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Metatarsalgia

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Metatarsalgia is a term used to describe pain in the ball of the foot. It is usually caused by uneven weight distribution, with patients reporting a sensation of walking on marbles or stones. Certain foot shapes — particularly those with relatively long second and third metatarsals or a high arch (pes cavus) — are more susceptible.

Symptoms

• Pain in the ball of the foot, particularly under the second or third toe
• A feeling of walking on pebbles or marbles
• Pain that worsens with standing, walking, or activity
• Calluses or skin thickening under the forefoot

Causes

• Abnormal foot shape (long second/third metatarsal, high arch)
• Tight posterior chord muscles
• Inappropriate or high-heeled footwear
• Overuse in running or sport
• Associated conditions such as Morton's neuroma or plantar plate injury

Non-Surgical Treatment

• Thick, padded insoles or metatarsal pads (felt or silicone)
• Footwear modification — wide, cushioned shoes
• Stretching exercises for the posterior chord (calf and Achilles)
• Activity modification

Surgery

When conservative measures fail, a small corrective osteotomy of the affected metatarsal bone can help. This procedure involves cutting the bone and repositioning it — usually shortening and elevating it — before securing it with a small screw under general anaesthetic. Recovery involves a period in a surgical shoe with return to normal footwear typically by 6–8 weeks.