How to Self-Treat Metatarsalgia

Pain in the female footMetatarsalgia is a general term that refers to pain in the foot (typically around the ball of the foot).

It’s common in runners, track and field athletes, and for those who participate in high impact related sports (such as basketball and soccer). It’s also commonly associated with overuse syndrome.

Metatarsalgia is pain and irritation at the end of the metatarsal joints near the toes. Potential causes for the pain include: a stress fracture; gout; osteoarthritis; hammertoes; calluses; and pain in the joint from swelling and irritation. It can also be from neuromas, in which nerves tend to bundle and become irritated between the metatarsal heads.

How to Self-Treat Metatarsalgia

Metatarsalgia typically begins as a mild discomfort which grows steadily and quickly to the point that a person may struggle to walk, stand, or run. The key to treatment and management of this condition is to intervene quickly and to identify the actual cause or causes that led to the pain and irritation. Learn the potential causative factors for metatarsalgia and how to self-treat this condition so you don’t lose too much time with your training.

Risk factors for developing metatarsalgia include:

  • Excessive foot pronation. Your feet tend to roll inward as you stand, walk, and/or run.
  • Either excessively high arches or overly flat feet.
  • Spending long periods of time standing or walking (overuse).
  • High impact activities and sports.
  • Spending long periods of time on hard surfaces, such as concrete.
    Obesity.
  • Your shoes don’t fit well or the shoe is worn out. Typically due to shoes being too narrow or wearing high heels.
  • You have transitioned too quickly from a more built up running shoe into a minimalistic style.
  • Poor ankle mobility, particularly excessive tightness in the Achilles tendon or calf muscles.
  • Poor foot muscle strength, particularly the foot intrinsic muscles which help to support the arch of the foot.
  • Prominent metatarsal heads.
  • Having a hammertoe deformity.

Initial Treatment

Metatarsalgia is a condition that can start off as a minor annoyance. It can quickly progress into a painful irritation, and then suddenly sideline you for weeks. Take the pain seriously, and begin treatment right away. Whenever possible, begin the rehabilitation upon injury or the onset of pain. The goal is to restore normal range of motion (ROM) while reducing pain, irritation, and swelling. Restoring strength and function as soon as possible is also critical. Depending on the amount of pain and swelling, begin with RICE (Rest, Ice, Compression, and Elevation).

  • Rest. Initially, limit any activities that are causing pain. As the pain subsides, you can slowly taper up the use while taking care to avoid pain.
  • Ice. Apply ice to the painful area–typically the sooner, the better. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel pack style. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Compression. If swelling is present, utilize a simple ACE wrap around the foot and ankle to help with the swelling and pain. Start at the toes, and work up the leg. Take care to not apply the ACE wrap too tightly. Depending on the cause of the injury, over squeezing the foot can be irritating.
  • Elevation. Use pillows to position the foot above the level of your heart to help reduce swelling. This would be an excellent time to apply ice, too.

After you have initiated RICE and the pain and swelling have decreased, address any risk factors noted above (if possible). Please refer to Metatarsalgia Rehabilitation Exercises.pdf for detailed descriptions and photos on how to address other causative factors including: poor tissue mobility in the feet; tightness in the Achilles tendon; weakness in the foot intrinsic muscles; and balance deficits.

How to Self-Treat Metatarsalgia:

  • Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) can lead to excessive strain on the tissues on the bottom of the foot including the plantar fascia. I recommend initiating a complete ankle/foot strengthening protocol. Please refer to Ankle Resistance Exercises.pdf.

  • Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as weakness in the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which ultimately can lead to metatarsalgia. Improving your balance can help to reduce the risk of metatarsalgia and is an important part of the rehabilitation process. For more ideas on how to improve your balance, please refer to Improving Balance by Using a Water Noodle. As your pain level improves, I recommend that you perform these balance exercises without shoes on.

  • Add a metatarsal pad. Using metatarsal pads can help to provide pain relief (particularly, in the early phases of treatment). Some people don’t have much padding over the metatarsal area. This is particularly true as you age. Shoes with adequate cushion around the ball of the foot (or the area where the metatarsal heads are located near the base of the toes) can make all the difference. Visit your local running store to purchase a quality metatarsal pad. If unavailable, you can usually find one at a specialty shoe store or you may need to call a local podiatrist for recommendations.

  • Add an orthotic. Semi-rigid corrective devices worn in supportive shoes have been shown to be an effective treatment for metatarsalgia. If the metatarsal pad is helpful, but it doesn’t fully address the pain, you may consider orthotics. If you have flat feet or an excessively high arch, you may need a specially fitted orthotic that also includes a metatarsal pad. Supportive shoes worn alone, with or without soft corrective devices, may not provide adequate pain relief. Most orthotics requiring a metatarsal pad are custom made by either a podiatrist or a physical therapist that specializes in orthotics.

  • Did you progress too quickly into a minimalistic shoe? The standard built up shoe offers more foot support and padding than most minimalistic style shoes. If you attempt a quick progression, you may be at risk of developing metatarsal pain. Unless you are a child or teenager, expect a safe transition to take at least three months. Don’t transition during a period of intense training. A slow transition will allow your body to adequately adapt to the new stresses. I highly recommend waiting until the off season as progressing slowly is always a better choice. Taper back your running and implement my recommended strengthening exercises and balancing activities prior to a slow transition.

I recommend following this protocol for two to three weeks. While you’re self-treating your metatarsalgia, you’ll likely need to modify your exercise or running program. This would be an excellent time to focus on cross training activities.

If you’re not experiencing significant relief upon progressing into your exercise program, please consult a medical professional. I recommend a physical therapist that specializes in feet or who works with athletes for the treatment of metatarsalgia. The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. You may also consider consulting with a podiatrist.

For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.

157 Responses to How to Self-Treat Metatarsalgia

  1. sharon December 2, 2016 at 10:28 am #

    what are some good shoes for metatarsalgia?
    i mostly walk and do not run.

