What is metatarsalgia?

Metatarsalgia is pain located in the front part of the sole of the foot, beneath the heads of the metatarsal bones (the long bones of the forefoot, between the tarsus and the toes). It can be described as a “feeling of walking on small pebbles, “ a “tight sock,” or a constant burning sensation in the area under the toes where the foot makes contact with the ground.

It is not a disease in itself, but rather a symptom of mechanical overload of the forefoot. It can affect a single metatarsal head (the second is the most common) or several, and is usually accompanied by:

• Calluses and plantar helomas under the affected metatarsal heads.
• Claw toes or hammer toes (when the plantar fascia is damaged).
• Hallux valgus (bunion) that alters the distribution of weight to the smaller toes.
• Morton’s neuroma, which shares symptoms and sometimes occurs alongside it.

Is this a common problem?

It is one of the most common causes of forefoot pain in adults over the age of 50 and is more common in women, especially those who have worn high heels for years. It also occurs in runners and in patients with a cavus foot or a history of forefoot surgery.

Why does metatarsalgia occur?

Metatarsalgia occurs when one or more metatarsal heads bear more weight than they should. The most common causes are:

• Hallux valgus (bunion): When the big toe deviates, the weight is transferred to the second and third metatarsal heads, which are not designed to bear that load.
• Claw toes or hammer toes: The bent toe does not make proper contact with the ground, placing all the weight on its metatarsal head.
• Insufficient first metatarsal (Morton’s): The first metatarsal is short or hypermobile and does not bear its share of the load.
• Rupture of the plantar plate: degeneration of the “ligament” that stabilizes the metatarsophalangeal joint, very common in the second toe.
• Cavus foot: With a very high arch, the metatarsal heads are subjected to abnormally high pressure.
• Inappropriate footwear: high heels, narrow toes, stiff soles without cushioning.
• Loss of the plantar fat pad (common with age).
• High-impact sports: running, jumping, dancing on hard surfaces.
• Rheumatic diseases: rheumatoid arthritis, spondyloarthropathies.

Understanding the underlying cause is key: metatarsalgia cannot be cured with insoles alone if the cause is mechanical or structural. That is why our first step is always a comprehensive biomechanical assessment.

Your first appointment with us

The initial consultation is free and requires no obligation. In 30 minutes, we’ll do:

1. Clinical examination: palpation, specific tests (forefoot compression, Mulder’s test, etc.).
2. Biomechanical gait analysis of static and dynamic foot strike.
3. Weight-bearing X-rays to assess the metatarsal alignment and associated deformities.
4. Musculoskeletal ultrasound if Morton’s neuroma or a plantar fascia tear is suspected.
5. Personalized treatment plan (conservative, shockwave therapy, injection, or minimally invasive surgery) and a fixed-price quote.

We provide service in Spanish, English, German, French, and Dutch.