Ball-of-foot pain (metatarsalgia)

What is ball-of-foot pain, and how common is it?

Ball-of-foot pain, known medically as metatarsalgia, is pain on the sole of your foot near your toes¹. It's best seen as a symptom with several possible causes rather than a diagnosis on its own², so the aim is to work out what's overloading your forefoot.

It's common. In adults aged 45 and over, the toes and forefoot are the most common place for foot and ankle pain, and foot and ankle pain seems to be more common in women³. Published figures for how many people get it vary widely, so treat any single number as a rough guide.

What causes it, and who gets it?

It's mainly a mechanical problem. The way your foot is built or moves can raise pressure under the metatarsal heads (the rounded ends of the long bones behind your toes) when you push off⁴. A high arch or a long second metatarsal are examples⁴. Foot injuries or forefoot surgery can also change how load is shared across the forefoot⁴.

A sudden increase in activity can set it off⁵. Tight calf muscles are often linked with forefoot pain, though it isn't clear whether tightness is a cause or a result⁶. Activity, body weight and footwear are all risk factors for foot and ankle pain⁷.

It can help to think back to what changed around when the pain started: new shoes, a new activity, or more time on your feet.

What does it feel like, and how is it diagnosed?

It often feels sharp, stabbing, burning or tingling in the ball of the foot, sometimes into the toes. It's usually worse when you're on your feet and eases with rest, and some people feel as if they're walking on a pebble or lump⁸. It tends to build gradually over several weeks rather than appearing suddenly¹.

A podiatrist or doctor will ask when it started and what changed, then examine your foot, especially the sole². X-rays taken while you stand are often enough to find the cause⁹.

Other problems can feel similar, so it's worth having it checked rather than guessing. Tingling or burning in typically 3–4 toes, with a pebble feeling, can point to Morton's neuroma (an irritated nerve between the toe bones)⁷. A toe that starts to drift or bend can point to a torn plantar plate (the supporting tissue under the toe joint)⁸.

What can I do first?

Most people start with self-care, and non-surgical care is usually enough¹⁰. First-line care means learning about the condition and using steps you can do yourself¹¹:

• Change your shoes. Look for a wide, deep toe box and a low heel¹¹.
• Stretch your calves. It may ease forefoot pain by reducing the force on the ball of the foot¹¹.
• Ease back, don't stop. Cut down on what aggravates it, and build activity up gradually.

It isn't clear yet which of these works best, so a podiatrist can tailor the plan to you. If you have a health problem, injury, recent operation or heart attack, or are pregnant, check with a health professional before starting general exercises, and stop if pain or unwellness occurs⁵.

What helps if that isn't enough?

If home care isn't working, the cause is unclear or the pain is getting worse, see a podiatrist or your GP about next steps¹². Referral on to a musculoskeletal service can be considered after at least 3–6 months of thorough non-surgical care, or sooner if the pain has a big impact or the cause isn't clear⁷.

Injections and surgery come after non-surgical options. A steroid injection can cause a flare of pain, rarely an infection, and higher blood sugar in people with diabetes¹³. After surgery that shifts or shortens a metatarsal bone, adults can have long-lasting swelling, slow bone healing or pain that moves to a neighbouring bone¹⁴. Forefoot surgery means 6 weeks on crutches and in a surgical shoe, and diabetes, poor circulation and a high body mass index are best managed beforehand¹³.

It isn't clear yet how surgery compares with carrying on with non-surgical care. If it's offered, ask about risks, recovery time and what happens if it doesn't help.

How long does it take to get better, and how can I stop it coming back?

How long it takes to settle isn't clear, so give each step a few weeks and keep track of any change. Body weight can matter: people living with obesity are more likely to have symptoms that last, so it's worth asking your GP or another health professional about support if that applies to you⁷.

Wide, deep toe-box shoes with a low heel are the usual advice¹¹, though it isn't clear yet whether footwear changes stop the pain coming back. Build walking, running and standing up gradually. Runners who move to minimalist shoes have more injuries, including bone swelling in the metatarsal region, so make that change gradually¹⁵.