What causes pain in the ball of the foot?

Ball of foot pain often comes from forefoot overload. Common triggers include training spikes, tight calves, thin-soled shoes, narrow toe boxes, foot posture changes, or irritation around a metatarsal head.

Can shoes cause metatarsalgia?

Yes. High heels and narrow shoes can shift pressure onto the forefoot and toes. Shoes with a wider toe box and supportive midsole often feel more comfortable during a flare.

Do orthotics help metatarsalgia?

Orthotics or metatarsal padding may help some people by spreading pressure across the forefoot. A physiotherapist can assess whether padding, orthotics, or exercise-based control will suit your foot and activity goals.

When should I see a physiotherapist for metatarsalgia?

Consider an assessment if pain persists beyond 1–2 weeks, keeps worsening, or limits walking and sport. Get checked sooner if you have marked swelling, numbness, night pain, or pain after a sudden load increase.

Metatarsalgia

Q: What is metatarsalgia?

Metatarsalgia is pain under the ball of the foot, most often around the metatarsal heads just behind the toes. It commonly increases with walking, running, or standing.

Article by John Miller, Shane Armfield

Metatarsalgia treatment consult for ball of foot pain assessment — Physiotherapist Assessing Ball Of Foot Pain During A Metatarsalgia Consultation.

Metatarsalgia treatment often starts by reducing overload on the ball of your foot, then restoring better foot control and walking comfort.

Metatarsalgia is a common cause of ball of foot pain. It usually involves irritation around one or more metatarsal heads (the joints just behind your toes). Symptoms often increase with long walks, standing, or training loads.

Many people notice this problem alongside other issues such as foot pain, footwear changes, or increased activity. Sometimes, a physiotherapist will also screen for nearby or similar conditions, such as Morton’s neuroma or a foot stress fracture.

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What is metatarsalgia?

Metatarsalgia describes pain under the forefoot, most commonly under the 2nd–4th metatarsal heads. It can feel like you are “walking on a pebble”, or like your sock is bunched up under the ball of your foot.

Common symptoms

Symptoms vary, although many people report:

sharp, aching, or burning pain in the ball of the foot
pain that increases with walking, running, jumping, or standing
tenderness when you press under the forefoot
callus build-up under one metatarsal head
relief when you rest, offload, or change shoes

Why it happens

Metatarsalgia is usually a “load management” problem. In other words, one part of the forefoot takes more force than it can tolerate for now.

Common contributors include:

training spikes or high-impact sport, including running
tight calves or limited ankle mobility that shifts load forward
high-heeled or narrow shoes that concentrate pressure at the toes
foot posture changes (flat or high-arched feet) that alter pressure patterns
metatarsal length differences, forefoot overload, or stiffness through the big toe
arthritis or inflammatory conditions
nerve sensitivity, including in people with diabetes

A quick “People Also Ask” check

Can metatarsalgia feel like a stone in your shoe? Yes. Many people describe metatarsalgia as a bruised or pebble-like feeling under the ball of the foot. This often happens when one metatarsal head takes extra pressure during push-off.

Metatarsalgia treatment options

Treatment depends on the cause. In most cases, you can improve symptoms by reducing irritation first, then rebuilding capacity.

Footwear changes: Choose shoes with a wider toe box and a supportive midsole. Avoid thin, flexible soles if they increase pain.
Activity edits: Reduce aggravating load (long walks, hills, speed sessions) while pain settles. Then rebuild gradually.
Orthotics or padding: Some people do well with orthotics or a metatarsal dome to spread pressure. This can be useful during flares or higher-load phases.
Metatarsal domes: If suitable, a dome may reduce “hot spot” pressure under a metatarsal head. See metatarsal domes.
Strength and control: Building intrinsic foot strength and calf strength can improve load sharing during walking and running.
Targeted foot posture work: Some people benefit from graded arch-control exercises such as active foot posture correction exercises.
Hands-on treatment: Treatment may include soft tissue techniques to address calf or foot stiffness, alongside exercise.
Medication advice: Anti-inflammatory medicines may help short-term symptoms for some people. Speak with your GP or pharmacist first, especially if you have other health conditions.

When to get checked

Book an assessment if you have night pain, marked swelling, numbness, pain that keeps worsening, or pain after a sudden increase in activity. A physiotherapist may screen for stress fracture, nerve irritation, joint arthritis, or other causes of forefoot pain.

What to do next

Start with footwear that feels supportive and comfortable, reduce high-impact load for 1–2 weeks, and use simple walking breaks to offload symptoms. Next, add a graded strengthening plan for calves and foot muscles. If pain persists, a physiotherapist can test your foot posture, walking mechanics, and training load, then guide the best mix of exercises, padding, or orthotic support for you.

You can also browse Foot, Ankle & Heel Pain Products & FAQs for related supports and guides.

Feet Products

These feet products are commonly used by our physiotherapists to improve support, comfort, strength, balance, flexibility, and home exercise programs.