The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Foot & Ankle

Metatarsalgia

Metatarsalgia is not a single diagnosis but a clinical descriptor for pain localized to the plantar aspect of the metatarsal heads — the "ball of the foot." It is among the most common forefoot complaints in adults, particularly in runners, women who wear high heels, and older patients with age-related fat pad atrophy. Accurate identification of the underlying cause is the key to effective treatment.

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What is metatarsalgia?

Metatarsalgia is pain and inflammation in the ball of the foot, where the long metatarsal bones bear weight during push-off. It often results from abnormal pressure due to foot shape, footwear, or high activity. Symptoms include aching or burning pain that worsens with walking, running, or standing.

The metatarsal heads bear substantial load during the push-off phase of walking and running. When load is abnormally concentrated — due to anatomy, footwear, or adjacent pathology — the plantar soft tissues become irritated and inflamed.

Primary metatarsalgia arises from intrinsic biomechanical factors: a long 2nd metatarsal, a plantarflexed metatarsal, cavus foot with fixed forefoot load, or fat pad atrophy (common in older adults and in patients on long-term steroids).

Secondary metatarsalgia is caused by adjacent pathology shifting load to the central metatarsal heads:

  • Morton's neuroma: Perineural fibrosis of the interdigital nerve; distinguished by the Mulder's click (palpable click with lateral forefoot squeeze + direct web space pressure) and burning/radiation to adjacent toes — neither is present in simple metatarsalgia.
  • Sesamoiditis: Inflammation or stress fracture of the sesamoid bones beneath the 1st MTP joint; causes pain under the great toe rather than the central metatarsals.
  • Freiberg's infraction: Avascular necrosis of a metatarsal head, most commonly the 2nd; adolescent females; X-ray shows flattening and sclerosis of the metatarsal head.
  • Plantar plate tear: Disruption of the fibrocartilaginous plate at the 2nd MTP joint; causes a "V" deformity of the 2nd toe with dorsal subluxation.

Treatment options

Metatarsalgia almost always responds to changes in footwear and offloading.

Non-Operative

Switching to shoes with a wider toe box and lower heel immediately reduces pressure on the ball of the foot. A metatarsal pad placed just behind the metatarsal heads spreads the bones and relieves the sore spot. Custom orthotics are helpful for patients with high arches or a structural foot problem contributing to the pain.

Surgical Treatment

Surgery is rarely needed and considered only when a specific structural problem — such as an abnormally long metatarsal — has failed conservative care; a metatarsal osteotomy (realignment cut) corrects the underlying bone position.

Frequently Asked Questions

How do I know if it's metatarsalgia or Morton's neuroma?
Key differences: metatarsalgia causes pain directly under the metatarsal heads; Morton's neuroma causes burning/numbness radiating into adjacent toes, and Mulder's click is positive. Clinically the distinction is usually clear; ultrasound confirms a neuroma if there is doubt.
Will orthotics fix my metatarsalgia?
Custom orthotics with metatarsal pads are effective for ongoing management and reducing recurrence but rarely "cure" the underlying anatomic cause. They are an excellent long-term solution for most patients.
What is Freiberg's infraction?
Freiberg's infraction is avascular necrosis (bone death from poor blood supply) of a metatarsal head — usually the 2nd. It most often affects adolescent girls and causes localized metatarsal head pain and joint stiffness. X-ray shows characteristic flattening and sclerosis.
How long does it take for metatarsalgia to get better?
With appropriate footwear modifications, metatarsal pads, and activity adjustments, most patients notice significant improvement within 4–8 weeks. Athletes or individuals who remain on their feet for prolonged periods may take 3–4 months to experience full relief. If an underlying cause such as a tight calf muscle or a hammertoe is contributing, addressing that problem is essential to lasting recovery. At MOS, your treatment plan targets both the symptoms and the biomechanical factors driving them, which leads to more durable outcomes.
Do I need surgery for metatarsalgia?
Surgery is rarely necessary for metatarsalgia and is only considered when conservative measures — including proper footwear, metatarsal offloading pads, custom orthotics, and physical therapy — have failed after several months. When surgery is needed, it typically addresses an underlying structural problem such as an excessively long second metatarsal (Weil osteotomy) or a fixed hammertoe deformity. Your MOS surgeon will evaluate your foot mechanics and imaging to identify any correctable deformity and discuss whether an operative approach is likely to provide lasting benefit.

Meet the specialists

Gary Feldman, DPM, FACFAS

Gary Feldman, DPM, FACFAS

Podiatry (Foot & Ankle Surgery)

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Related conditions

Morton's NeuromaBunion (Hallux Valgus)Stress Fractures (Foot)
Medically reviewed by Gary Feldman, DPM, FACFAS, DPM, FACFAS
Last reviewed May 1, 2026

References

  1. Espinosa N, Brodsky JW, Maceira E. Metatarsalgia. Journal of the American Academy of Orthopaedic Surgeons. 2010;18(8):474–485. doi:10.5435/00124635-201008000-00003
  2. Pérez HR, Reber LM, Christensen JC. The effect of frontal plane position of the first ray on first metatarsophalangeal joint range of motion. Journal of Foot and Ankle Surgery. 2008;47(4):281–291. doi:10.1053/j.jfas.2008.03.006
  3. Highlander P, VonHerbulis E, Gonzalez A, Britt J, Buchweitz J. Complications of the Weil osteotomy. Foot & Ankle Specialist. 2011;4(3):165–170. doi:10.1177/1938640011402822
  4. OrthoInfo — AAOS. Metatarsalgia (Foot Pain in the Ball of the Foot). Available at: https://orthoinfo.aaos.org/en/diseases--conditions/metatarsalgia