarsalgia.
So to compensate, the body pushes more weight into the forefoot—directly into the metatarsal heads. This leads to inflammation, bursitis, synovitis, and callus formation.
Foot in equinus above.
The best way to combat this is with achilles tendon stretches which I recommend to most of my patients suffering from metatarsalgia.
Please check out my youtube episode to learn how to properly stretch the achilles tendon while at the same time strengthening the gastrosoleal muscle group ( calf muscles) and tendon.
Research has shown that achilles stretching helps increase range of motion:
- 15+ min/day → ~2° increase in ankle mobility
- 30+ min/day → ~2.49° increase
Shoes That Reduce Ball-of-Foot Pain
- Stiff rocker soles to reduce push-off pressure
- Forefoot rocker upturn to offload joints
- Zero-drop or negative-heel shoes
Altra Torin 8 is my favorite zero drop sneaker.Orthotics and Metatarsal Pads
Orthotics especially custom molded orthotics are wonderful to limit abnormal motion in the foot, allow the foot with poor mechanics operate more efficiently and take pressure off the ball of the foot. I like to incorporate adhesive felt callus protectors 
and metatarsal pads on the orthotic for more offloading at times.
The adhesive felt metatarsal pads or callus offloading pads can give immediate relief even if applied to a shoe insert. Please see the YouTube episode on how to DIY spenco orthotics with the adhesive felt pads and how to apply a metatarsal pad.
2. Neurological Causes
Some ball-of-foot pain is nerve-related:
- Morton’s neuroma – burning or tingling sharp pain. Metatarsal pads on a shoe insole, OTC orthotic or best on a custom orthotic help this condition a lot.
- Tarsal tunnel syndrome
- Peripheral neuropathy
- Referred pain from the lower back
Check out my neuroma pain relief episode and neuropathy treatment guide.
3. Arthritic Causes
Arthritis can generate stiffness, swelling, and deep aching pain in the forefoot. This includes RA, psoriatic arthritis, gout, and osteoarthritis.
These conditions are helped by a more accommodative orthotic which is more soft and flexible than the functional more rigid custom orthotic. The offloading padding help these conditions as well.
Shoes are very important for an arthritic foot. I like using pedors which a stretchy shoe that decreases pressure on forefoot deformities and a rocker sole.
When to See a Podiatrist
If you have persistent ball-of-foot pain, tingling, numbness, or calluses, a biomechanical evaluation and X-rays may be needed. Proper diagnosis of ball of the foot pain is very important to dictate treatment. Please see your podiatrist for proper diagnosis and before trying treatments.
The following are usually my go to for initial treatment for most causes of metatarsalgia
- metatarsal pads
- callus offloading pads
- supportive rocker-sole shoes
- Achilles tendon stretches
You don’t have to live with chronic forefoot pain—please see your podiatrist for diagnosis and effective ways to treat it.
Please check out my video about metatarsalgia :
Thanks for reading !
Here's to Your Best Foot Forward!
Melissa Gaffney, DPM
I am a affiliate for pedors and get a small commission when you click on the pedors link. Thank-you for your support.
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The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons. 2009 Mar-Apr;48(2):239-50. doi:10.1053/j.jfas.2008.12.004.
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