    • Ben December 18, 2016 at 9:39 pm #

      Hi Sharon,

      This is a difficult question to answer as the right shoe will differ for everyone depending on the shape of your foot. I personally like shoes with a larger toe box as I find the narrower shoes hurt my feet. Also depending on how your foot reacts to the ground a different shoe may be needed. For example if you have a “flat foot” then you may need a shoe that has more arch support. My recommendation would be to go to your local running store and have your foot mechanics analyzed. Let them recommend the right shoe for you. Most running stores have a lot of people that buy from them that walk only. So they should be very good at fitting the proper shoe and carry some good ones in stock. If they don’t seem to know what they are doing or don’t carry shoes for people that walk a lot then go to a different store. The goal is to find a shoe that fits your foot shape and will help hold your foot in a neutral position as you walk.

    • Mohito January 17, 2018 at 12:31 am #

      I’ve similar pain in my ball of the right foot. I didn’t know about metatarsalgia, until I started doing some research over the net. I play tennis thrice a week and in addition do some running and gym on weekly basis. I started experiencing the pain about a month ago, but I haven’t cut down on my tennis rounds. While playing tennis, it doesn’t interefere much as my tennnis shoes are quite supportive and stiff. However, I feel the pain during normal standing and walking activities, as I wear a minimalist style canvas shoes.
      What can you suggest me without disturbing my tennis schedule as I love to play?
      Thnx
      Mohito

      • BenShatto January 17, 2018 at 8:26 pm #

        Hi Mohito,

        I think based off of your description the first thing I would do is look to either change to a different shoe for daily wear, and not utilize the canvas minimalistic style or I would add an over the counter orthotic into the shoe to provide some support and cushion to the metatarsal area, and possibly some to the arch.

        Ben

        • Satish September 16, 2020 at 11:29 am #

          I have also same pain. I got to know about metatarsalgia after six month on net. Currently I am working from home. Giving maximum rest to my foot but still while walking it’s paining.
          I am a marathon runner and now bcoz of this pain I can’t run.
          Just wanted to know is this metatarsalgia pain 100% curable? Can I run again?

          Please help

          • Ben Shatto September 16, 2020 at 9:09 pm #

            Hi Satish….Yes Metatarsalgia pain curable. It usually takes a combination of finding the right shoes and/or orthotics and working on the biomechanics of the lower leg that likely led to the condition.

            Ben

            • Adam February 27, 2021 at 10:30 pm #

              Hello,
              I got lisfranc injury 1 year ago. I still have problems. Now I believe Metatarsalgia developed. Arch height in my left foot is 1.14 cm while right foot has 1.04 cm. I think this is the reason. Do you think there is a way to fix it ? ( Conservative or surgery??)

              • Gokmen February 27, 2021 at 11:34 pm #

                Hello Adam, I’m in pretty much the same position. I got Lisfranc injury a year ago. I believe that I’ve had metatarsalgia for a couple months. I’m not sure if lisfranc injury is often followed by metatarsalgia. My concern is that it might be due to the deformity the lisfranc injury left on my foot. There is a clear bump over my inter. cuneiform.

              • Ben Shatto February 28, 2021 at 2:11 pm #

                HI Adam and Gokmen…..Interesting the similarities for you two. This injury is fairly complicated as the mechanism of injury can impact treatment. Yes it can lead to the development of other foot problems either directly by changing the foot mechanics or indirectly as your foot mechanics change avoiding pain after the injury or from other possibly injuries that occurred with the original injury. Hope that makes sense. Surgery is sometimes needed to correct significant deformities to avoid worsening symptoms and deformity over the long term. But with all injuries like this……Work towards symmetry. Not just of the foot but the entire lower chain. Identify areas that are weaker, tighter, or possibly overly mobile/hypermobile and of course any changes in gait mechanics. Work towards normalizing these areas. This will either allow your body to heal and return to full activity or give you clarity that additional medical management is needed. Hope that helps!

      • Harriet May 21, 2019 at 6:24 am #

        Check it’s not Morton’s Neuroma as well. x

    • Kristen Rasmussen March 21, 2018 at 4:17 am #

      I found the only shoes that work for me are the Hoka’s. Especially those with the most cushion. I purchased the Bondi 5’s and I won’t go back. I’ve tried to wear other tennis shoes, but found after wearing the Hoka’s, the other tennis shoes (Nike, Addias, etc.) don’t have enough cushion and my feet start hurting immediately.

      Also – I used to walk around my house barefoot after getting up in the morning. If I do that now, I get a flair up. So I purchased some good slippers with a metatarsal insert for support and use those around the house.

      • BenShatto March 21, 2018 at 7:10 pm #

        Kristin, That is a good tip about the house slippers. Often times if you have tile or hardwood flooring a person will need a cushion during their rehab or even ongoing to help manage the symptoms.

        • Kristina January 27, 2021 at 2:02 am #

          I’ve washed a pair of my old running shoes and am using these around the house instead of slippers!

          • Ben Shatto January 27, 2021 at 12:29 pm #

            Great idea to re-purpose those! Thanks for sharing.

    • Kim November 1, 2018 at 1:34 pm #

      Hello Ben,

      I have been having increasing pain to the ‘ball’ of my left foot. I recently saw a podiatrist who told me I have a “displaced” fat pad due to a dropped arch and slightly hammered toes. She recommended “Superfeet” inserts and after seeing a gait analyst, neutral sneakers were recommended. She also told me to get a 1/2 size bigger for a larger toe box area. I am a nurse on my feet for 12 hour shifts and my current ‘work shoes’ are causing significant pain by the end of my shift. Any recommendations on what a good shoe I should get? And…can I switch the Superfeet inserts back and forth between shoes or sneaks? Is it possible to get the fat pad back into normal alignment simply with inserts to “lift” my arch?? The pain has gotten markedly worse and has been slowing my walking and exercise routine down 🙁

  2. Suzanne Herlihy January 7, 2017 at 6:44 pm #

    Hello…. I started with swelling And edema in both feet over two years ago. Most of the swelling has gone down but now both feet have what looked like planters warts on both balls of the feet. It has put me in a wheelchair. They started with blisters on the ball of the foot. The callus on both balls of the feet are so painful especially on a hard floor. Forget about wearing shoes or slippers. I can only wear white socks. Everyone says to go see a doctor but they would have to strap wings to my back and get me to the car because I can’t walk.. Thanks for any advice??

