Metatarsalgia describes pain beneath the forefoot; it is initially a description of symptoms. It can have very different underlying causes. Before prescribing insoles or considering surgery, it is therefore important to establish which structure is causing the pain.
Sudden forefoot swelling, severe pain after injury or an open sore in someone with diabetes needs prompt assessment.
Causes and risk factors
Increased pressure on individual metatarsal heads, unsuitable shoes or a rapid increase in running may contribute. Depending on the findings, joint conditions, toe deformities, nerve irritation and injuries also need to be considered.
Typical symptoms
Walking through the ball of the foot may cause pressure, burning or stabbing pain. Some people develop painful calluses. Numbness or an electric sensation in the toes is more suggestive of additional nerve involvement.
Diagnosis
We examine the painful area, skin, toe alignment, joint stability and walking pattern. Weight-bearing X-rays or other imaging follow according to the suspected cause. A stress injury or Morton’s neuroma needs different treatment from pressure overload alone.
Non-surgical treatment
Wide shoes, adjusted running activity and targeted pressure relief may help. Insoles with appropriate cushioning are tailored to the findings; the position of a pad is crucial. A graded programme of strength and flexibility exercises may also be useful.
Surgical options
If surgery is needed, it treats the underlying condition, not the general symptom label of metatarsalgia. It is considered only after establishing the diagnosis and weighing conservative options. Specialist assessment is coordinated when needed.
Aftercare and rehabilitation
The effect of shoes and insoles is assessed during everyday walking. New pressure points are a reason to adjust them. Running volume should increase gradually. Persistent pain requires another examination rather than simply adding more padding.
Common questions
Do I automatically need insoles?
No. The cause must first be established. Suitable insoles can help with pressure-related symptoms.
Can I exercise despite forefoot pain?
It depends on the findings. If a stress fracture is suspected, activity should first be discussed with a doctor.
Arrange a consultation
We discuss which treatment is suitable for your findings and which procedures are available within our outpatient service during a personal consultation. Outpatient operations take place at an external surgical centre.
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Further reading
Selected external resources about this condition. Some linked publications are in German.
Medical background
Sources & further information
These professional and patient resources provide further information about this condition. The text on this page is independently written.
NHS: Pain in the ball of the footNHS inform: Foot and toe problems