What is metatarsalgia?
Metatarsalgia is pain in the ball of the foot and at the base of the toes. It is usually felt in the sole of the foot and sometimes feel like "walking on pebbles". Other people feel a more diffuse vague pain, ache or burning. Some people have trouble around only one or two toes, others have it throughout one or both feet.

What causes metatarsalgia?
Anything which puts extra stress on the front of the foot can cause metatarsalgia. Common examples are:
- being overweight
- high-heeled shoes
- certain foot shapes such as a high-arched "cavus" foot in which the bones in the front of the foot (metatarsals) point down into the sole to an excessive extent, or a long metatarsal bone which takes extra pressure
- claw or hammer toes which press the metatarsals down towards the ground
- a stiff ankle which cannot be drawn up to right angles with the leg but points the foot down to the ground
- A bunion or arthritis in the big toe can weaken the big toe and throw extra stress onto the ball of the foot. This can also happen after an operation on the big toe, such as a bunion correction.
- A stretched or irritated nerve in the ball of the foot (interdigital neuroma) or behind the ankle (tarsal tunnel syndrome) can produce pain in the ball of the foot. Diabetes can also produce irritation of the small nerves in the foot leading to a burning pain.
- Athletes or walkers occasionally get stress fractures of the metatarsal bones.
- Arthritis, gout or inflammation of the joints in the ball of the foot (metatarso-phalangeal joints) can produce local pain

Can it be prevented?
As you can see from the list above, some causes of metatarsalgia can be prevented:
- being overweight
- wearing high-heeled tight shoes
- allowing the ankle to become stiff, especially after a sprain or other injury
- getting treatment for diabetes, gout or arthritis

However, in many people, metatarsalgia just happens and cannot be prevented

I have pain in the ball of my foot. What can I do about it?
Try to take the pressure off your feet as far as possible:
- rest with your feet up after periods of standing or walking
- keep your weight at the right level for your height and build
- wear comfortable shoes with a small heel and plenty of room for your feet

Other things you could try:
- exercise your ankle and stretch your Achilles tendon
- take simple pain-killers such as paracetamol
- a metatarsal insole or pad can be prescribed by your podiatrist, but many of these pads are too thick or difficult to fit.
- Orthotics/Insoles to control foot function and cushion.

What tests may be done?
Many causes of metatarsalgia can be diagnosed by listening carefully to your complaints and examining you carefully, especially your foot. A simple test of the urine will check for early diabetes. Blood tests for inflammation, arthritis, diabetes or gout may be useful. An Xray of your foot may show a problem in the bones or joints.

Most people will not need any other tests. However in a few people, more complicated tests such as a bone scan, magnetic resonance (MR) scan, foot pressure measurements or nerve tests may be helpful in diagnosing a difficult problem.

What can be done about it?
The simple measures outlined above will be re-emphasised by your professional adviser, especially about weight and shoes! Treatment can be offered for any disease such as diabetes, gout or arthritis. An insole to share the weight more evenly about your foot may be prescribed. An injection of steroid into an inflamed joint or around an irritated nerve may reduce inflammation and pain. Exercises may improve stiffness

Do I need an operation?
The great majority of people with metatarsalgia will be helped by the measures outlined above. In a few people an operation may help:

- release of a trapped nerve or removal of an irritated nerve
- straightening of hammer or claw toes to take pressure off the metatarsal bones
- reshaping or shortening prominent metatarsal bones