  3. Ben January 9, 2017 at 9:45 pm #

    Hi Suzanne,

    It sounds like your condition is really bad. Unfortunately, there is likely not a good home remedy fix. You need to see a podiatrist. The callus will need to be professionally trimmed and likely fairly deep as you may have a small plug of tissue that is causing them to be overly painful. The plantar warts will also need to be addressed. In my experience plantar warts do not respond overly well to over the counter medications. I realize it is painful to leave the home but at some point you may have to decide that it is worth the effort to seek out the right medical assistance to get this condition under control. You may also consider working with the Podiatrist or a good shoe specialist to insure you are wearing properly fitting shoes to address your particular condition. I wish you a speedy recovery.

  4. John March 24, 2017 at 3:41 pm #

    Hi Ben,
    I’m a 58yo male and run about 25 – 30 miles per week, both street and treadmill. After a week vacation in Florida that include a lot of walking on the beach, I have pain around my 3rd mtp joint. When I complete a stride on that foot, I get a quick jab of pain that is felt at the tip of the 3rd or 4th toe – hard to say for sure. On palpation, I feel only a mild tingling with pressure applied over the 3rd mtp. My calf is relatively tighter on that side as well. Does any of this info help narrow down what my diagnosis might be, and how long it will side-line me?
    Thanks,
    John

    • Ben Shatto April 4, 2017 at 8:39 pm #

      Hi Jon….it sure sounds like you may have metatarsalgia. I would work through the suggested exercises and see how the symptoms fair. You will definitely need to address the tightness in the calf as it can also lead to Achilles issues and plantar fasciitis. Because you are reporting tingling you may also be suffering from a Morton’s neuroma. If you symptoms don’t start to resolve after a week or two of being diligent about working through the suggested exercises and eliminating risk factors then you may want to have it officially looked at by a medical professional. Ben

  5. Julie March 30, 2017 at 9:28 pm #

    Thank you. I’ve been reading for hours and this post offers me more than anyone else has.
    I have begun training for my first 1/2 marathon. I’ve had some irritation for over a year on my 2nd metatarsal due to doing my job (massage therapist) barefoot on a hardwood floor. It hadn’t been bothered too bad by my running (I am still in the walk/run phase) until I was recently fitted with more stabilizing running shoes. I initially was having some knee discomfort. The knee pain is gone, but it’s been replaced with the metatarsalgia. I never really thought I’d like to run, but I do, so this setback is very frustrating. I will be laying off the running for a bit and trying your advice. Thanks.

    • Ben Shatto April 4, 2017 at 8:53 pm #

      Hi Julie,

      Well it sure sounds like you are dealing with Metatarsalgia. From your description I would say your shoe is the culprit. One of three things has likely happened.

      One…..The new built up shoe has changed your running form slightly causing you to put more pressure over the metatarsal heads and giving you pain.

      Two….The shoe fit isn’t right for your foot. The bottom of the sole is flexing at a point that does not line up optimally with the metatarsal joint and so this increases the pressure over the MTP joint. When fitting the shoe the flex point of the sole is an important consideration as to where it will located on your foot. I hope that makes sense.

      Third….The new shoe feels really good so you tapered up your mileage too quickly and your old irritation point at the 2nd MTP has flared up. Remember to progress slow and steady don’t taper up so quickly your body can’t adjust.

      Check out those 3 possible issues and see what you can to do resolve them. In the mean time try to follow the suggestions in the post to get the pain to calm down.

      Good Luck! Ben

  6. Greg April 25, 2017 at 5:18 am #

    Hi Ben,

    I’ve assumed for a few years I had plantar fasciitis but now I’m realizing, after starting to run again, that the pain is localized to the pad where my fifth toe connects to the ball of my foot.

    Every time this pops up I have to stop running due to the pain and it seems to take months before I start running again. I’ve been dealing with this for three years now and woke up last night with pain. It sucks because as badly as j want to run, I can’t because I worry I’m going to make the situation worse.

    Should I run through the pain while treating it or stay off of it? Since I had always assumed it was PF, I would lay off the running.

  7. Benjamin May 10, 2017 at 8:29 pm #

    Hi, Ben

    Thank you for the wonderful post.
    I use minimalist shoes for five or six years now.

    I have some minor pain and swelling on my right feet and I know that I walk putting most of the weight on then and almos don’t use the heels.

    What do you recommend to change the way I stand and walk?

    • Ben Shatto May 10, 2017 at 10:12 pm #

      Benjamin,

      Thanks for the kind words. Running with a mid foot strike is a good technique for a lot of runners. But many also run with a heel strike and do just fine. So far the evidence cannot prove one way is better than another. So if you run with a mid foot strike that is fine. But walking is another matter. One should really walk with a partial heel strike. If you tend to walk landing toes first I would work on landing heel first. Even if it is just slight. If you like the minimalist type shoes I would keep with them. I hope that answers your question. Let me know if you have more questions.

      Ben

  8. Ben Shatto May 10, 2017 at 9:53 pm #

    Greg,

    Good questions. It sounds like something about your running form is affecting your foot. Its hard to know exactly since I can’t evaluate your foot. But there are several biomechanical factors that may need to be addressed. The most common are issues in the hip such as weakness that affect how your feet hit the ground or generally a specific style of running or possibly just a shoe issue. If you can I would have someone evaluate your running gait first. Often times there are free clinics offered at your local running store. If that isn’t available have someone record you running and look for issues that may affect how your foot is hitting the ground. You may also try a different style of shoe. I wouldn’t push the pain too much with your running. Try to get to the root of the problem. Start with the hip strengthening exercises and the foot/ankle mobility exercises and stretches. I hope that helps! Good luck!

  9. Gareth Jones June 17, 2017 at 1:30 pm #

    I am training for marathon and have changed from supported shoe (was told I had pronation in past but now assured I don’t) to a neutral shoe. Before change I had knee pain which is cured but in new shoes the balls of my feet hurt (on the inside below big toe) after 30/45 minutes road running. Found this post which seems to indicate this is common for such a shoe change. If I keep running will my feet get used to the new dynamics and things improve. The pads sound an option to help transition or am I barking up wrong tree.

