Metatarsalgia

When you walk, your heel touches the ground first, your whole foot then supports your weight, and finally you push off the ground with your forefoot and toes. In this last phase, your weight concentrates just behind the bases of your toes—the ball of the foot. Running, jumping, or standing on tiptoe increases the load on this area.

Rather than naming a specific disease, metatarsalgia is an umbrella term describing where pain occurs, so a variety of causes and contributing factors can be involved. Common factors include the following.

• Footwear — Shoes with high heels or narrow toe boxes shift weight toward the forefoot and squeeze the toes together. Shoes with very thin, hard soles can also directly irritate the ball of the foot.
• Activity — Doing a lot of activities that repeatedly load the forefoot, such as running, jumping, or standing for long periods, can easily make it ache.
• Foot shape — High or low arches, bent toes, or a big toe that angles outward, as in hallux valgus, can change the path of weight transfer through the foot. Stiff calves that limit ankle bending can also place more strain on the forefoot.
• Body weight and skin — Weight gain or thick calluses on the sole can concentrate pressure. You can read more about calluses in Plantar calluses and corns.
• Surrounding tissues — Conditions involving nearby structures, such as the nerves running between the toes (Morton's neuroma) or the small bones beneath the big toe (sesamoiditis), can cause pain in a similar location.

Pain in nearby locations does not always have the same cause. So a starting point when the ball of your foot hurts is to pay close attention to which shoes or activities make the pain worse.

• A stabbing or burning sensation beneath the bases of the toes.
• More pain when walking barefoot on a hard floor, with a feeling like stepping on a pebble.
• Worse pain when pushing off with the forefoot during a step, standing on tiptoe, or going down stairs.
• More aching at the end of a day spent standing or walking for a long time, which eases with rest.
• Sometimes, tingling in the toes or a feeling as though something is bunched up inside your sock.

Change your footwear

• Wear shoes with a roomy toe box and enough width across the forefoot. Check that your toes have enough room to spread out. See Forefoot width and toe box for more detailed criteria.
• Shoes with low heels and cushioning under the forefoot tend to feel comfortable. Try reducing the time you spend wearing high heels.
• Many people use cushioned insoles or metatarsal pads inside their shoes to support the ball of the foot.

Adjust your activity

• On days when the pain is severe, take a break from high-impact exercise such as jumping or running, and try switching to activities that put less strain on the forefoot, such as cycling or swimming.
• Once the pain settles, gradually return to your previous exercise duration and intensity.
• On evenings when your foot hurts, elevate it and cool it with ice or a cold towel for 10–15 minutes.

Loosen up your feet and calves

• Calf stretches help the ankle bend more freely, which helps distribute the load on the forefoot.
• Foot exercises such as straightening and curling your toes or pulling a towel toward you are good ways to engage the intrinsic foot muscles.
• Roll the sole of your foot over a ball or gently massage it with your hands. However, do not press hard on the painful area.

Check your surroundings

• If you spend a lot of time walking barefoot on hard floors at home, try wearing slippers or indoor shoes.
• Measuring plantar pressure can help you see where your weight is concentrated.

• No improvement despite changing your footwear and activities for 2 weeks or longer
• Swelling in the foot, or a foot that is red and hot
• Persistent tingling or electric-shock sensations in the toes
• Sudden, severe pain that makes it difficult to bear weight
• Pinpoint pain when pressing on one spot, especially just after increasing your running
• Concerns about foot sensation or wounds when you have diabetes