Metatarsalgia refers to pain in the ball of the foot, often described as a burning sensation, a dull ache, or the feeling of “walking on pebbles.” Some people experience discomfort under one or two toes, while others may feel it across the whole forefoot or even in both feet.

What Causes Metatarsalgia?

Any condition that increases pressure on the front of the foot can trigger metatarsalgia. Common contributing factors include:

  • Excess body weight
  • Wearing high-heeled or tight-fitting shoes
  • Foot shapes such as a long second toe, high arches (cavus foot), or long metatarsal bones
  • Hammer toes or claw toes that force the metatarsals downward
  • Tight calf muscles that prevent proper ankle flexibility
  • A weak or arthritic big toe joint (sometimes after bunion surgery)
  • Nerve problems such as interdigital neuroma or tarsal tunnel syndrome
  • Diabetic nerve irritation causing burning pain
  • Stress fractures in the metatarsal bones (common in runners and walkers)
  • Joint inflammation from arthritis or gout

Can Metatarsalgia Be Prevented?

Some causes are avoidable with simple lifestyle adjustments:

  • Maintain a healthy body weight
  • Stretch your calf muscles regularly
  • Avoid tight or high-heeled footwear
  • Keep the ankle mobile after sprains or injuries
  • Manage gout, diabetes and arthritis properly

However, many cases occur even when all precautions are taken.

What Should I Do If I Have Pain in the Ball of My Foot?

Start by reducing stress on your feet:

  • Practice proper calf stretching
  • Rest with your feet elevated after prolonged standing or walking
  • Maintain appropriate body weight
  • Choose supportive shoes with a small heel and ample toe room

Additional steps you may try:

  • Pain relief medications such as Paracetamol
  • Silicone metatarsal pads or cushioned insoles

When Should I See a Doctor?

If home measures don’t help and the pain begins affecting your daily routine, it is advisable to consult an Orthopaedic Foot and Ankle specialist. They can determine the cause of your discomfort and whether further evaluation or treatment is needed.

What Tests Might Be Required?

A careful history and examination often provide enough information. Your doctor may also recommend:

  • Urine tests for early diabetes
  • Blood tests for inflammation, gout, arthritis or diabetes
  • Foot X-rays to assess bones and joints

In more complicated cases, additional diagnostic tests such as an MRI, bone scan, nerve studies or foot pressure mapping may be used. Sometimes, even after thorough testing, the exact cause remains unclear.

What Are the Treatment Options?

Your healthcare provider may reinforce the importance of proper footwear and weight control. Treatment may include:

  • Managing underlying conditions like gout, diabetes or arthritis
  • Prescribing insoles to distribute pressure more evenly
  • Steroid injections for joint inflammation or nerve irritation (used cautiously and not repeatedly)
  • Exercises to improve stiffness and mobility

Will I Need Surgery?

Most patients improve with conservative measures. However, surgery may be considered when symptoms persist:

  • Minimally invasive reshaping of prominent metatarsal bones (often with immediate weight-bearing allowed)
  • Correcting claw or hammer toes to reduce pressure on the metatarsals