  10. Ben Shatto June 17, 2017 at 8:56 pm #

    Hi Gareth, Yes it does sound as if you may have metatarsalgia. One needs to always go slow when changing to a new type of shoe. If you are getting pain with the new shoe you have a few options. You could stop wearing the shoe and find a different type of shoe. You may want to be re-fitted before looking at different brands. If possible, it is always a good idea to have your gait analyzed when you change shoe types. Another option is to keep the shoe and just reduce the mileage for a while as your foot accommodates to the new shoe. You would want to really focus on the mobility and stability of the foot as I wrote about in the post. You can also trial a metatarsal pad as you indicated but again be very slow with the initial mileage to insure the pain does not worsen. But I recommend against increasing mileage until the pain is resolved. Worst case scenario is to ignore the pain as you increase the mileage. This can lead to even worse pain or other issues. Definitely be proactive in managing the pain. I hope that helps.

  11. Jay July 25, 2017 at 9:53 pm #

    I went to the Doctor but they just said rest before they will do any mri’s or other tests. I would like your opinion. About 3 weeks ago I went walking in a mountain stream and there was a sudden drop off which caused me to hit the ball of my left foot hard on a rock, and then my leg caught between two rocks on the way out somewhat violently. I had no after effects whatsoever, except for a very light bruise near just below my shit on the left part of the leg where it got caught. After 3 days of no pain on the bottom of my foot, I developed badly aching metarsalgia that increased in pain upon walking on it (causing me to limp and eventually twist my ankle), it also can hurt badly when bending my toes back the right way. It’s been 3 weeks now with no improvement, but I have only rested it about half that time. Do you think it’s possibly a small acute fracture that caused it, from the impact of the rock? Coul that impact on the ball of my foot in the stream possibly just be a coincidence and not the actual factor?

    • Ben Shatto July 26, 2017 at 8:40 am #

      Hi Jay, based up your description I would be suspect for a small metatarsal fracture. Especially since over the last 2 weeks of “rest” there has been no improvement. I would recommend a follow up appointment and x-ray. Sometimes it can be difficult to see a small fracture in the foot on x-ray and so a bone scan can be done to at least rule in or rule out a possible bone injury. Keep us posted but I would definitely go in for a follow up.

  12. Jay July 25, 2017 at 9:54 pm #

    *shin

    • Timothy J. Gass July 26, 2017 at 10:56 am #

      have you tried toilet paper?

      • Trevor Spencer July 26, 2017 at 12:25 pm #

        Shin happens

  13. Brian Whyte December 12, 2017 at 2:29 pm #

    Hello Ben
    I am reading these posts with extreme interest. I am active hiking daily and walking while golfing. I am 61 year old male. Little heavy but with strong legs from all my hockey etc. I have developed a very painfil callous behing my baby toe. I can barely walk on hard floors without orthotics. They seem to alleviate the pain. Say from a 10 to a 4 . Will this painful lump go away? How can I get rid of it. My doctor confirms metatarsalgia. I have had this in varying degrees fo over a year. It really kicked up when i tried a new pair of runners that did not have any support( but looked cool)!!. Thanks for any help.

  14. BenShatto December 12, 2017 at 7:32 pm #

    Hi Brian…..Thanks for the question. If you are developing a callous then there is likely something about how you are walking that is leading to the callous. I would recommend you have someone analyze your gait and see if there is a small abnormality that is leading to the callus formation. If you do not address the root cause which may ultimately be further up the kinetic chain then the callous will continue to form and likely remain painful. In the mean time you could see a podiatrist to shave down the callous to alleviate the pain it causes. There may also be some creams that help prevent it from forming as quickly. But ultimately have someone check your walking form and see if there is an issue. If you are like many guys you may be a little bull legged and have your feet pointed out more which can definitely cause this issue. Hope that helps! Keep us posted!

  15. neil December 20, 2017 at 7:13 pm #

    Hello Ben,
    While searching the internet for answers I came across your jnformative article, great article. I currently have bilateral pain on the ball of my feet that does not seem to be getting better. Along with that I have planter fasciitis and achilles tendinitis. If I stand for too long my calves and achilles becomes tiring where relief is accomplished by sitting. My calf muscle down to my achiles tendon are also sore. It feels like the pain is moving upward because recently my knees began to hurt. If push onto my hamstrings and certain muscle areas I can feel pain deep inside. I have done physical therapy, icing, cortisone shots, ESWT and now I have taken time off from work to try resting. I am really worried that I will be disable due the worsening condition. Can I please get your opinion on what may be wrong.

  16. BenShatto December 20, 2017 at 8:52 pm #

    Hi Neil. Thank you for the question. Your symptoms do sound a bit unusual. Particularly the fact that they seem to be moving upward (proximal). Because you have multiple issues and the pain is progressing I would definitely follow up with your physician. I of course do not know your health status, but there could be something more global going on such as peripheral vascular disease or another form of neuromuscular disease that can affect the lower legs more globally. I would start with a physician that can look for possible medical reasons for the pain. If nothing is found, which would be great, then you will need to find a new PT that can look at the whole kinetic chain and address the orthopaedic side of your pain. Hope that helps. Good Luck!

  17. Mohito January 17, 2018 at 12:49 am #

    I’ve similar pain in my ball of the right foot. I didn’t know about metatarsalgia, until I started doing some research over the net. I play tennis thrice a week and in addition do some running and gym on weekly basis. I started experiencing the pain about a month ago, but I haven’t cut down on my tennis rounds. While playing tennis, it doesn’t interefere much as my tennnis shoes are quite supportive and stiff. However, I feel the pain during normal standing and walking activities, as I wear a minimalist style canvas shoes.
    What can you suggest me without disturbing my tennis schedule as I love to play?
    Thnx
    Mohito

  18. Ryan January 29, 2018 at 2:36 pm #

    Hi Ben,
    My road running shoe has a 10mm drop, and I just got a new pair of trail running shoe that’s a 4mm drop. Is that to big of a distance to switch between? I went train running the other day and felt fine. Couple of days later I went road running and started to get a pain under my right forefoot that shoots pain into 2nd and 3rd toes. I just found out about the different drops in shoes

    • BenShatto January 29, 2018 at 9:54 pm #

      Hi Ryan,

      This is a good question without a clear cut answer. There will be many runners that can switch between different styles, fits and drop distances from more minimalistic to built up without issue. The volume or amount of running in each shoe may also be a factor. However, for many a 6mm change maybe too much. It really depends on your body and how you run. I would advise you that if you are getting pain when switching between shoes then stick to one that feels the best and try to find shoes that have similar drops, maybe within 2 mm or so. So to answer your question…..yes….it maybe too much for you so I would proceed with caution if you are going to keep wearing both shoes. Otherwise try to keep them more similar.

