Metatarsalgia (Ball of Foot Pain)

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Burning or aching under the forefoot? We diagnose and treat metatarsalgia—from shoe/insert solutions and custom orthotics to plantar plate care—so you can walk and run comfortably. Same-week care in San Mateo.

“Metatarsalgia” describes pain under the ball of the foot where the metatarsal heads bear weight. It can feel aching, sharp, or burning, and often worsens with time on your feet, running, or tight shoes.

Common symptoms

• Pain under one or several metatarsal heads (often 2nd–3rd)
• “Pebble in the shoe” or burning sensation
• Worse in thin or high-heeled shoes; better with cushioned, supportive footwear
• Swelling, callus, or tenderness with push-off

Why it happens (typical causes)

• Overload mechanics: long or dropped metatarsal, tight calf (limited ankle motion), high arches or flatfoot
• Toe deformities: hammertoe, bunion, crossover toe → shifts pressure forward
• Plantar plate strain/tear at the 2nd MTP joint
• Fat pad thinning, repetitive impact, or abrupt training changes
• Shoe factors: narrow toe boxes, thin/rigid soles
• Related conditions to rule out: Morton’s neuroma, stress fracture, sesamoiditis

We begin with a focused history and exam, shoe and gait review, and pressure/load assessment.

• Weight-bearing X-rays check alignment, metatarsal length, and joint health.
• Ultrasound or MRI may be used for suspected plantar plate injury or neuroma.

Most patients improve with targeted offloading, flexibility, and shoe strategy.

Footwear & offloading

• Supportive shoes with roomy toe boxes and forefoot cushioning
• Rocker-sole options to reduce forefoot push-off stress
• Metatarsal pads (precisely placed) or dancer’s pads for focal relief

Custom orthotics & support

• Custom orthotics with forefoot offloading (met pad/dome or cutout) to redistribute pressure
• Address contributing mechanics (flatfoot/high arch, calf tightness)

Mobility & strength

• Calf and plantar fascia stretching to improve ankle motion
• Intrinsic foot and hip strengthening; balance and gait cues
• Taping or toe spacers when deformities drive overload

Activity modification & symptom control

• Short-term load reduction, cross-training options
• Ice/contrast and a brief course of anti-inflammatory measures (as appropriate)

Injections/advanced options (select cases)

• Image-guided injections for bursitis or neuroma when indicated
• For persistent plantar plate instability or structural overload, we’ll discuss surgical options (see below)

If pain persists despite well-fitted shoes, pads/orthotics, and a focused rehab plan, surgery can address the underlying structure:

• Plantar plate repair (often for 2nd MTP instability or crossover toe)
• Metatarsal osteotomy (e.g., Weil) to rebalance pressure
• Adjunct procedures for associated deformities (bunion/hammertoe correction)
  We’ll review benefits, risks, timelines, footwear milestones, and return-to-activity goals.

1. Evaluation: Exam, footwear review, pressure/biomechanics assessment; imaging if needed.
2. Plan: A clear offloading + mobility program, met pad placement, and footwear/orthotic guidance you can start the same day.
3. Follow-up: Progress check at 4–6 weeks; we fine-tune pad/orthotic position and activity goals.

• Inability to bear weight after an injury
• Sudden focal forefoot pain with swelling (possible stress fracture)
• Spreading redness, warmth, or fever
• Rapid toe deformity or dislocation symptoms

• Board-certified podiatric care led by Hannah Lee, DPM
• Emphasis on evidence-based offloading and conservative care first
• Custom orthotics and precise met pad placement for durable relief
• Surgical solutions for plantar plate tears or structural overload when appropriate

Is this the same as a neuroma?
Neuroma pain is usually between the toes with tingling/burning; metatarsalgia is under the metatarsal heads. They can coexist—we’ll examine and image if needed.

Will met pads make my pain worse?
When placed correctly, met pads unload hot spots. Placement matters—we’ll mark the ideal spot and adjust at follow-up.

How long until I feel better?
Many patients notice relief in 2–6 weeks with shoe changes, proper pad placement, and mobility/strength work; stubborn cases may take longer.

Do orthotics fix the problem permanently?
They redistribute pressure and address mechanics; combined with shoe strategy and exercises, they can provide long-term control.

Let’s rebalance pressure so walking and running feel comfortable again.