Metatarsalgia

Metatarsalgia is a pain localised beneath the forefoot, specifically at the level of the metatarsal heads (just behind the toes). The metatarsals are the long bones situated between the midfoot and the toes. They play a key role in weight-bearing and propulsion during walking.

Metatarsalgia foot pain often appears when there is an imbalance in the forces acting on the forefoot. This forces the metatarsals to bear excessive loads, resulting in mechanical overload that causes discomfort or even persistent pain. It is this excess pressure that is referred to as metatarsalgia.

The cause of metatarsalgia may involve a combination of factors (foot morphology, weight-bearing abnormalities, physical activities, footwear, associated foot conditions). A specialist consultation is therefore essential to identify the precise origin of the imbalance.

Related treatment(s)

Metatarsal osteotomy

See the treatment in detail

Metatarsalgia: Causes

Metatarsalgia causes are numerous however, the main cause is an imbalance of the forefoot. Under normal circumstances, the forefoot distributes mechanical loads evenly across the various toes and metatarsals.

However, any abnormality in the length, axis or orientation of one or more metatarsals disrupts this distribution. The foot compensates, leading to localised and painful overloading.

Most common causes

The causes of metatarsalgia are numerous and may occur in isolation or in combination.

Among the most common are:

Hallux valgus
Freiberg’s disease
Stress or fatigue fractures, often linked to repetitive overloading
Ankle stiffness or equinus, with muscular contractures
Fracture sequelae with malunion (bony callus deformity)
Plantar plate abnormalities, causing toe instability
Inflammatory conditions such as rheumatoid arthritis
Congenital foot morphology abnormalities
Nerve tunnel syndromes with nerve compression, such as Morton’s neuroma

A specialist assessment is essential to identify precisely the cause or causes of metatarsalgia and to treat it with an appropriate plan.

Diagnosing Metatarsalgias

Diagnosing metatarsalgias requires a precise clinical evaluation to identify the specific cause of your foot pain and mechanical imbalance. This assessment ensures your treatment plan is tailored to your unique anatomy.

1. Clinical Consultation

Your consultant will first discuss your symptoms and medical history, focusing on:

The exact location and intensity of the metatarsalgia pain.
Aggravating factors, such as specific footwear, sports, or prolonged standing.
Any previous foot or ankle injuries.

2. Physical Examination

A thorough physical exam identifies areas of “overload” or pressure. Your specialist will assess:

Weight distribution: Checking for calluses and pressure points under the foot.
Biometrics: Analysing toe mobility, metatarsal length, and foot alignment.
Specialised Tests: This may include the Mulder test (for nerve compression) or the Silverskjöld manoeuvre (to check for calf muscle tightness).

3. Diagnostic Imaging

To confirm the diagnosis and rule out stress fractures, the following may be required:

Weight-bearing X-rays: Taken while standing to assess bone alignment and forefoot curvature.
Soft Tissue Scans: An MRI or ultrasound may be used to inspect the plantar plate, ligaments, or any inflammation.

Note: Following this assessment, a bespoke treatment strategy will be established. In many cases, metatarsalgia can be managed effectively with non-surgical medical care.

Metatarsalgia: Symptoms and Clinical Signs

The most recognisable metatarsalgia symptom is a pain localised beneath the front of the foot, at the level of the metatarsal heads.

It most commonly appears during walking, when bearing weight or rolling through the step, and may intensify with prolonged standing or wearing unsuitable footwear.

In some cases, foot pain due to metatarsalgia can radiates towards the midfoot or ankle, indicating more widespread mechanical overloading.

On the skin, a thickening is frequently observed beneath the forefoot, with the formation of hard skin or calluses. These pressure zones increase pain and can become very sensitive to the touch.

In addition to these general signs, specific features may be present depending on the underlying cause:

pain more pronounced beneath a particular metatarsal,
a burning or overheating sensation,
difficulty with push-off,
joint stiffness or visible deformity of the forefoot.

Metatarsalgia of the Foot: Bespoke, Premium Treatment

Metatarsalgia of the foot must be managed in a progressive and personalised manner. Initially, medical treatment is proposed. Surgery is only considered at a later stage, should the pain persist.

