“I have plantar fasciitis and Doctor was very patient, providing exercises and answers. I'm seeing improvement for the first time in months.”Google · Sean Murray · Jun 2023
“He finally freed me from my plantar fasciitis! Orthotics he casted are exceptional.”Google · Gleb Kartsev · Nov 2021
“Best orthotics ever! Before — horrible pain from plantar fasciitis heel spurs. Best arch support ever!”Google · Weilian Tang · Nov 2021
“Dr Patish and his staff are great! Ingrown nail and plantar fasciitis — he helped immensely with both!”Google · Polly Trump · Mar 2023
“Doctor took very good care of my plantar fasciitis problem — quick and effective.”Google · Judy Wahl Talley · Apr 2019
“Dr. Patish's orthotics have changed my life! I can walk for hours with no pain.”Google · Sarah Tang · Mar 2022
“For fifteen years I saw countless doctors for pain in the ball of my foot. Dr. Patish's diagnosis was dead on.”Google · A. Holston · Jan 2023
“I wish I could give Dr. Patish 10 stars!!! He has literally been a life changer.”Yelp · Troy E. · Aug 2019
“I have plantar fasciitis and Doctor was very patient, providing exercises and answers. I'm seeing improvement for the first time in months.”Google · Sean Murray · Jun 2023
“He finally freed me from my plantar fasciitis! Orthotics he casted are exceptional.”Google · Gleb Kartsev · Nov 2021
“Best orthotics ever! Before — horrible pain from plantar fasciitis heel spurs. Best arch support ever!”Google · Weilian Tang · Nov 2021
“Dr Patish and his staff are great! Ingrown nail and plantar fasciitis — he helped immensely with both!”Google · Polly Trump · Mar 2023
“Doctor took very good care of my plantar fasciitis problem — quick and effective.”Google · Judy Wahl Talley · Apr 2019
“Dr. Patish's orthotics have changed my life! I can walk for hours with no pain.”Google · Sarah Tang · Mar 2022
“For fifteen years I saw countless doctors for pain in the ball of my foot. Dr. Patish's diagnosis was dead on.”Google · A. Holston · Jan 2023
“I wish I could give Dr. Patish 10 stars!!! He has literally been a life changer.”Yelp · Troy E. · Aug 2019
Metatarsalgia: Why the Ball of Your Foot Hurts and What to Do About It
Ball-of-foot pain can slow you down and get worse over time. Learn what causes metatarsalgia, when to see a podiatrist, and which treatments can help.
Does the ball of your foot hurt when you walk, stand or push off while running? That's the padded area just behind your toes. Pain there is what podiatrists call metatarsalgia. It simply means pain under the metatarsal heads (the rounded ends of the long bones that connect to your toes). Pain in the toes and forefoot is common. A review of population studies found it was the most often reported site of foot pain in middle and older age (Thomas and colleagues, 2011).
Before you read on. This article is general information, not medical advice. See us promptly if the pain started with a sudden injury, or if the top of your foot is swollen or you can't bear weight. Do the same if the ball of your foot is red, hot and swollen. If you have diabetes or numb feet, have any new pain or callus here checked, since a sore can form without much pain. If your pain turns out to come from a problem outside our scope, we'll refer you to the right specialist.
The metatarsals are the five long bones in the middle of your foot. When too much pressure lands on one or more metatarsal heads, the tissue around them can get irritated. The result is often a deep ache or a burning feeling right under the ball of the foot. Some people say it feels like walking on a pebble.
Common Causes of Ball-of-Foot Pain
Metatarsalgia usually starts because something changed how pressure spreads across your forefoot. Things that can overload the ball of the foot include the following.
- High-impact activities like running and jumping
- Shoes with thin soles or high heels
- Extra body weight
- Foot shape, such as high arches, hammertoes or a long second metatarsal
- A sudden increase in walking, standing or training
Age plays a part too. As we get older, the padding under the ball of the foot gets stiffer and less springy (Kwan and colleagues, 2010). The authors suggested that this loss of give may be one reason foot problems become more common later in life.
Why It Gets Worse Without Treatment
When metatarsalgia makes the ball of your foot hurt, you naturally shift weight to other parts of the foot. That can ease the pain for a while, but it can also overload other areas and cause new aches. Foot pain at this stage of life isn't a small thing. In the review above, about two-thirds of people with foot pain had at least moderate trouble (Thomas and colleagues, 2011). It affected some part of their daily life. Pain that keeps coming back is worth sorting out rather than waiting out.
Other Causes of Pain in the Ball of the Foot
Not all ball-of-foot pain is metatarsalgia, and the right treatment depends on the cause.
- Morton's neuroma (an irritated, thickened nerve between the toes). It causes burning pain in the ball of the foot, and numbness or burning that can spread into the toes, most often the third and fourth (Cooper and colleagues, 2023).