  19. Karyn February 22, 2018 at 8:14 am #

    Hi Ben,

    I’ve been reading up a lot about Metatarsalgia and I’m pretty sure I’ve got it. I’m training for my first marathon in 2 weeks and I have been running in excess of 60/70km a week. On longer runs i feel a dull pain below my 2nd toe on one foot. It’s not terrible but it gets worse as I go on and the toe occasionally tingles. I’ve got very high arches which might not help. I’m working through all the exercises but do you think that this is something that will recurringly affect me in the long term as I plan to run an ultra 90km later this year and i don’t want this to be the reason I pull out. What do you suggest I do to avoid this, whilst still training!

    Thanks

    • BenShatto February 22, 2018 at 9:49 pm #

      Hi Karyn,

      With the marathon in 2 weeks I would taper and rest it and continue with the rehab exercises, don’t change your footwear yet. Long term continue with the exercises and then start to experiment with different shoes or a meta tarsal pad or button to help with the pain. If the Ultra is in the fall or later summer you should have time to deal with the issue so you can meet your goal.

      • Karyn February 27, 2018 at 4:15 am #

        Thanks Ben – I’ll keep on doing the exercises. I ran a PB half marathon on the weekend and my underfoot was (and still is) tender but not painful. So the exercises must be helping. The ultra is in June so it might be cutting it fine.. fingers crossed 🙂

        • BenShatto February 27, 2018 at 6:37 am #

          Karyn that sounds fantastic! You should be well on your way. Keep progressing the exercises and stay focused on the recovery aspect of your training. Good Luck! and tell us how the Ultra goes.

          • Karyn May 17, 2018 at 2:29 am #

            Hi Ben,

            Following a visit to the Podiatrist I discovered that my metatarsal pain is being caused to a collapsed arch, possibly due to weakened ligaments from recent twin pregnancy hormones. The podiatrist suggested that I change my brand of shoes and prescribed an insole which seem to be helping,

            BUT, I compensated for so long that I now have an extremely tight piriformis that causes pain into my lower back and all the way down my hammy into my calf. I’ve seen a multitude of chiros and physios and have endured many (enjoyable!) needles but the pain does not subside. Do you have any advice?

            24 days till I run my 90km Ultra!!!

            • Ben Shatto May 18, 2018 at 6:33 am #

              Hi Karyn, It sounds like you have a couple of different issues going on. You need to be working on the strength of your feet to help support the arch. The shoes and orthotics will help. Likely you continue to have pain and weakness in the pelvis and hip area. You didn’t mention how far after pregnancy you are, but it definitely takes time for your body to fully recover especially after twins. It can take many, many months to be back to your pre baby baseline if there is such a thing. But as to the pain you are feeling it sounds a lot like a low back issue that is causing pain down the leg. This is more involved than I can answer in a post, but you need to try and establish a directional preference to the pain. Basically a pattern and then tailor the exercises based off the pattern. There is more information on how to do this in the Resilient Runner Program through MTA or through my low back pain information. Here is a link. https://www.thephysicaltherapyadvisor.com/store/

              Good luck on the Ultra

              • Karyn June 19, 2018 at 4:46 am #

                Thank you for all of your help and advice! The Ultra went well and my pains all behaved far better than expected. 10.10 hours and 91km later! BTW – the twins are now 20 months.

                Cheers Karyn

                • Ben Shatto June 19, 2018 at 8:51 pm #

                  Karyn…..thank you for the update!! That is awesome news and great work on the Ultra!!!

  20. Brynley February 22, 2018 at 9:47 am #

    Hi Ben. Just turned 30 and I do ALOT of walking in work. I also play football (used to anyway)
    Back in August I started getting a pain under my right foot. It felt like a pebble which gradually got more sore. Now here I am over 6 months later and the pain is still there and I’m also getting extreme pain down the left side of my left foot as well as pain across the top and bottom of both knuckles of the toes. I’m seeing an osteopath who’s treating it with ultra sound but it seems to be taking forever. Is this a normal thing?

  21. BenShatto February 22, 2018 at 9:52 pm #

    Hi Brynley,

    In my experience ultrasound is not likely to address the issue. It sounds as though you may have a neuroma. You need to look at the your walking mechanics. This starts from the hips and works it way down to your feet which may also include changing your footwear. I would suggest a PT that specializes in feet and manual therapy. You should start to see results in 2-3 weeks at most if you are on the right track. I would ditch the ultrasound and go for a different treatment. You can get past this, but you need a more proactive approach, not a passive treatment.

    • Brynley February 27, 2018 at 9:18 am #

      Thank you for the reply. Will arrange a session with a Physio Therapist asap and get back to you if I see results. Thanks again

  22. Mark March 13, 2018 at 5:46 am #

    Hi
    I have developed matarsaglia over the past 3 weeks – the pain has not been too bad until now when I have just ran a half marathon race.
    I have 6 weeks to the London Marathon and training had been going well until now. My plan was to do 3 20 mile runs over the next 3 weeks and then a 3 week taper.

    Should I push on through the pain then rest for 3 weeks or something else?

    Help!

