What Causes Metatarsalgia, or Pain in the Ball of the Foot?
Metatarsalgia is pain and inflammation around the metatarsal heads, the bony area under the ball of your foot. It usually happens when too much pressure falls on one or two metatarsals instead of spreading evenly. The most common causes are high arches, tight shoes, too much load on the front of the foot and thinning of the fat pad.
Key points
- Metatarsalgia means pain in the ball of the foot. It is not one single disease. Several structures can be involved.
- The pain often shows up in one spot, but it is driven by alignment or loading problems elsewhere in the foot, ankle or leg.
- Scans taken lying down can miss how your foot takes your full body weight.
- A standing weight-bearing x-ray shows pressure patterns in the front of the foot that standard scans hide.
- Treatment is guided by what the scan shows. The right diagnosis comes first.
You may have felt a sharp, burning pain under the ball of your foot when walking, running or even just standing. If so, you know how much it can get in the way of daily life. The medical term for this is metatarsalgia. It is not a diagnosis in itself. It describes a symptom, pain around the metatarsal heads, and that symptom can have several different causes.
Knowing why the pain is there matters more than simply giving it a name. The ball of the foot is where five long metatarsal bones meet your toes. When everything is aligned, your body weight spreads evenly across those bones. When it is not, one or two metatarsals take far more load than they should, and pain follows.
What does metatarsalgia feel like?
Most people describe a burning, aching or sharp pain under the ball of the foot. It gets worse with walking, standing or pushing off. It may feel like stepping on a pebble, especially in thin-soled shoes or bare feet.
What causes pain in the ball of the foot?
Metatarsalgia is caused by anything that shifts too much load onto a small area of the front of the foot. That can be a structural problem in the foot itself. It can be a problem further up the chain, in the ankle, knee or hip. Or it can simply be repeated overload from activity or footwear.
Other causes include a long second metatarsal bone, hammer toes that push the metatarsal heads downward, and conditions such as overpronation. If the foot rolls inward too much, the inner metatarsals take more force. You can read more about how orthotics and overpronation relate to pain in the front of the foot.
It is also worth knowing that pain in this area does not always mean metatarsalgia. Morton's neuroma, a thickening of nerve tissue between the metatarsal heads, causes similar symptoms but needs a different approach. A stress fracture of a metatarsal bone can feel much the same, too. The right scan is the first step towards telling these apart.
Why does a standing scan show more than a lying-down x-ray?
A standard x-ray is often taken while you lie on a table. In that position, your muscles relax, your arch lifts and the metatarsals spread out. The image may look normal, even when one bone is taking too much load every time you stand or walk.
When you stand on the EOS platform, gravity presses your full body weight through your feet. The scan shows exactly how each metatarsal sits under real load. It can reveal a dropped metatarsal head, collapse of the front of the foot or uneven spacing that a lying-down x-ray would miss completely.
The EOS system images you from head to toe in one pass. So it also shows whether the alignment of your knee, hip or spine is sending extra force into the front of your foot. Pain in the ball of the foot is often the end of a longer chain of compensation.
Lying flat takes gravity out of the picture. Your foot carries no load, the arch springs up and the metatarsals sit in a neutral resting position. This is useful for spotting fractures and bone disease. But it cannot tell you how the front of the foot behaves when you are actually on your feet.
Many people with metatarsalgia have completely normal lying-down x-rays, which can leave them without answers.
At ScanAlign, weight-bearing standing imaging uses ultra low-dose EOS technology, delivering about 90% less radiation than a standard x-ray, around ten times less. You simply stand still for a few seconds while the scan captures the alignment of your whole skeleton.
When MRI is the better choice: EOS is excellent at showing bone position, joint alignment and how the front of the foot takes weight. For soft tissue problems such as Morton's neuroma, plantar plate tears, nerve inflammation or disc problems, MRI is usually the better tool. Your consultant can advise which scan you need.
What helps with metatarsalgia?
