Metatarsalgia is a very common problem that occurs right behind the toes. It can involve throbbing pain, or radiating pain that goes into the toes or up into the arch, or instep, of the foot. There is usually no known injury associated with this problem, though it often can feel like a bruise.

Disclaimer: The manuscript is intended for those who know they have a diagnosis of Metatarsalgia.  This article is not to help you arrive at a diagnosis.  For a specific diagnosis, such as this, you will need to see a qualified medical professional.

Causes of Metatarsalgia

Metatarsalgia foot pain
Click to enlarge

The bones right behind the toes, the metatarsal bones, are the bones that accept the weight on the ball of the foot. The metatarsal bone behind the big toe is the largest metatarsal; it is supposed to bear the most weight when standing. This first metatarsal bone is unique in that it can move up and down more than the other metatarsals. This bone can be compared to the thumb of the hand. It has a much broader function than the other metatarsals behind the smaller toes.

When this metatarsal moves up, too much of the weight on the ball of the foot is transferred to the smaller metatarsals behind the smaller toes 2, 3, 4, and 5. Because these metatarsals are unable to move up as much as the first metatarsal, much of the weight that is supposed to be taken by the first metatarsal is transferred to the smaller metatarsals. These bones are not supposed to accept that much weight.

When extra weight is transferred to the smaller metatarsals, the bone can become damaged or swollen. There are other soft tissues on the ball of the foot that will become damaged as well; these include the joint capsule, the plantar plate on the bottom of the joint, the ligaments around the joint, and the tendons going into the toes.

Ball of Foot Pain bone diagram for Metatarsalgia foot pain
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Much of this problem is related to the ligament on the bottom of the foot called the plantar fascia. The tension in the plantar fascia is affected by a lack of proper movement of the toes as you move forward. If the plantar fascia is not functioning properly, then abnormal pressure and strain will develop in the smaller metatarsals. When proper motion is restored to the toes, the pressure on the ball of the foot will be balanced and the abnormal pressure in back of the smaller metatarsals can be reduced to more normal levels.

A tight Achilles tendon and a lack of motion of the ankle can also cause a significant overload of the metatarsals. The tight Achilles tendon is usually the result of more movement occurring in the ankle as a result of less mobility of the toes in general. Restoring proper mobility of the toes is important to restore normal motion of the ankle and reduce the contracture of the Achilles tendon.

High-heeled shoes or boots can also cause a significant overload of the forefoot. When the foot rolls too much to the inside (pronation), this can also result in more trouble with pain and pressure underneath the smaller metatarsals.  Excessive pronation can also be related to a lack of toe movement, primarily the big toe.

Conditions that can feel like Metatarsalgia

  • Stress fracture of the metatarsal
  • Plantar plate injury or rupture
  • Tendonitis
  • Neuroma
  • Corns and calluses
  • Plantar wart
  • Bone tumor (either benign or malignant)
  • Soft tissue tumor (either benign or malignant)
  • Inflammatory arthritis
  • Degenerative arthritis
  • Gout
  • Trauma (a broken bone)

Risk factors that lead to this condition

  • Obesity (Body Mass Index greater than 35)
  • Occupations which require standing for a prolonged time, walking in very small spaces regularly, or carrying heavy loads regularly
  • Wearing the wrong shoes
  • Shoes that do not bend well in the back of the toes and do not support the heel properly
  • Shoes that bend too much in the middle of the foot
  • Having a flatter foot or a foot that rolls to the inside too much
  • Walking on hard concrete surfaces most of the time
  • Not wearing proper insoles to allow normal movement of the foot to occur
  • Doing strenuous activity without proper shoes, stretching, and insoles to allow the foot to move normally
  • Walking up and down hills frequently
  • Short steps and a shuffling walking pattern
  • High arched feet

What activities are limited because of Metatarsalgia?

Just about all activities will be limited by metatarsalgia. You may find yourself limiting your activities more and more over time just to deal with the foot pain. You will probably spend a fortune trying to find the right shoe to fix the pain. As the ball of the foot hurts more, you will tend to alter the way you walk, which leads to leg pain, knee, hip, and back pain.  

Metatarsalgia foot pain
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If you do not have any deformity of the foot, one will eventually develop, such as a bunion or hammertoes. You will then be more limited in the shoes that you can wear and may also require surgical correction of these problems to restore normal function.

Much of this may have been prevented by proper awareness of the issue when it first presented itself and dealing directly with the cause of the problem at that time.

How do the Cluffy Everyday Insoles help with Metatarsalgia?

Cluffy Everyday Insoles (formerly known as Lux Step) will balance the pressures on the forefoot with our unique patented system of controlling movement of the big toe and enhancing correct function of the foot in general.  This allows for balanced pressures across the forefoot and resolution of pain when one area is taking more pressure than it should.

