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Metatarsalgia is one of the most common problems that we treat here at The Podiatrist. In fact, we think that we could have a clinic solely dedicated to this problem! This also means that we’re very good at treating it and getting the best outcomes for your feet.

What is metatarsalgia?

Metatarsalgia is a general term describing pain at the metatarsals, which are the long bones in the front half of the feet. It is often considered to be a symptom of other injuries or conditions, as opposed to a condition in itself. Because the ball of the foot and the metatarsals take a lot of pressure with every step, metatarsalgia is a relatively common foot problem. Luckily, this also means that it’s very treatable!

What causes metatarsalgia?

There are many causes of metatarsalgia. Often, there is a biomechanical problem that puts stress on the metatarsal bones at the ball of the foot. Other causes include:

  • Systemic diseases such as diabetes
  • Joint degeneration from arthritis
  • Irregularities in bone size or shape, such as an enlarged metatarsal head
  • Other conditions in the feet such as hammertoes or claw toes
  • Any skin conditions affecting the bottom of the foot that alter the weight distribution on the met heads, such as callus
  • Fat pad atrophy, which reduces the cushioning beneath the met heads
  • High-impact activities that overload and stress the metatarsals
  • Poor footwear that cramps the feet and causes changes in the position of the bones, place greater pressure on the metatarsals or offer little support or cushioning to the midfoot and metatarsals
  • Increased weight
  • General biomechanical problems that result in excessive stress or pressure at the ball of the foot and/or the loss of the transmetatarsal arch of the foot

What are the symptoms?

Metatarsalgia is characterised by pain at the ball of the foot or through the midfoot. The pain can range from sharp to a dull ache, and can feel bruised or swollen. The pain is usually exacerbated by walking because it puts pressure on the metatarsals. Depending on the cause, swelling may also be present, which may irritate the surrounding structures of the foot and cause the pain to radiate.

How is it treated?

The treatment of metatarsalgia must address its specific cause. We identify the cause through a comprehensive biomechanical assessment, which will examine everything from the biomechanics and alignment of your feet and legs to pressure testing, muscle strength testing, footwear assessment, gait analysis and more.

Any concurrent conditions, such as callus or bursitis in the feet, also need to be managed appropriately. While the PRICE (protection, rest, ice, compression and elevation) principles can help relieve the painful symptoms, treatment needs to be directed at correcting the cause so that metatarsalgia doesn’t become an ongoing issue. To achieve this, treatment may include:

  • Orthotics to correct alignment issues in the feet and legs and offload pressure away from painful metatarsals
  • Metatarsal dome (within shoe or as orthotic addition) to restore and offload the transmetatarsal arch and help relieve painful symptoms
  • Assessing footwear to ensure it is helping and not hindering your recovery
  • Increasing cushioning beneath the ball of the foot
  • Strengthening weak muscles
  • Stretching tight muscles
  • Gait retraining and assessing your running technique
  • Manual therapies including dry needling, mobilisation, massage, and tissue release to improve the range of motion in the foot and ankle


Two weeks with Calcaneal Spur and finally got to see Doc. He sent me to Kevin @ Eleven and with One Appointment, he had me walking without Crutches. Yes! It still hurt. Did the Stretching, Rolling my Foot on a Spikey ball and Iced it occasionally. Return visit, after he had his Holiday, and I' am walking fine. They do NOT want to see me again, unless it deteriorates. Which it has not :-)
- Ivan CooKe