What Causes Metatarsalgia, or Pain in the Ball of the Foot?
Metatarsalgia is pain and inflammation around the metatarsal heads, the bony area under the ball of your foot. It usually happens when too much pressure is concentrated on one or two metatarsals instead of being spread evenly. High arches, tight footwear, excess forefoot loading and fat pad thinning are the most common causes.
Key takeaways
- Metatarsalgia refers to ball of foot pain, not a single disease. Several structures can be involved.
- The pain often shows up in one spot but is driven by alignment or loading issues elsewhere in the foot, ankle or leg.
- Lying-down imaging can miss the way your foot loads under your full body weight.
- A standing weight-bearing x-ray reveals forefoot pressure patterns that standard scans hide.
- Treatment is guided by what the imaging shows. The right diagnosis comes first.
If you have ever felt a sharp, burning pain under the ball of your foot when walking, running or even just standing, you know how disruptive it can be. The medical term for this is metatarsalgia. It is not a diagnosis in itself. It describes a symptom, pain around the metatarsal heads, that can have several different causes.
Understanding why the pain is there matters more than simply naming it. The ball of the foot is where five long metatarsal bones meet your toes. When everything is aligned, your body weight spreads evenly across those bones. When it does not, one or two metatarsals take far more load than they should, and pain follows.
What does metatarsalgia feel like?
Most people describe a burning, aching or sharp pain under the ball of the foot that worsens with walking, standing or pushing off. It may feel like stepping on a pebble, especially in thin-soled shoes or bare feet.
What causes ball of foot pain?
Metatarsalgia is caused by anything that shifts too much load onto a small area of the forefoot. That can be a structural issue in the foot itself, a problem further up the chain in the ankle, knee or hip, or simply repeated overload from activity or footwear.
Other contributors include a long second metatarsal bone, hammer toes that push metatarsal heads downward, and conditions like overpronation. If the foot rolls inward excessively, the inner metatarsals bear more force. You can read more about how orthotics and overpronation relate to forefoot pain.
It is also worth knowing that pain in this area does not always mean metatarsalgia. Morton's neuroma, a thickening of nerve tissue between the metatarsal heads, causes similar symptoms but needs a different approach. Stress fractures of a metatarsal bone can feel much the same, too. Getting the right imaging is the first step toward telling these apart.
Why does a standing scan show more than a lying-down x-ray?
A standard x-ray is often taken with you lying on a table. In that position, your muscles relax, your arch lifts, and the metatarsals spread. The image may look normal, even when a particular bone is taking too much load every time you stand or walk.
When you stand on the EOS platform, gravity presses your full body weight through your feet. The scan captures exactly how each metatarsal sits under real load. It can reveal a dropped metatarsal head, forefoot collapse or uneven spacing that a lying-down film would miss entirely.
Because the EOS system images from head to toe in one pass, it also shows whether your knee, hip or spine alignment is sending extra force into your forefoot. Pain in the ball of the foot is often the end of a longer chain of compensation.
Lying flat removes gravity from the equation. Your foot is unloaded, the arch springs up, and the metatarsals sit in a neutral resting position. This is useful for spotting fractures and bone disease, but it cannot tell you how the forefoot behaves when you are actually on your feet.
Many people with metatarsalgia have completely normal lying-down x-rays, which can leave them without answers.
At ScanAlign, weight-bearing standing imaging uses ultra low-dose EOS technology, delivering about 90% less radiation than a standard x-ray, around ten times less. You simply stand still for a few seconds while the scan captures your full skeletal alignment.
When MRI is the better choice: EOS excels at showing bone position, joint alignment and forefoot loading under weight. For soft tissue problems such as Morton's neuroma, plantar plate tears, nerve inflammation or disc issues, MRI is usually the better tool. Your consultant can advise which scan you need.
What helps with metatarsalgia?
The right approach depends entirely on what is causing the excessive forefoot loading. That is why accurate imaging matters before any treatment begins. Common strategies your clinician may consider include:
- Footwear changes. Switching to shoes with a wider toe box, lower heel and better cushioning can reduce pressure on the metatarsal heads.
- Metatarsal pads. A small pad placed just behind the painful area can help redistribute weight away from the overloaded metatarsal heads.
- Custom orthotics. If arch collapse, overpronation or leg length differences are contributing, orthotics may help correct the loading pattern.
- Activity modification. Reducing high-impact exercise temporarily and replacing it with lower-impact movement can ease symptoms while the cause is addressed.
- Further investigation. If imaging shows a stress fracture, Morton's neuroma or structural problem, your clinician will recommend the appropriate next step.
ScanAlign does not provide treatment. It provides the detailed, weight-bearing diagnostic imaging that lets your treating clinician see exactly what is happening under load and plan accordingly.
Want to understand what is causing your ball of foot pain? A weight-bearing scan shows how your forefoot loads in real life.
Book a free video consultationFrequently asked questions about metatarsalgia
Metatarsalgia is a broad term for pain around the metatarsal heads, usually caused by excess pressure on the bone. Morton's neuroma involves thickening of nerve tissue between the metatarsals, often between the third and fourth toes. The symptoms overlap, so imaging is important for telling them apart.
Mild cases triggered by a sudden increase in activity or unsuitable shoes may settle with rest and footwear changes. However, if there is an underlying structural cause such as a dropped metatarsal head or high arches, the pain tends to return without addressing the root problem.
A burning sensation usually means one or more metatarsal heads are absorbing more impact than they should. The tissues around the bone become inflamed. Nerve irritation in the same area can add a tingling or burning quality to the pain.
No. ScanAlign is a private, self-pay clinic. You can refer yourself directly without needing a GP letter. Your journey starts with a free video consultation where we discuss whether a scan is appropriate for your situation.
Yes. The EOS system uses about 90% less radiation than a standard x-ray, around ten times less. You stand on the platform for a few seconds while a full image is captured.
Pricing details are available on our book a weight-bearing foot scan page or during your free video consultation.
Comfortable, loose clothing without metal fastenings works best. You will stand on the platform in bare feet or socks so the scanner can capture your natural foot position.
A metatarsal pad can relieve symptoms by redistributing pressure behind the metatarsal heads. Whether it fully resolves the problem depends on the underlying cause. Imaging helps your clinician decide if a pad alone is enough or if something else is needed.
It is possible. Metatarsal stress fractures cause pain in a similar location and feel worse with weight-bearing activity. A weight-bearing scan can show bone alignment and may detect changes, but early stress fractures sometimes need MRI for confirmation.
Your body is a connected chain from feet to head. A hip that sits slightly higher, a knee that turns inward, or a pelvic tilt can all change how your foot meets the ground. A whole-body standing scan shows these connections so your clinician can see whether the forefoot is compensating for something further up.
See how your forefoot loads under your own weight
A free video consultation lets us understand your symptoms and advise whether a standing weight-bearing scan is the right next step.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- Espinosa N, Brodsky JW, Maceira E. Metatarsalgia. Journal of the American Academy of Orthopaedic Surgeons. 2010;18(8):474-485.
- NHS. Metatarsalgia (pain in the ball of the foot). nhs.uk. Available at: https://www.nhs.uk/conditions/metatarsalgia/
- Illfeld FW, Field SM. Radiographic assessment of the forefoot under load. Foot & Ankle International. Various weight-bearing imaging studies cited in clinical guidelines from the American Orthopaedic Foot & Ankle Society (AOFAS).
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.