Metatarsalgia
Metatarsalgia refers to any pain under the forefoot. Common in athletes and in people who wear high heels, it is effectively treated with a custom foot orthotic that redistributes pressure.
What is metatarsalgia?
Metatarsalgia is a medical term that refers to any pain located in the forefoot region, more precisely under the metatarsal heads. The metatarsals are the five long bones of the foot that connect the toes to the midfoot, and their ends (metatarsal heads) bear a significant share of body weight during walking and running.
When weight distribution on the forefoot is unbalanced, certain metatarsal heads endure overload that causes inflammation, pain and sometimes the formation of calluses. The pain is often described as feeling like walking on pebbles or as a burning under the foot.
Metatarsalgia is one of the most common reasons for consultation in foot orthopaedics. It can affect a single metatarsal or several at the same time, and one or both feet. Without treatment, the pain can become chronic and significantly limit the ability to walk and to take part in sports activities.
Causes of metatarsalgia
- Inappropriate shoes: high heels shift body weight onto the forefoot. Narrow shoes compress the metatarsals and increase friction.
- High arch: a high arch concentrates pressure on the heel and forefoot, overloading the metatarsal heads.
- Hallux valgus: deviation of the big toe alters pressure distribution and overloads the neighbouring metatarsals.
- Sports activities: running, jumping, tennis and sports involving forefoot landings increase mechanical forces.
- Excess weight: extra weight increases the load on all foot structures.
- Fat-pad atrophy: with age, the pad that protects the metatarsal heads thins out, reducing natural cushioning.
- Toe deformities: hammer or claw toes alter forefoot mechanics and concentrate pressure.
Symptoms of metatarsalgia
- Forefoot pain: pain localised under one or more metatarsal heads, worsened by walking, running or standing.
- Pebble-in-the-shoe sensation: feeling of stepping on a hard object under the forefoot.
- Burning or tingling: sensation of heat or burning under the forefoot, sometimes with tingling in the toes.
- Calluses: formation of calluses under the metatarsal heads due to excessive pressure.
- Worse barefoot: pain intensifies when walking barefoot on hard surfaces.
- Relief at rest: pain decreases with rest and offloading of the foot.
Treatment of metatarsalgia with foot orthotics
Custom foot orthotics are the gold-standard treatment for metatarsalgia:
- Retrocapital support: a raised feature placed behind the metatarsal heads lifts the metatarsals and redistributes pressure toward the plantar arch.
- Discharge zones: specific cavities carved into the orthotic eliminate direct pressure on the most painful metatarsal heads.
- Reinforced cushioning: absorbent materials under the forefoot compensate for the loss of the natural fat pad.
- Alignment correction: the orthotic corrects underlying biomechanical anomalies (high arch, hallux valgus) that contribute to forefoot overload.
When to consult an orthotist?
Consult an orthotist if:
- You feel persistent pain under the forefoot
- You feel like you are walking on pebbles
- Painful calluses form under the forefoot
- Pain prevents you from practising your sports activities
- Changing shoes does not bring enough relief
Our orthotists are members of the OTPQ and AOPQ. They will identify the precise cause of your metatarsalgia and design an orthotic suited to your condition.
Relieve your metatarsalgia
Book an appointment with a orthotist for a comprehensive evaluation and custom orthotics.
Frequently asked questions about metatarsalgia
What is metatarsalgia?
Metatarsalgia is pain located under the forefoot, at the level of the metatarsal heads. It is a general term for any pain in this region, often described as feeling like walking on pebbles.
What are the most common causes of metatarsalgia?
Causes include ill-fitting footwear (high heels, narrow shoes), biomechanical foot anomalies (cavus foot, hallux valgus), excess weight, high-impact sports and ageing of the fat pad under the forefoot.
Do foot orthotics relieve metatarsalgia?
Yes, custom foot orthotics are highly effective for metatarsalgia. They redistribute pressure under the forefoot, include a retrocapital support that lifts the metatarsal heads, and can incorporate targeted offloading zones.
Can I still wear high heels with metatarsalgia?
High heels significantly increase pressure on the forefoot. It is recommended to limit their use and favour shoes with a heel of 3 cm or less. Slim orthotics can be adapted to certain dressier shoes.
Can metatarsalgia resolve on its own?
Mild metatarsalgia can improve with rest and a change of footwear. However, persistent cases generally require foot orthotics to correct the underlying biomechanics and prevent recurrence.
How long does metatarsalgia treatment take?
With custom foot orthotics, most patients feel significant relief within 2 to 4 weeks. Continuous wear of the orthotics is recommended to prevent recurrence.