Metatarsalgia is a common problem of diffuse pain under the sole of the foot. It is often located under the 2nd, 3rd, and 4th metatarsal heads, or more isolated at the first metatarsal head. Painful calluses and swelling may also appear in certain areas.

Symptoms of metatarsalgia

  • Dull, bruise-like pain in the sole of the foot.
  • More pronounced pain when walking barefoot, especially on hard surfaces such as concrete or ceramics.
  • Pain that forces you to walk on the outside of the foot to avoid stepping on the ball of the foot.
  • Pain alleviated by wearing good running shoes, especially those with extra cushioning.
  • Formation of a callus where pain and pressure are greatest. Calluses form to protect the body from excessive pressure.

Causes of metatarsalgia

Most often, metatarsalgia is the result of poor weight distribution on the front of the foot. Normally, when you walk, weight is gradually transferred from the little toe to the big toe.

As the big toe engages the ground, most of the weight is carried by it. The first metatarsal of the big toe joint carries most of the weight, while the other toes share a small portion.

If too much weight is distributed to the outer metatarsals, this can cause microtrauma to the joint capsules, leading to injury.

Normally, the small muscles that run between the bones of the feet contract during the last phase of each step to prevent the forefoot from widening and the toes from deforming. If these small intrinsic muscles don't do their job, the foot sags and the toes contract, bringing the heads of the metatarsals into too direct contact with the ground, and damage begins to appear.

As you can imagine, the onset of symptoms is usually gradual, as microtrauma takes some time to become a real injury.

However, if you suffer a shock or wear new, ill-fitting shoes, metatarsalgia can appear suddenly. A poor barefoot landing, wearing high-heeled or un-cushioned shoes, running over stones or a hard object are all ways of creating this damage.

Other possible causes

Metatarsalgia may also develop because of foot bunions, different metatarsal lengths, hammertoes, hollow arches, arthritis, and stress fractures.

In some cases, it may present following compensatory gait associated with foot surgery, specifically of the big toe. It's important to understand that this pathology is not of a single origin, but rather a combination of several problems. What's more, it's not uncommon for them to appear at the same time.

An often-missed pathology: the plantar plate tear.

Plantar plate tearing is often confused with metatarsalgia, neuroma or even capsulitis. It involves an incomplete or incomplete tear in the extension of the joint capsule beneath the metatarsal head. It is particularly common in the 2nd toe of people suffering from hallux abducto-valgus and hallux rigidus.

A clinical examination accompanied by medical imaging will confirm its presence during a visit with our podiatrist experienced in foot surgery.  Please note that the symptoms associated with this condition are most often resolved by surgery, since the nature of the tissue is poorly vascularized and therefore refractory to conservative treatments.


As the majority of metatarsalgia cases are attributable to biomechanical problems, many patients can be treated with a plantar orthosis with forefoot pad adjustment. If pronation of the foot is significant, you'll need a shoe designed to control movement. If you're replacing your shoes, consider a pair that offers some form of cushioning for the ball of the foot. Your podiatrist can help you find a great shoe for your foot that meets your needs. A surgical option may be considered if conservative means have not helped, or if a pathology such as plantar plate rupture is present.

Make an appointment with a podiatrist today.

All content on this site is verified and approved by Dr. Sarah Cantin-Langlois, podiatrist.

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