    Thanks

    Mark

  23. BenShatto March 13, 2018 at 8:56 pm #

    Hi Mark,

    Metarsalgia can really derail your running. I would work really hard on a rehab protocol and likely cut back 1 or 2 of your 20 mile runs particularly if you have run the marathon distance before. It is always better to enter a race healthy. If you are worried about the cardiovascular fitness then aqua jogging is your best bet to keep you VO2 max up. But pushing through the pain can be a risk strategy as it could get to a point you cannot run. This is always a hard call and you know your body best. You may take a week to recover and rehab then do a shorter run then try a medium run and finally the 20 mile before you taper giving yourself 2 weeks to taper? Just a thought? Good Luck!

  24. Norma March 22, 2018 at 2:09 am #

    I think this is what I have now :\ I’ve been walking around for about an hour or more everyday for 2 months and I’m now travelling so I have been walking even more, but now I can’t walk on my left foot cause it is swollen and painful when I stand on it. There are like 3 red spot on it that hurt if I press on them. When I lay down it’s ok, just swollen. It’s been 3 days like this now… How long is it supposed to last? I still need to walk to school 1h20 min everyday next week XD! This has never happened to me before and I’m in Japan!!! Help me, please!!

    • BenShatto March 22, 2018 at 9:05 pm #

      Hi Norma. Your presentation sounds interesting. With the “red” spots I am not entirely sure you have metatarsalgia. It could be plantar warts, bunions, calluses or something else. It may also just be where your shoes are rubbing and not fitting properly. You may want to have a professional look at the feet and make sure of the exact diagnosis.

  25. David W March 26, 2018 at 9:33 am #

    Good morning,

    I had developed tightness and pain on the ball of my foot. No lumps, just tightness. I have no issues with the heal of my foot, but the balls of the feet feel tight and can burn at times. I have tried all the stretching recommended but nothing happening. At first thought it was PF but told otherwise. Seemed to start after using Newton shoes for a period of time where they try to get you to run more on the ball of the foot. Icing seems to help as does inserts but not going away. Any idea of what this issue might be?s

    • BenShatto March 26, 2018 at 8:56 pm #

      Hi David, It does sound like you may have metatarsalgia or a morton’s neuroma. If the stretching and exercises are not helping then be sure you address your shoes and running form. The research is not entirely clear that running on the ball of your foot is the best way. Many people naturally heel strike more and that is okay too. It maybe that you are attempting to change your natural running pattern which is causing issues. If you want to pursue changing your running pattern than I would suggest a very slow progression for some it may be 6 months to a year. Remember it can take a long time for bones and ligaments to adapt to new stressors.
      Here is a link to information on Morton’s Neuroma. https://www.thephysicaltherapyadvisor.com/2017/06/07/do-i-have-mortons-neuroma-in-my-foot/

  26. Kev May 4, 2018 at 7:21 am #

    Hi Ben

    Great article. Thanks to the web it’s reached me here in Oz!!

    I didn’t do anything too agressive with my usual CrossFit routine. Leg wise – Monday was some squats and farmers carry and Tuesday rowing. Didn’t feel any pain or injury on those days.

    However I woke up on Wednesday I felt the sensation of a “stone” on the ball between my 4th and 5th toe.

    1. Can metatarsalgia occur so randomly without any specific trauma?

    2. It’s Friday now and it’s slightly subsided. But it’s still there.
    How long do I have to wait to resume CrossFit exercises (box jumps, skipping, running) again?

    Thanks in advance.

  27. Ben Shatto May 5, 2018 at 9:24 am #

    Great question! It’s hard to specifically answer this question without examining you. A good rule of thumb is 5-7 days which gives the tissue time to rest and progress through phases of inflammation. Then you can start back slowly while looking for any return in symptoms. With this presentation, you need to be sure it is just metatarsalgia and not a stress fracture or Morton’s Neuroma. Here are links to two other posts. I hope you find them useful. If the pain continues, I would suggest an x-ray to rule out a stress fracture.

    https://www.thephysicaltherapyadvisor.com/2016/12/14/q-a-how-did-i-get-a-stress-fracture-in-my-foot/

    https://www.thephysicaltherapyadvisor.com/2017/06/07/do-i-have-mortons-neuroma-in-my-foot/

    • Kev May 6, 2018 at 6:35 pm #

      Thank you Ben for your response. Much appreciated.

      • Ben Shatto May 8, 2018 at 8:39 pm #

        You’re welcome! Keep us posted–good luck!

  28. Joe May 9, 2018 at 4:40 pm #

    Hi Ben, I’ve had a pain in my foot since the end of January, it’s the first metatarsal on the inside of my foot. I went to my doctor about a month ago who said it was most likely metatarsalgia and recommended sorbathane insoles to help this. I believe the pain started after one of my regular running sessions which I haven’t done since the pain occurred as it’s too uncomfortable, even when walking. I’ve now got some sorbathane insoles and I also have flat feet so I’ve got some to also raise my arch. I still haven’t seen any improvement and I’m due to go travelling in a few weeks so I’m concerned it will hamper my trip. Do you have any advice? Many thanks

  29. Ben Shatto May 9, 2018 at 8:00 pm #

    Hi Joe,

    It’s hard to offer specific advice having not assessed you myself. But I would start with the exercises recommended in the post. If you have been taking it easy since January and the pain has not changed then there is something that is still aggravating the joint most likely. I would compare one foot to the other. Do the toes move similar in all directions, does the forefoot move the same, does your strength and/or balance feel the same. IF not then work towards symmetry. It maybe difficult for you to do on your own. So with a big trip coming up you may want to have an assessment by a PT that specializes in feet to get some specific advice to help you through. I hope that helps. Best of luck!

  30. Ann May 10, 2018 at 10:53 am #

    Thanks for the informative article Ben.

    I have recently been diagnosed with metatarsalgia by a podiatrist, who associated it with a bunion that I have. I am wondering about recovery time (weeks, months?). This has been painful for about a month, and doesn’t seem to be letting up (especially when I pivot on my foot). Do you have any sense at how long it can take to start to feel better. I have stopped running and am only walking as necessary.

    • Ben Shatto May 10, 2018 at 8:52 pm #

      Hi Ann,

      This is a complex question. It can take weeks to months. So not the best answer but it depends on how long it takes you to elevate the aggravating condition. Once you have addressed the underlying condition that is causing the meta tarsalgia then it will usually take a couple of weeks to really start feeling better. So you will really had to address the root cause before you can expect to feel better. Sorry I can’t be more clear on my answer. Good luck!!!

