Metatarsalgia: symptoms, causes and treatments

Updated 5/15/2024
Metatarsalgia, University Foot and Ankle Institute

What is Metatarsalgia?


Metatarsalgia often referred to as "ball of the foot pain" or a "stone bruise" is not so much a condition but a general term describing a group of foot problems whose symptoms are caused by several conditions.


In some cases, there can be more than one condition causing metatarsalgia symptoms. This is just one of several reasons why a proper diagnosis can be challenging and why the experience of your doctor is such a critical part of diagnosis and getting a successful treatment plan from the start.


What does Metatarsalgia Feel Like?

Metatarsalgia is a term most often used to describe ball of foot pain or forefoot pain. Other symptoms can include:


  • Pain in your toes (in addition to the ball of your foot): can be described as an aching, sharp, or burning pain.
  • Increased pain when walking, running, standing for going barefoot
  • Numbness or tingling in your toes
  • A feeling like there’s a pebble in your shoe that you are constantly stepping on.
  • Stabbing pain in ball of foot


Diagnosing Metatarsalgia

To determine the underlying condition of your pain, your podiatrist will exam your foot and ask about your activity level and associated pain. Because there are many causes of metatarsalgia, tests may be ordered to pinpoint the exact cause of the pain. These tests can include:


  • Blood test: to identify diabetes or arthritis
  • X-Ray: to check for fractures or problems with bones and joints
  • Ultrasound: to rule out Morton's neuroma
  • MRI: in some cases, a more detailed image is needed to accurately identify the underlying condition



What Causes Metatarsalgia? 

Conditions that contribute to metatarsalgia symptoms are not usually caused by an acute injury or trauma. They often occur gradually, over time, by overuse, repetitive motion, or having excess weight.


Common causes of ball of foot pain can include:


Big Toe Arthritis (Hallux Rigidus)

The inflammation in the big toe or ball of foot joint is a painful condition that may present as metatarsalgia. Having rheumatoid arthritis, osteoarthritis, or gout can also contribute to metatarsalgia.  Read more about hallux rigidus here.



A bunion is an unnatural bump on the side of the foot at the base of the big toe. The tissue surrounding bunions often becomes painful and inflamed.  Read more about bunions here.



A hammertoe is a deformity of the toe that causes it to be permanently bent in a claw-like position. The abnormal position can put increased pressure on the ball of the foot resulting in pain. Read more about hammertoes here.


Metatarsal Conditions, UFAI

Metatarsal Stress Fracture

A metatarsal stress fracture is a tiny break or fracture in the metatarsal bone. A stress fracture is often an overuse type of injury that occurs over time. Read more about metatarsal stress fractures here.


Mortons Neuroma

Morton's neuroma is a benign but painful growth of fibrous tissue. The growth arises in the nerve cells and most often occurs between the third and fourth metatarsal. Read more about Morton's neuroma here.



Nerve damage in the foot due to a diabetic condition may present metatarsalgia symptoms. Read more about diabetic nerve conditions here.


Achilles Tendonitis

An inflamed or tight Achilles tendon can change how stress is distributed throughout your foot and can lead to increased pressure and pain in the ball of the foot.  Read more about Achilles' injuries here.


Heel Pain

Heel pain can emanate from underneath the heel or behind the heel, called posterior heel pain. Read more about heel pain here.


High Arches

A short first metatarsal bone or a long second metatarsal bone (a second toe that is longer than the big toe) can result in shifting an increased amount of weight to the second metatarsal. Read more about high arches here.


Plantar Plate Injury

The plantar plate is the ligament at the base of your toes on the sole of your foot. If this ligament becomes inflamed or torn, the resulting pain is consistent with the symptoms of Metatarsalgia.  Read more about plantar plate injuries here.


As we said earlier, there can be more than one condition causing metatarsalgia symptoms. This is why diagnosis can be challenging and the experience of your doctor is such a critical part of the diagnosis.


How to Treat Metatarsalgia 

Diagnosing the actual condition and cause of metatarsalgia is imperative when determining a treatment plan. Because there are many conditions that can cause pain and contribute to metatarsalgia, treatment plans vary, making proper diagnosis critical.


There are conservative measures that may help relieve metatarsalgia pain until you can visit a doctor. These include:


"RICE" stands for "Rest, Ice, Compression, and Elevation. This helps to reduce inflammation and can be very helpful.


Wear Proper Shoes

It's important to wear well-fitted shoes that are loose enough to not put added pressure on the problem area. Loose shoes cause the foot to move excessively within the shoe, creating friction and rubbing that can irritate the metatarsals, potentially leading to Metatarsalgia. Tight shoes, on the other foot, compress the foot, leading to increased pressure on the metatarsals, which can cause pain and inflammation characteristic of Metatarsalgia. Always wear proper athletic shoes when exercising.


Custom orthotics can help provide proper arch support and reduce the pain.


Over-the-Counter Pain Medicine

Taking OTC anti-inflammatory medication can temporarily alleviate inflammation and pain. Never take anti-inflammatories on an empty stomach to help avoid the very real danger of a GI bleed.


Surgery might be necessary for Metatarsalgia when there is a need to remove a bony prominence or to correct a structural deformity that is contributing to the pain and discomfort in the foot. This could involve procedures to reshape the bone or adjust the alignment to relieve pressure on the metatarsal bones.



UFAI, We Are Near and Here for You!


University Foot and Ankle Insitute, Metatarsalgia treatment

The physicians at University Foot and Ankle Institute are nationally recognized experts with decades of experience who come armed with the latest techniques and technologies at their disposal.


Our physicians are dedicated to providing the very best care in a professional and relaxed environment. It's what we are known for.


Our team of physical therapists is dedicated to returning you to your full potential as quickly as possible. If conservative treatments are not effective, no other center can provide the level of surgical options and care for the treatment of metatarsalgia symptoms.


  • Foot and Ankle Surgeon at University Foot and Ankle Institute
    Dr. Justin Franson, DPM, University Foot and Ankle Institute, Foot and Ankle Surgeon

    Dr. Justin Franson, DPM, is a Board Certified Podiatric Foot and Ankle Specialist and Diplomate of the American Board of Podiatric Surgery. He attended the School College of Podiatric Medicine in Chicago, graduating in 2001. Dr. Franson then accepted a three-year residency program at the Greater Los Angeles VA and UCLA County Hospital. 


    Dr. Franson specializes in several areas including total ankle replacement and sports medicine. Treating athletes and weekend warriors like himself brings him a lot of joy. Dr. Franson keeps active with running marathons, triathlons, hiking, basketball, and golf.

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