Metatarsalgia

Metatarsalgia is the medical term for pain in the ball of your foot — under the bony heads of the long forefoot bones, just behind the toes. It's a symptom, not a single diagnosis. The underlying cause varies: thinning of the natural fat pad on the bottom of your foot with age, foot shape that concentrates pressure on those bones (high arches, claw toes, a tight calf), a prior surgery that shifted the load, inflammation of one of the toe-base joints, a torn ligament under the joint, or a stress fracture. Pinning down the actual cause is essential for treatment.

• Ball-of-foot pain — aching or sharp pain under one or more metatarsal heads that worsens with standing, walking, or running and eases with rest
• Burning or tingling sensation — a hot or prickling feeling under the forefoot, sometimes extending into the toes
• Callus buildup — thickened skin under the affected metatarsal head from abnormal pressure concentration
• Feeling of a pebble in the shoe — many patients describe the sensation of walking on a stone or a fold in the sock

Standing X-rays show the length and alignment of each forefoot bone and pick up any stress fracture. MRI evaluates the small ligaments under the toe joints (the plantar plates), any bursitis between the bones, and joint inflammation. Ultrasound is uniquely useful here because it shows the structures in real time as the foot moves.

1. Corticosteroid injection

   An corticosteroid injection helps when the pain is from joint inflammation or a small bursa between the forefoot bones.

Surgery is targeted at whatever underlying problem is causing the pain. A Weil osteotomy shortens an over-long forefoot bone; a plantar plate repair fixes the small ligament under the joint; correcting a claw-toe deformity takes the abnormal pressure off.

External patient-education references and related OSI pages for additional background:

• Britannica — Ankle (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language