When the mobility of the ball of the foot improves, this results in a stabilizing through the arch of the foot structure and increased motion of the ankle. The ankle moves better because the arch structure is more stable. Once mobility of the ankle is improved, then the gastrocnemius tendon, a part of the Achilles tendon, can be stretched normally when walking and this results in load reduction of the ball of the foot. When the ankle moves correctly, then the knee can become more stable, the hip can move better, and the lower back becomes more stable. Body mechanics dictate that a mobile segment is followed by a stable segment that is followed by a mobile segment, etc.

Improving the motion of the foot not only has a significant impact on metatarsalgia, but it can cause a total realignment of the whole lower extremity bone structure and a considerable change of foot function.

Support of all three arches in the foot structure is also important, particularly when standing. The Cluffy Everyday insole is the only insole on the market today that supports all three arches in the manner we do, worthy of 3 patents from the U.S. Patent and Trademark Office. It is of particular importance in Metatarsalgia that the transverse arch of the foot is properly supported.  Our unique arch support in this part of the foot is addressing pressure on the ball of the foot in the best possible manner. 

Proper shoe selection is very important for Metatarsalgia, but will not solve the problem by itself.  It is very important that the shoe allows the foot to bend properly, but support the heel in a more normal position. It is important to state that the shoe alone is often not going to be enough to overcome the symptoms of Metatarsalgia.  Stiff, rocker-soled shoes may help the pain temporarily but should be avoided, as they do not allow the foot to move normally and are counter-productive at addressing the core issues causing your pain.

High-heeled shoes will also tend to make metatarsalgia pain worse. However, if you have been wearing high-heeled shoes for a while, it is not a good idea to stop wearing them all of a sudden. You need to wean off of these gradually and stretch the Achilles tendon as you start to wear shoes with a lower height. Shoes with no support through the middle of the foot can put significant stress on the ball of the foot as well. Please see our shoe guidelines for proper shoe selection.

It is often necessary to stretch. The most common muscles to become tight are the flexor hallucis longus (the tendon on the bottom of the big toe), the gastrocnemius tendon (part of the Achilles tendon and the calf muscle), the hip flexor tendons including the iliopsoas and the rectus femoris, these muscles allow you to bend the hip to move upward as you move forward during walking.

Walking properly is also important for the resolution of Metatarsalgia. Oftentimes when people have pain from Metatarsalgia, they tend to walk with a very short stride and a shuffling type of gait pattern. It is recommended to walk at a faster pace, take a longer step and roll through the big toe properly, swing the arms, and walk like you mean it. This will allow for proper weight-bearing on the metatarsal bones on the ball of the foot.  As you start to do this, you should see an almost immediate reduction in pressure on the ball of the foot.

Other symptomatic treatments can be employed by using topical analgesics on the areas that are tender, oral anti-inflammatory medication, and cryotherapy or cold packs applied to the ball of the foot twice a day. These treatments are considered symptomatic and not addressing the root cause of the problem, but can be very useful in the temporary resolution of symptoms once the root cause of the problem is identified and properly addressed.

When to see a Doctor for Metatarsalgia

If metatarsalgia is not specifically related to an injury, it is helpful to initially try conservative care. Cluffy Everyday Insoles can be very effective for this condition. Metatarsalgia should resolve relatively quickly once the mechanical cause is corrected.

If the problem is not resolved within three months, it would be wise to seek the advice of a qualified medical professional to make sure there is not something else causing your pain. If you have crooked toes that cannot straighten out (hammertoes), these may need to be corrected to achieve full resolution of your pain.


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About The Inventor

James Clough, DPM is a Podiatric Foot and Ankle Surgeon with over 37 years of experience in clinical practice. In his pursuit to help more of his patients with common foot pains, he developed the Cluffy Wedge, which has been successful in the marketplace. His customers then wanted an insole with the Cluffy Wedge in place and after many years, trying to create a best-in-class product, he developed Cluffy Insoles which were introduced to the market in 2019. These insoles are uniquely different from the other common brands of insoles sold on the market today. The need for an over the counter, affordable and simple solution was clear to him. His research indicates that Cluffy insoles are successful for most common foot pain problems, as the root cause of many of these issues has not been readily understood.

It is his goal to empower the consumer with an insole that is highly effective and inexpensive to deal with the root cause of most foot pains. This a powerful tool to let you return to your life without foot pain. Dr. Clough continues to see patients in Polson, Montana.

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This website is not intended to diagnose a medical condition. Seeking a qualified healthcare provider may be necessary to receive a medical diagnosis.

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