If you are one of those people who suffer from pain in your soles of the feet after standing on your feet for a long time, join us to introduce you to the causes and treatment of this problem medically known as "metatarsalgia". Here is what you will read next:


What is metatarsalgia?

Anatomy of the structures of the sole of the foot

What are the symptoms of metatarsalgia?

What causes metatarsalgia?

What are the risk factors for metatarsalgia?

Diagnosis of metatarsalgia

How is metatarsalgia treated?

How to prevent the recurrence of metatarsalgia and pain under the toe?




What is metatarsalgia?

Metatarsalgia is quite common among people who use their feet a lot during the day, like runners and dancers. The pain you feel in the bulge under your toes following a long day of activity or a long period of wearing tight shoes or standing is called metatarsalgia. In short, metatarsal bones are a group of five long bones in the foot and when they become painful, the circumstance is called "metatarsalgia"


Anatomy of the structure of the sole of the foot

First, to better understand the metatarsalgia, let us first become a bit familiar with the structure and anatomy of the foot. We can simply divide the bones in the sole of the foot into three general categories:


1. Tarsus bones

2. Metatarsal bones

3. phalanx bones


Tarsus bones:

These are large bones in the back of the foot; the heel bone is also in this category and is the largest bone in this group.

Metatarsal bones:

The five long bones in the sole of the foot. The largest human metatarsal bone is the first metatarsus, which connects to the toe bones. these bones are responsible for arc of the foot.

Phalanx bones:

The bones that make up the toes are called phalanxes. The big toe has two phalanx bones while the other four fingers have three phalanxes.


What are the symptoms of metatarsalgia?

Pain under the toe: The main and the most important symptom of metatarsalgia is the pain that is felt under the toe, after running and standing for a long time. Sometimes the pain is not present in all areas of the toe and is felt only in the head of one or more metatarsal bones.

The pain gradually increases over several weeks and intensifies with increasing activity (exacerbated by walking and running). The pain can be sharp and clear. Sometimes a dull pain can be felt, or even burning. It will get more painful by press under the toe.

Feeling numbness and tingling under the toes may accompanied the pain but the presence of these symptoms also raises a flag of sciatica which should be ruled out before starting any treatment.


What causes metatarsalgia?

In general, metatarsalgia occurs when a lot of pressure is applied to the area under the toe, especially in professional athletes, runners and dancers who are constantly putting their toes under pressure.

In addition to this, sometimes disorders and defects in the bones and muscles cause non-standard distribution of forces on the soles of the feet and toes causing inflammatory pain that usually progresses gradually over weeks. To summarize, the main causes of metatarsalgia can be summarized as follows:


Runners, tennis players, dancers, and people who, for any reason, stand for long periods of time, without using medical shoes, put a lot of pressure on the metatarsal bones, causing metatarsalgia. 

Obese and overweight people:

Obesity and being overweight increase the force exerted on the toe bones which can cause metatarsalgia.

Using inappropriate and tight shoes

Using high heels shoes:

Increased force on the metatarsal bones will cause pain under the toes.


Arthritis (inflammation of the joints) of the metatarsophalangeal joints (the joint that forms between the sole of the foot and the bones of the first toe) can be a cause of pain under the toes.


It causes pain under the toe by causing inflammation at the junction connecting the sole of the foot to the first toe.

Stress fractures:

Existence of stress fractures in the head of the metatarsal bones of the sole of the foot. these fractures occur because of chronic and repeating forces and stress.

Freiberg disease:

this disease happens when the blood supply to the second metatarsal become insufficient increasing the pain in the bone.

Morton neuroma or interdigital neuroma:

Morton's neuroma refers to the formation of extra tissue around the nerve, which usually forms between the third and the fourth toes. In fact, this nerve gets stimulated, inflamed, and enlarged and therefore will cause pain.

It should be noted that sometimes in addition to pain, numbness may also be present in the front of the foot.

Anatomical malformations 

People whose second metatarsal bone is taller than the first metatarsal are more prone to this pain. Having a short first metatarsal or a long second metatarsal will cause an unequal distribution of forces around foot fingers which can be the cause of pain.

Weakness of the flexor muscles of the toes

muscles responsible for bending the fingers are called flexors. When they become weak for any reason, the excess force will be concentrated in the metatarsal bones and make them painful.

Tightness of the muscles that open the toes

muscles responsible for opening of the fingers are called extensors and when they become weak for any reason, the excess force will be concentrated in the metatarsal bones and make them painful.

Have a previous history of foot and toe surgery

Hallux Valgus:

This problem occurs when the joint between the first metatarsal and the first thumb bone deviates outward.  This creates a bony protrusion on the inside of the toe, which puts a lot of pressure on the metatarsals, especially when wearing shoes.

When the foot has a large arch:

Increased arch of the foot puts a lot of pressure on the head of the metatarsal bones.

Achilles tendon tightens


Diabetes can cause toe pain by causing plantar nerve damage, neuropathy, etc.

Toe hypermobility

Hammer toe deformity 


What are the risk factors for metatarsalgia?

  • Athletes: soccer players, volleyball players, tennis players, dancers.
  • Diseases that lead to inflammation of the joints
  • Aging: It causes the fat pad under the toe to break down.


Diagnosis of metatarsalgia:

Patient medical history and clinical examination are usually sufficient, but proper diagnosis may sometimes require the following to rule out other causes:

X-ray image 


It is sometimes used to differentiate bursitis and Morton neuroma 



How to cure metatarsalgia?

The following are suitable for reducing and relieving pain and discomfort:

  • Stop activities that cause or aggravate pain

If you are an athlete, to avoid pain, avoid participating in sports and hard training for a while.

  • Apply a cold compress to the spot having the maximum pain and discomfort

  • Keep your feet elevated when resting

  • Use a suitable pressure bandage

  • Use standard shoe insoles with toe pads (soft pads under the toe)

  • If your feet have a high arch, use suitable insoles

  • Appropriate stretching exercises

Gradually start appropriate stretching exercises as the relative pain of the acute phase decreases. These exercises strengthen the wrist and prevent stiffness and dryness of the Achilles tendon.

  • Nonsteroidal anti-inflammatory drugs to reduce inflammation and pain:

1. Ibuprofen (Advil, Motrin, Nuprin)

2. Naproxen

  • Nervous block

  • weight loss

  • Wear standard shoes with the right size

Remember that when the acute phase of pain is over, you can start appropriate stretching movements and gradually intensify the exercises and activities.

Also if you have metatarsalgia, to prevent chronic injuries such as back pain or deformed toe (hammer toe) and to reduce the second injury to other part of your skeleton, it is best to diagnose the possible cause and treat metatarsalgia as soon as possible.


How to prevent recurrence of metatarsalgia and the pain under the toe?

To prevent the recurrence of pain under the toe, consider the following:

  • Do not wear high heels
  • Use medical and standard shoe pads
  • Lose weight
  • Do not engage in strenuous exercise without warming up and doing stretching exercises
  • Do not increase the duration and intensity of the exercises all at once.


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Address: 393 University Avenue,Suite 200,Toronto ON MG5 2M2,CANADA


Phone: +1(647)303 0740

All Rights Reserved © By MarsoClinic

Terms of Use