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Metatarsalgia or pain beneath the ball of the foot has various causes. The ball of the foot is comprised of 5 metatarsophalangeal joints which are the joints in which the toes flex and push off the ground. The common cause of metatarsalgia is an abnormal foot structure which leads to additional pressure at the ball of the foot. This often occurs when an individual has a high arch on the foot or with contracted toes or hammer toes.

Any condition that affects the foot that leads to excess pressure on the ball of the foot can result to metatarsalgia. In most circumstances, it is common to have calluses on the ball of the foot that occurs as a response to stress but can contribute to discomfort and pain.

Common causes of metatarsalgia

There are a number of conditions that can cause metatarsalgia. If the individual finds the pain too unbearable that it disrupts with daily activities at home or work, it is best to consult a doctor for proper assessment and diagnosis.

  • Trauma

Chronic trauma to the metatarsal heads can result to bone bruising, bursitis, arthritis or inflammation of the neighboring tissues. Acute trauma such as sesamoid bone fracture, metatarsal bone fracture or torn ligaments in the big toe can cause metatarsalgia.

  • High arched foot (pes cavus)

Having a high arched foot does not distribute pressure from walking well, thus adding pressure at the heel and ball of the foot. It is common for an individual with high arches to experience metatarsalgia

Acute trauma such as sesamoid bone fracture, metatarsal bone fracture or torn ligaments in the big toe can cause metatarsalgia.

Those who have high arches feel uncomfortable while walking barefoot on hard surfaces and they require shoes that have thick, supportive soles.

  • Loss of plantar fat pad

The plantar surface or sole of the foot has a dense layer of connective tissue to protect the underlying bones from excessive pressure. Due to the aging process, the fat pad thins out which makes the sole of the foot sensitive to pressure while walking.

Other possible causes of metatarsalgia

  • Neuroma typically causes pain in between or below the 3rd and 4th toes and caused by nerve thickening and irritation.
  • Abnormal metatarsal length which is either too long or too short
  • Sore sesamoid bones due to inflammation of the surrounding soft tissue or fractures
  • Hallux limitus is a condition that causes limited range of motion at the big toe joint which causes increased pressure at other metatarsal bones.


It is important to note that the treatment will vary depending on the actual case but in most cases, it involves the following:

  • Cortisone shots or anti-inflammatory medications to help relieve the pain
  • Customized or over-the-counter orthotics
  • Debriding or shaving down of the calluses to reduce the pain
  • Placement of padding or special modifications to arch supports or orthotics to reduce the pressure under the ball of the foot
  • Surgery to fix any bone abnormalities

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