Metatarsalgia is the general name for pain in the ball of the foot, under the ends of the long metatarsal bones just behind the toes. It is a symptom rather than a single diagnosis, and is often caused by too much pressure through the forefoot. Most people improve with footwear changes, padding or insoles, stretching and load management.
Also known as metatarsalgia, forefoot pain, ball of foot pain, stone bruise
Symptoms
- Aching, burning or sharp pain under the ball of the foot
- Pain that is worse when standing, walking, running or wearing thin-soled or high-heeled shoes
- A feeling of walking on a pebble or bruise
- Hard skin or corns under the ball of the foot
- Pain that eases with rest or when you take your shoes off
Causes and risk factors
- High heels and thin, poorly cushioned or tight shoes
- Long periods of standing or high-impact activity
- Foot shape, such as a high arch, or metatarsals of uneven length
- Bunions or other toe deformities that shift load onto the smaller toes
- Tight calf muscles, which increase forefoot pressure
- Other conditions, such as Morton's neuroma, stress fractures or inflammatory arthritis
What the evidence says helps
- Conservative care, including footwear changes, insoles, calf stretching and treatment of hard skin, is recommended first and is usually enough to settle symptoms.23
- A systematic review found that custom-made foot orthoses reduced forefoot pain in several groups, including people with metatarsalgia linked to other foot conditions.1
- Custom orthoses reduce pressure under the central metatarsals, but appear to work about as well as off-the-shelf insoles, supportive footwear and simple metatarsal domes.4
- Simple metatarsal pad insoles were associated with less pain and better function in a hospital series, although this study had no comparison group.5
- Because metatarsalgia has many causes, identifying the underlying reason, such as a neuroma, stress fracture or joint problem, is important for choosing the right treatment.23
Things you can try at home
- Choose shoes with a cushioned sole, roomy toe box and low heel
- Try a metatarsal pad positioned just behind the painful area, or a cushioned insole
- Stretch your calves daily
- Reduce barefoot walking on hard floors and limit high-impact activity while it settles
- Keep hard skin under control, ideally with help from a podiatrist
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Localised pain and swelling on top of the forefoot after an increase in activity (possible stress fracture): see your GP or an urgent treatment centre
- A hot, red, swollen joint, or several swollen joints with morning stiffness: see your GP promptly
- Redness and swelling with a high temperature or feeling unwell: contact NHS 111 or your GP urgently
- Numbness or burning in both feet: see your GP
- If you have diabetes and notice a wound, colour change, swelling or heat in your foot: seek same-day advice from your GP, diabetes foot team or NHS 111
How Apollo can help
Our podiatrist and osteopaths assess your forefoot, footwear and walking pattern to work out what is overloading the ball of your foot and to rule out other causes. We manage hard skin, give footwear and loading advice, and provide stretching and strengthening exercises. Where an insole or padding is likely to help, we can fit simple padding or assess you for 3D-printed custom orthotics, and we refer on for imaging or medical review when needed.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
What is the fastest way to relieve ball-of-foot pain?
Switching to cushioned, low-heeled shoes with a roomy toe box and using a metatarsal pad or cushioned insole often gives the quickest relief. Reducing standing and high-impact activity for a while also helps.
Are custom insoles better than off-the-shelf ones for metatarsalgia?
Custom orthoses can reduce pain and pressure, but studies suggest they may work about as well as good off-the-shelf insoles or simple metatarsal pads for many people. Custom devices are worth considering if simpler options have not helped or your foot shape is unusual.
Is metatarsalgia the same as Morton's neuroma?
No. Metatarsalgia is a general term for ball-of-foot pain, and Morton's neuroma is one specific cause of it. An assessment can help tell the difference, as the treatment may differ.
References
- Arias-Martín I, et al. (2018). Effectiveness of custom-made foot orthoses for treating forefoot pain: a systematic review. International Orthopaedics. View source
- Besse JL (2017). Metatarsalgia. Orthopaedics & Traumatology: Surgery & Research. View source
- Espinosa N, et al. (2010). Metatarsalgia. Journal of the American Academy of Orthopaedic Surgeons. View source
- Ruiz-Ramos MJ, et al. (2024). Effectiveness of bespoke or customised orthotic treatment in plantar pressure reduction of the central metatarsals: a systematic review and meta-analysis. Journal of Orthopaedics. View source
- Sahlman J (2017). The effect of metatarsal padding on pain and functional ability in metatarsalgia. Scandinavian Journal of Surgery. View source
- Bardelli M, et al. (2003). Definition and classification of metatarsalgia. Foot and Ankle Surgery. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