  31. Kim Haslam May 18, 2018 at 10:03 am #

    11 weeks ago I had big toe fusion and 2nd/3rd toe weils osteotomy to correct metatarsalgia.
    When can I expect the toes to lay flat?….still feels as though I’m walking on the balls if my feet

  32. Ben Shatto May 18, 2018 at 8:47 pm #

    HI Kim, that is a difficult question. You need to be working on the foot mobility daily, except the great toe of course. Sadly I have seen cases where the toes do not ever lay flat again. I would follow up with your physician.

  33. Kim Haslam May 19, 2018 at 4:48 am #

    Thank you Ben….

    As this is revised surgery after the original surgery for “a simple bunion removal” 3 years ago left me with the problem of walking on the balls of my feet I’m at a loss as to whether to just put up with it, which is quite sad as the fusion was supposed to be part of the cure…

    • Ben Shatto May 19, 2018 at 8:23 am #

      Unfortunately, surgical results can vary and not every surgery has an optimal result. IF you are still having a lot of issues I would follow up with a professional. If your goal is to return to activity you may need either a custom orthotic or even a more specialty shoe to help support your feet and insure the stress on the feet is adequately displaced to prevent other issues from occurring. You may have to ask for a second opinion. If you go that route find someone that specializes in more active individuals, not necessarily older adults.

  34. Ben Shatto May 19, 2018 at 8:23 am #

    Surgical results can vary and not every surgery has an optimal result. IF you are still having a lot of issues I would follow up with a professional. If your goal is to return to activity you may need either a custom orthotic or even a more specialty shoe to help support your feet and insure the stress on the feet is adequately displaced to prevent other issues from occurring. You may have to ask for a second opinion. If you go that route find someone that specializes in more active individuals, not necessarily older adults.

  35. Linda Wylie June 4, 2018 at 12:10 pm #

    Great article, Ben I have suffered with this for 8 years now. I had been a runner for 15 years, always in Brooks Addictions with custom orthotics. Out of the blue one day I tried to get out of bed and found both feet swollen and painful. Long story short, have tried everything, including 5 pair of custom orthotics, two of which had metatarsal pads built in. I am currently trying Hoka Bondis with some degree of comfort. Oh, I should add that because of the pain from metarasalgia, I have not been able to run since that day 8 years ago. At this point I just want to walk without pain! Right now half a mile seems to be my limit! So discouraging! Have consulted with 6 podiatrists, 3 orthopedists (including one at a renowned university!), done all kinds of stretching and strengthening exercises, tried many sessions of massaging…Any other suggestions?

    • Ben Shatto June 4, 2018 at 9:00 pm #

      Hi Linda, Sorry to hear about this. The sudden onset seems unusual. Based off the information provided its hard to make any solid suggestions. Can you provide more detail as to what the other medical professionals said and what there thoughts were on the sudden onset. Do you have other lower leg related issues? Any information on your body type and build could also provide insight. Ben

      • Linda Wylie June 5, 2018 at 5:40 pm #

        Hi Ben,
        Thanks for getting back to me so quickly! Unfortunately, no one has really commented on the sudden onset. The first few professionals, from podiatrists to orthopedists to a physiatrist to physical therapists all decided I have tight calves and should stretch which I did and continue to do…helps a little. I’ve also been told my feet are flat by most podiatrists but one contended I have high arches! What?! X-rays and MRIs reveal nothing. It seems like properly constructed orthotics should help, but what are the odds that five pair of custom ones didn’t help at all…in fact, this last pair made the pain so much worse! No other lower leg issues. I’m fairly slim…5 ft, 6 inches, weight 125. Latest podiatrist contends I have “loose ligaments” in my feet and need a stabilizing orthotic, but his caused me more pain than any others.

        • Ben Shatto June 5, 2018 at 9:04 pm #

          Wow….that is a tough case when so many do not agree and the best advice offered is to stretch your calves. If in fact you do have “loose” or hypermobile ligaments in your feet it is likely this is true throughout your body. Its unfortunate that I cannot evaluate you my self. But if I were to do so I would start at you low back and work my way down looking for asymmetries and muscle imbalances that might affect how the feet are hitting the ground. I would start you on a program to strengthen the weak areas and address any tight areas that could cause imbalance. As we progressed back into a strengthening program I would probably suggest a mild stability shoe with a moderate amount of cushion and then take an extra amount of time to progress back into a run walk program. The whole process would likely by 3-6 months all depending on what we find. Any potential orthotic needs to be full length with moderate stability and some give to it. If it is too rigid it will not work typically only cause more pain. Its a lot to tackle but should be possible. I wish you all the best in attempting this or finding someone like a PT who is a runner that can help you on your journey. I would not work with any medical professionals that are not runners themselves. Good Luck! Hang in there you can definitely improve!

          • Linda Wylie June 6, 2018 at 7:34 pm #

            Thanks again, Ben, for taking your time to listen and offer suggestions. Wish I were closer to come see you, but you have given me several things to consider on my “journey”. I will definitely take note of what you’ve said as I look for a PT!

            • Ben Shatto June 6, 2018 at 9:02 pm #

              Thank you Linda. Keep in touch and let us know how it all comes out. Hang in there you can get back on track!

  36. Kristi June 5, 2018 at 9:16 am #

    Hi there!

    I’m been experiencing some pain in the ball of my left foot for a few days now. It’s worse when walking/standing, and is preventing me from my regular exercise that I’ve been doing for the last few months (typically walking/jogging intervals, 3 mi/day). I don’t think it’s footwear related, I wear Brooks Glycerin, and have never had this issue before. I do have high arches, and a longer 2nd toe, which I’ve read could make me prone to this type of issue?