The right approach depends entirely on what is causing too much load on the front of the foot. That is why an accurate scan matters before any treatment begins. Common options your treating specialist may consider include:
- Changing your shoes. Shoes with a wider toe area, a lower heel and better cushioning can reduce pressure on the metatarsal heads.
- Metatarsal pads. A small pad placed just behind the painful area can help move weight away from the overloaded metatarsal heads.
- Custom orthotics. If arch collapse, overpronation or a difference in leg length is playing a part, orthotics may help correct the loading pattern.
- Changing your activity. Cutting down high-impact exercise for a while and replacing it with lower-impact movement can ease symptoms while the cause is addressed.
- Further tests. If the scan shows a stress fracture, Morton's neuroma or a structural problem, your treating specialist will recommend the right next step.
ScanAlign does not provide treatment. It provides detailed, weight-bearing diagnostic imaging. This lets your treating specialist see exactly what is happening under load and plan from there.
Before you start a treatment, or change the one you are on, it is worth getting a detailed diagnosis. Whether the cause sits in your pelvis, your legs or your spine changes what will actually help.
Want to understand what is causing the pain in the ball of your foot? A weight-bearing scan shows how the front of your foot takes load in real life.
Book a free video consultationFrequently asked questions about metatarsalgia
Metatarsalgia is a broad term for pain around the metatarsal heads, usually caused by too much pressure on the bone. Morton's neuroma involves a thickening of nerve tissue between the metatarsals, often between the third and fourth toes. The symptoms overlap, so a scan is important for telling them apart.
Mild cases set off by a sudden increase in activity or unsuitable shoes may settle with rest and a change of footwear. However, if there is an underlying structural cause, such as a dropped metatarsal head or high arches, the pain tends to come back unless the root problem is addressed.
A burning feeling usually means one or more metatarsal heads are taking more impact than they should. The tissues around the bone become inflamed. Nerve irritation in the same area can add a tingling or burning quality to the pain.
No. ScanAlign is a private, self-pay clinic. You can book directly without a referral letter from your doctor. Everything starts with a free video consultation, where we discuss whether a scan is right for your situation.
Yes. The EOS system uses about 90% less radiation than a standard x-ray, around ten times less. You stand on the platform for a few seconds while a full image is captured.
The price for patients travelling from abroad is confirmed during the free video consultation, which you can arrange on our book a weight-bearing foot scan page.
Comfortable, loose clothing without metal fastenings works best. You will stand on the platform in bare feet or socks, so the scanner can capture the natural position of your feet.
A metatarsal pad can relieve symptoms by spreading pressure behind the metatarsal heads. Whether it fully solves the problem depends on the underlying cause. A scan helps your treating specialist decide whether a pad alone is enough or something else is needed.
It is possible. Metatarsal stress fractures cause pain in a similar place and feel worse with weight-bearing activity. A weight-bearing scan can show bone alignment and may pick up changes, but early stress fractures sometimes need an MRI to confirm them.
Your body is a connected chain from feet to head. A hip that sits slightly higher, a knee that turns inward or a tilted pelvis can all change how your foot meets the ground. A whole-body standing scan shows these links, so your treating specialist can see whether the front of the foot is making up for something further up.
See how the front of your foot takes your own weight
A free video consultation, from wherever you are, lets us understand your symptoms and advise whether a standing weight-bearing scan in London is the right next step.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- Espinosa N, Brodsky JW, Maceira E. Metatarsalgia. Journal of the American Academy of Orthopaedic Surgeons. 2010;18(8):474-485.
- NHS. Metatarsalgia (pain in the ball of the foot). nhs.uk. Available at: https://www.nhs.uk/conditions/metatarsalgia/
- Illfeld FW, Field SM. Radiographic assessment of the forefoot under load. Foot & Ankle International. Various weight-bearing imaging studies cited in clinical guidelines from the American Orthopaedic Foot & Ankle Society (AOFAS).
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.