Metatarsal Pain

Metatarsalgia (Met-uh-tahr-SAL-juh)

Metatarsalgia is pain in the ball of the foot. It is called stone bruise for good reason, it feels like you stepped on a sharp stone and then a 300 LB person stepped on that foot. The degree of pain varies and it can be tender to the touch. Pain is caused by inflammation at the end of the metatarsal bones which is above the ball of the feet. There are five long metatarsal bones that extend above the arch of the foot to the toe joints. The first and second metatarsal bones absorb the majority of this force. Most Metatarsal pain is between the third and fourth metatarsal heads (view pictures). Pain is felt when weight is applied to the ball of the foot and worsens when the walking gait transfers the weight to the toes. People with high arches and long second toes are prone to metatarsal pain. The longer second toe absorbs more weight during the gait and aggravates the metatarsal joint. If the pain is in the big toe it is often from osteoarthritis. Metatarsal pain is mostly an overuse pain. It is most common in athletes, runners, women who wear high heels and overweight or obese people.


  • 80% of the time symptoms develop slowly as it is an overuse condition. 20% of the time it is from an extreme overuse condition. Take a father who plays basketball with his son for example. The next day he might wake up and feel extreme pain in the balls of his foot/feet.
  • Pain in the ball of the foot and or in the second, third, or fourth toes
  • Increasing pain when walking on hard surfaces
  • Pain that increases when flexing the feet
  • A tingling or numbness that can be felt in the toes
  • When standing or moving there is pain but when sitting pain decreases

Healing Time of the injury include:

  • Lifestyle of the patient
  • Medical history of the patient.
  • How long the injury has been inflicted.
  • Severity and frequency of the pain
  • The person’s medical history and is there pain elsewhere?
  • The person’s gait, does the patient put excessive weight on the injured area from pronation?
  • Is surgery required?

Treatments may include:

  • Anti-inflammatory drugs, such as Ibuprofen or Aleve, are useful in pain relief.
  • Appling ice to the area up to several times a day. Do not apply ice directly to the skin.
  • Doctors may subscribe Steroid injections to reduce pain and swelling. Remember to ease into recovery often steroids mask the pain and patients are eager to over evert the injury.
  • Foot orthotics with metatarsal pads work well especially for people with high arches and arthritis pain and will be likely be prescribed to all, with or without surgery.
  • Shoes with Cushioned heels that absorb shock.

Note: if pain is persistent see a doctor it could be a stress fracture in the toe. Be aware that forefoot pain is the most misdiagnosed in podiatry. Other mitigating circumstances: Hammer Toe, a pinched nerve, etc.

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