- Stress fracture (a small crack in a bone from overuse). It can cause pain and swelling that get worse with activity, and it needs an exam and sometimes an X-ray.
- Joint irritation or a strained ligament under a toe, often the second. This can make the toe start to drift or lift.
- Arthritis or gout in the joints of the forefoot.
When to See a Podiatrist
If metatarsalgia pain hasn't improved with rest and supportive shoes, it's time for an exam. The same is true if it keeps coming back. Come in sooner if you notice swelling, or numbness or tingling in the toes. The same goes for a toe that's starting to drift, or pain sharp enough to change how you walk. An exam, and sometimes an X-ray or ultrasound, tells us which problem you have.
Treatment Options That Can Help
Treatment for metatarsalgia starts with taking pressure off the sore spot. Here's what we use.
- Custom orthotics and pads. An insert with a metatarsal pad or extra cushioning spreads pressure away from the sore spot. In a pressure study, both cushioned insoles and metatarsal pads lowered pressure under the ball of the foot (Yi and colleagues, 2022). A pad in the wrong spot can feel uncomfortable, so placement matters. Learn more about custom orthotics.
- Footwear changes. Shoes with a wide toe box, a lower heel and a cushioned or rocker-style sole can take some load off the forefoot.
- Targeted exercises. Calf and toe exercises from our foot and ankle exercise guide can support recovery.
- Shockwave therapy. Some people with long-standing pain ask about shockwave therapy. Research on it for forefoot nerve pain is still limited (Nazim and colleagues, 2022), so we discuss it case by case. Learn more about shockwave therapy.
If a neuroma is the cause, first-line care also includes cutting back on painful activities and, in some cases, an injection (Cooper and colleagues, 2023). About 3 in 10 people with a neuroma don't improve with these steps (Cooper and colleagues, 2023). Then other options come into play.
Start with pressure relief and give it a fair trial. Better shoes, a well-placed pad or an orthotic, and exercises are the usual first steps. If they don't help, the exam may point to a different cause, like a neuroma or a stress fracture, that needs different care.
The Bottom Line
Ball-of-foot pain usually means pressure on the forefoot isn't spread well. Often it's a mechanical problem with a mechanical fix. Getting it checked early also helps rule out causes that need different care.
Learn about our approach to foot pain treatment, or read about work boots and foot pain.
Frequently Asked Questions
What causes pain in the ball of the foot?
Usually too much pressure on the metatarsal heads. High-impact activity, thin-soled or high-heeled shoes, extra weight and foot shape all play a part. Other causes include Morton's neuroma, a stress fracture, joint irritation and arthritis, so an exam matters.
Will metatarsalgia go away on its own?
Mild cases may settle with rest, better shoes and a cushioned insert. If the pain doesn't improve, keeps coming back or has changed how you walk, get it checked, since a neuroma, a stress fracture or a joint problem needs different care.
What is the best treatment for ball-of-foot pain?
It depends on the cause. For pressure-related pain, the first steps are shoes with a roomy toe box and a lower heel, plus an insert with a metatarsal pad or cushioning. In one study, this kind of insert lowered pressure on the front of the foot (Yi and colleagues, 2022). For a neuroma, first-line care also includes activity changes and sometimes an injection (Cooper and colleagues, 2023). An exam tells us which plan fits.
Why does the ball of my foot hurt when I walk?
Each step loads the ball of the foot as you push off. If pressure is concentrated on one spot, from thin shoes, high heels, foot shape or a busy week on your feet, the tissue there gets irritated. Burning or numbness that spreads into the toes points more toward a neuroma (Cooper and colleagues, 2023).
How can I relieve ball-of-foot pain at home?
Rest from what triggers it, switch to cushioned shoes with a roomy toe box and a lower heel, and try a cushioned insole or a metatarsal pad. Ice can help after activity. If you have diabetes or numb feet, see us, and don't use ice before checking with us. Otherwise, see us if it isn't improving.
Is it metatarsalgia or Morton's neuroma?
Metatarsalgia is pain under the metatarsal heads, often an ache or a pebble-like feeling. A Morton's neuroma is an irritated nerve between the toes. It typically causes burning pain, plus numbness or burning that spreads into the toes, most often the third and fourth (Cooper and colleagues, 2023). An exam sorts it out, and you can have both.
Does metatarsalgia get worse with age?
Forefoot pain is common in middle and later life (Thomas and colleagues, 2011), and the padding under the ball of the foot gets stiffer with age (Kwan and colleagues, 2010). Good shoes and cushioning matter more as we get older.
Can shockwave therapy help ball-of-foot pain?
The evidence for shockwave is strongest for heel pain. For forefoot nerve pain, reviewers say better studies are needed (Nazim and colleagues, 2022), so we discuss it case by case.
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