Medical Treatments (First-Line)

Medical treatment is based on two complementary approaches: relieving pain and addressing the cause of metatarsalgia.

To address the pain, the goal is to reduce excessive pressure beneath the forefoot and improve walking comfort. This involves custom-made orthotic insoles, designed to redistribute loads and reduce overloading of the metatarsal heads.

Chiropody care to remove the hard skin and calluses that worsen pain is also offered.

Physiotherapy helps to loosen muscular and tendinous structures, improve mobility and correct certain imbalances.

In cases of metatarsalgia secondary to gastrocnemius (calf) muscle contracture, regular stretching of the posterior chain over 30 days can lead to regression of the symptoms of metatarsalgia. Surgical lengthening should be discussed depending on the results.

Alongside symptom relief, it is essential to correct the underlying cause of the condition when it has been identified.

Surgery for Metatarsalgia

When pain persists and impairs quality of life despite well-managed medical treatment, surgery may be proposed.

The procedure is most often carried out on a day-case basis, with admission and discharge on the same day. Depending on the medical context or complexity, an overnight stay of one to two nights may be arranged.

Several anaesthesia options are available, chosen according to the patient and the procedure:

Regional anaesthesia (leg and foot),
Spinal anaesthesia (lower limbs),
General anaesthesia.

Surgical treatment depends directly on the cause of the metatarsalgia. In cases of mechanical metatarsalgia, it aims to:

restore a harmonious forefoot curve,
perform shortening osteotomies of the metatarsals (DMMO, DOMMO, DICMO, etc.),
correct the angle of attack of the metatarsals,
realign their axis to distribute loads evenly,
excise a Morton’s neuroma where present.

Depending on the situation, bone, joint or tendon procedures may be combined. Surgery is now most commonly performed using minimally invasive techniques with incisions of just a few centimetres, or percutaneous techniques using micro-incisions, for a more comfortable recovery.

Because every foot is unique, the surgical steps are explained in detail during the consultation so that the patient has a clear understanding of the proposed strategy and the expected benefits. Full weight-bearing is permitted on the day of surgery (with therapeutic footwear in the case of fractures).

Your Metatarsalgia and Feet Conditions Questions Answered

International Elite Care ’s experts answer all your questions about metatarsalgia and feet conditions.

What is metatarsalgia?

Metatarsalgia is a common condition causing pain and inflammation in the ball of the foot, specifically around the metatarsophalangeal joints (where the metatarsal bones meet the toes).

Is metatarsalgia painful?

Yes, metatarsalgia is painful. Its hallmark symptom is sharp, aching, burning, or shooting pain in the ball of the foot (metatarsal heads), often feeling like walking on a pebble.

This pain worsens with standing, walking barefoot, or high-impact activity and improves with rest. Pain severity ranges from mild discomfort to severe, limiting mobility, and may include tingling/numbness in toes.

How to fix metatarsalgia pain?

Metatarsalgia pain is typically managed conservatively first, with most cases resolving without surgery.

Can you run with metatarsalgia?

Yes, this is often possible when the pain has been identified and properly managed. Without adaptation, however, the repetitive impact can perpetuate the pain.

A specialist consultation can determine whether running and metatarsalgia can go hand in hand, with a temporary adjustment or a gradual return to activity after treatment.

Can you walk with metatarsalgia?

Yes, you can walk with metatarsalgia, but it often hurts. Pain in the ball of the foot worsens during walking, standing, or running (especially barefoot on hard surfaces) feeling sharp, burning, or like a pebble in your shoe, though rest eases it.

Limit activity, use supportive shoes/pads, and see a podiatrist if limping or severe to avoid complications like back pain.

Why choose International Elite Care to treat your metatarsalgia?

International Elite Care gives you rapid access to expert forefoot surgeons, recognised for their high level of expertise and surgical volume.

The team coordinates your entire pathway, from first contact through to post-treatment follow-up, with a personalised, smooth and reassuring approach that is particularly suited to international patients.

Surgeon performing the procedure