In United Kingdom, metatarsalgia is managed by podiatrys. Metatarsalgia is pain and inflammation in the ball of the foot, specifically the plantar surface of the metatarsal heads, that affects roughly 80 per 1,000 adults at some point and disproportionately impacts runners, dancers, and women who wear high-heeled or narrow-toed shoes. Pain typically localizes under the second, third, and fourth metatarsal heads and worsens during weight-bearing, push-off, and barefoot walking on hard floors.
Metatarsalgia (ICD-10: M77.40 unspecified foot; M77.41 right foot; M77.42 left foot) is a clinical syndrome of pain in the metatarsal region of the forefoot, specifically the plantar aspect of the second to fifth metatarsophalangeal joints. It is best understood as a final common pathway of multiple anatomical and biomechanical disorders that overload one or more metatarsal heads. Primary metatarsalgia arises from intrinsic foot anatomy: a long second metatarsal, plantarflexed metatarsals, hallux valgus, hallux rigidus, Morton's foot, equinus contracture, or cavus arch. Secondary metatarsalgia results from focal pathology: plantar plate tear, Morton's interdigital neuroma, Freiberg's avascular necrosis of the second metatarsal head, sesamoid disorders, rheumatoid arthritis with subluxation of the lesser metatarsophalangeal joints, gout, or stress fracture.
The key symptoms of Metatarsalgia are: Burning, aching, or sharp pain under the ball of the foot, most commonly beneath the second, third, and fourth metatarsal heads., Pain that worsens with weight-bearing, running, jumping, and barefoot walking on hard floors and improves with rest., Sensation of walking on a pebble, marble, or fold of sock under the foot., Numbness, tingling, or pins-and-needles between the third and fourth toes when Morton's neuroma is the cause., Callus formation under the second or third metatarsal head reflecting chronic high-pressure loading., Forefoot swelling or fullness in inflammatory or post-traumatic cases., Clicking or popping sensation during heel rise, sometimes audible in plantar plate tears (Mulder click)..
Diagnosis is primarily clinical, supported by selective imaging when the cause is unclear or surgery is being considered. The history asks about location, character (sharp, burning, aching), aggravating activities, footwear pattern, prior trauma, comorbid conditions (rheumatoid arthritis, diabetes, gout), and any systemic features. Examination begins with weight-bearing inspection of foot posture (cavus or flat arch, hallux valgus, hammer toes, crossover deformity), palpation of each metatarsal head for tenderness, the Mulder click maneuver for Morton's neuroma, the Lachman or vertical drawer test for plantar plate integrity, joint range of motion, and assessment of calf tightness (equinus). Plantar callosities are mapped — chronic callus under a metatarsal head indicates elevated pressure. Footwear is inspected for wear patterns, heel height, toe box width, and sole stiffness. Plain weight-bearing radiographs (AP, lateral, oblique) measure metatarsal lengths, identify Freiberg flattening, sesamoid alignment, stress fractures, and joint changes from inflammatory arthritis. Ultrasound is the first-line modality for Morton's neuroma, plantar plate tear, and intermetatarsal bursitis. MRI is reserved for difficult cases, plantar plate grading, suspected occult stress fracture, and pre-surgical planning. Plantar pressure mapping in shoe or barefoot identifies regions of focal high pressure and guides orthotic prescription. Blood tests (uric acid, rheumatoid factor, anti-CCP, ESR, CRP) are obtained when inflammatory arthropathy is suspected.
With structured conservative management, 70-85% of patients achieve substantial symptom relief within 12 weeks. Mechanical metatarsalgia from footwear and minor structural variations responds best, often with footwear changes and metatarsal pads alone. Plantar plate tears with crossover deformity, advanced Freiberg disease, and rheumatoid forefoot deformity have higher rates of progression and may require surgery; surgical outcomes for these indications are favorable, with 80-90% pain relief at 2 years. Recurrence within 5 years is common when underlying contributors (footwear, occupational standing, weight, equinus) are not addressed. In diabetic patients with neuropathy and metatarsalgia, vigilant offloading prevents progression to ulceration and Charcot foot. Athletes typically return to full sport within 3-6 months with appropriate rehabilitation; runners with biomechanical contributors may need permanent orthotic use.
Patients with metatarsalgia that fails to improve after 6-8 weeks of footwear modification and self-care, or with mechanical signs (deformity, crossover toe, instability), should see a podiatrist or foot and ankle surgeon. Earlier specialist input is needed for athletes, runners with suspected stress fracture, diabetic patients, and patients with known inflammatory arthritis to prevent progression.
Find specialists →Footwear modification and metatarsal pads: 6-8 weeks for noticeable improvement. Custom orthotics: 8-12 weeks for full benefit after the initial adaptation period. Corticosteroid injection: relief within 1-2 weeks, lasting 3-6 months. Surgical recovery: 4-6 weeks in postoperative shoe, return to regular shoes by 8-12 weeks, full activity at 4-6 months.
Substitute low-impact aerobic activity (swimming, stationary cycling, elliptical) during the active phase. Progressive return to walking and jogging guided by symptom resolution and orthotic use. Maintain calf and hamstring flexibility and intrinsic foot strengthening throughout recovery and long-term prevention.
Choose a podiatrist or foot and ankle orthopedic surgeon with access to plantar pressure mapping, ultrasound, and a custom orthotics laboratory. Surgical treatment should be performed by a fellowship-trained foot and ankle surgeon at a center performing more than 50 forefoot procedures annually.
Medically reviewed by AIHealz Medical Editorial Board · May 13, 2026
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