Ankle & foot
Metatarsalgia (Ball-of-Foot Pain)
Aching or burning pain under the ball of the foot from overloaded metatarsal heads. Common in runners, high-heel wearers and over-40s; orthotics often help.
Common symptoms
- Aching, burning or bruised feeling under the ball of the foot
- A sensation of walking on a stone
- Worse when standing, walking or running, especially barefoot, in thin soles or in heels
- Tenderness under one or more metatarsal heads, often the second and third
- Sharp pain when pushing off through the toes
- Hard skin or calluses under the ball of the foot
- Pain that eases with rest and taking weight off the foot
Overview
Metatarsalgia means pain under the ball of the foot, around the heads of the metatarsals — the long bones that end just before the toes. Rather than one single diagnosis, it describes a forefoot that is overloaded: too much pressure passes through one or more metatarsal heads, and the joints, fat pad and soft tissues underneath become sore.
The typical complaint is an aching, burning or bruised feeling under the ball of the foot, often beneath the second and third toes. It is usually worse when standing, walking or running on hard surfaces, and in thin-soled or high-heeled shoes. Some people say it feels like walking on a stone, and hard skin may build up under the sore area.
Metatarsalgia is not the same as Morton's neuroma. Metatarsalgia is pain at the bones and joints under the ball of the foot, while Morton's neuroma is an irritated nerve between the toes, typically with tingling or numbness into two neighbouring toes — although the two can occur together. Metatarsalgia is common in runners, people who stand all day, those who often wear heels and adults over 40. Many people improve with footwear changes and offloading, though outcomes vary.
Causes and risk factors
- High heels or thin-soled shoes that push weight onto the forefoot
- A high arch, or a second metatarsal that is longer than the first
- Bunions, claw toes or hammer toes changing how load is shared
- Running or jumping on hard surfaces, or a sudden increase in training
- Thinning of the protective fat pad under the forefoot with age
- Tight calf muscles, which shift load forward onto the ball of the foot
- Carrying extra body weight
How we may be able to help
Assessment first. We pinpoint which metatarsal heads are sore, examine the toe joints and how they move, and check for other causes of forefoot pain such as a stress fracture, Morton's neuroma or an inflamed joint. If a stress fracture is suspected, we can arrange imaging through an online private GP consultation.
Our 3D foot scan shows how pressure is spread across your forefoot. Custom orthotics, manufactured in the UK from your scan, can include a metatarsal dome and forefoot cushioning to move pressure away from the sore metatarsal heads. Many people find this makes standing and walking noticeably more comfortable.
Physiotherapy addresses why the forefoot is overloaded: calf flexibility, strengthening the toes and the small muscles of the foot, mobilisation of stiff foot joints, and advice on footwear, walking and running technique and training load. Therapeutic ultrasound may be used as an adjunct for irritated soft tissue in some plans, and kinesiology taping can help offload the forefoot between sessions.
What you can do at home
- Wear shoes with a cushioned sole, a wide toe box and a low heel
- Avoid walking barefoot on hard floors while the forefoot is sore
- Try an off-the-shelf metatarsal pad placed just behind the ball of the foot
- Cut back on running and jumping for now; cycling and swimming are good alternatives
- Stretch your calves against a wall twice a day
- Use a wrapped ice pack on the ball of the foot for 10 minutes after a long day
Frequently asked questions
What is the difference between metatarsalgia and Morton's neuroma?
Metatarsalgia is pain at the metatarsal heads and joints under the ball of the foot, usually an ache or bruised feeling directly under the bones. Morton's neuroma is an irritated nerve between two toes, and typically causes burning, tingling or numbness into those two toes. They can occur together, and we check for both at your assessment.
Will orthotics help?
Often, yes. Custom orthotics with a metatarsal dome and forefoot cushioning aim to spread pressure away from the sore metatarsal heads. Many people find them helpful alongside better footwear and exercises, though results vary.
Do I need an X-ray?
Usually not. The diagnosis is normally made from your history and examination. Imaging is considered if a stress fracture or another problem is suspected, and we can arrange this through an online private GP consultation.
Can I keep running?
Often yes, at a reduced level and in well-cushioned shoes, provided the pain is not building during or after runs. If there is pinpoint bone tenderness, running should stop until a stress fracture has been ruled out.
This page is general information, not a diagnosis. A clinician will assess you before recommending any treatment. Outcomes vary from person to person. Written with reference to NHS and other peer-reviewed guidance.