    I’ve been trying to rest up and elevate/ice when I can, but doesn’t seem to be improving. Is it worth a trip to a podiatrist, or do I just need to give it some time? Very frustrating, since I’ve been seeing some progress with my weight loss in the last months since amping up my workout routing, and I’m struggling to find a replacement for the walking. I hate biking, and everything else seems to cause more pain. 🙁

    Any advice would be appreciated. Thank you! Kristi

    • Ben Shatto June 5, 2018 at 9:07 pm #

      Hi Kristi, often times people with high arches will also have tight calves and poor foot mobility. I would work on stretching your calves and get a tennis ball to roll under your foot working on improving the general mobility of the mid and forefoot. Work on this while you take some time to heal. Water walking or swimming maybe a good alternative for a bit to keep the weight off the feet. Hang in there and keep with it. Just be diligent about keeping your feet/ankles strong and mobile particularly with the high arches. Hope that helps!

  37. Meg June 9, 2018 at 5:13 pm #

    Hi Ben,
    I have been reading your advice on Metarsalgia and wanted to thank you. I am not a marathon runner but have a life long history from age 6 of track and field, high jump, hiking, mountain biking and 20 years of classical ballet training and professional performance. So very athletic life.
    For the past 15 years I started doing Argentine Tango which unfortunately means high heel shoes. About 5 -7 years in I started to have ball of foot pain which was sharp and burning. I stopped wearing high heels and have been doing all the exercises and taking some of the great supplements you suggested.
    Now 15 years in I am in trouble. I was walking to work on concrete day and out, up and down steps, about 9 hours a day I was on concrete. I am no longer working at that job. At the last month of my contract I found that stepping on the ball of my foot was so painfully sharp I could barely walk. I immediately started R.I.C.E.
    I saw a podiatrist one year ago and was told no fracture but rather very severe Metarsalgia and that I had to wear a shoe with no flex at all and with an orthodox support and the small pads that you wear just behind the ball of the foot to take the pressure completely of the ball of the foot.
    I tried various shoes recommended by podiatrist. Slowly started stretching and walking again but the Cortisone wore off after 3 months and I went back in for another injection. Fast forward 3 months later, a new X-ray and another podiatrist at the same clinic. Good news, no fracture. Got another injection. Doc said they can only do a certain amount of injections as it thins the tissue (?) and also there is an option of surgery on the ligament but it does not always work. I am not keen on the idea of surgery.
    Immediately after the last injection I felt a lump in the ball of foot (between 3-4 toes). The lump sort of went away all of a sudden like stepping on a grape, it squished and I am back in severe pain. Back to R.I.C.E.
    I do have very flexible narrow feet, with high arch. No other foot problems which is amazing considering all the sports and dance. I have always had tight calves and stretch out.
    A Chiropractor I see mentioned the arch is gone, no fat pad and very flexible.
    I am 66 now, so 60 years of wear and tear has taken it’s toll I think. Should I just hang up my shoes? All I can do now is swimming and bike.
    Thank you for your advice.

  38. Ben Shatto June 10, 2018 at 9:04 pm #

    Hi Meg,

    Wow, it sounds like a very complicated history. Sadly sometimes the wear and tear can get to us. The podiatrist is correct that cortisone is only a temporary fix with possible significant side effects. The best advice I can offer is…….If you want to try and improve the condition when it is this severe you have to take several steps back and really evaluate every small detail of the lower leg and foot/ankle and how it moves. Then slowly work towards bringing the foot back into balance for you, and your body. This is a very slow and prolonged process. You will need someone that is an expert in foot mechanics and patient. Don’t give up!!

  39. Dave June 18, 2018 at 5:36 am #

    Hi Ben
    My orthotist says I have metatarsalgia caused by dropped metatarsals and I have been using custom made orthotics.Also,I pronate, but I don’t think excessively.

    I run in neutral shoes but really want to get to a stage whereby I run in neutral shoes without any orthotics.Assuming I adhere to the dictum of doing it in small increments is this an achievable goal?I understand there would also be an element of strengthening that goes with it.
    Best Regards
    Dave

    • Ben Shatto June 18, 2018 at 9:02 pm #

      Hi Dave, This maybe an achievable goal. It depends on how far the metatarsals have dropped and the shape of your foot. Is there a particular reason why you are set on no orthotics or a neutral shoe only? I realize that neutral shoes are all the talk now, but there is a time and place for a more built up shoe and orthotic. It really depends on the foot type and foot shape. Either way keeping a strong mobile foot is a worth while endeavor.

  40. Dave June 19, 2018 at 2:39 am #

    Thanks for your quick response Ben. The simple answer is I run for pleasure and orthotics are uncomfortable(although its better in my new shoes(neutral)) and the combination of this, and neutral shoes allow you to “feel your feet” much better. I did a 30 minute sans orthotics run the other day and loved it and there were no immediate “pulls” or issues but the calves were a bit tighter so I don’t think I have that serious biomechanics issues, otherwise the following day would have been a lot more tender(I guess).I have also started a regime of rolling underfoot which might be placebo but genuinely feel it works(Along with other leg/glut muscle rolling).
    My layman’s approach would be running with and without orthotics at a ratio of 80/20% increasing the without component at approx. 10 % per month whilst also keeping total mileage increase to less than 20% per month. I would appreciate your indicating if you support foot rolling, the graduated approach set out above, and what specific metatarsal exercises can be done in conjunction with standard mobility and strength exercises found on the web/you tube. I am in South Africa, so can do little to support you in any way but would be prepared to make a donation for your time.Regards.Dave Andrews

    • Ben Shatto June 19, 2018 at 8:50 pm #

      Hi Dave,

      Let me see if I can answer these questions. Yes, I definitely support rolling out the foot. It has many benefits from general stress relief to helping maintain good foot mobility. I think you have a very thoughtful approach to how you plan to increase your time without the orthotic. The most common mistake I see is people progressing too quickly. So the 80/20 plan with 10% increased time/volume out of the orthotic per month is a good strategy. As far as other exercises to incorporate. I would definitely work on arch raises in standing, general ankle strengthening and balancing drills particularly working on balance on softer unstable surfaces barefoot. I hope that helps. Good Luck! and keep in touch!

  41. Dave June 19, 2018 at 11:11 pm #

    Thanks. Will do.

  42. David henderson July 20, 2018 at 11:09 am #

    Hello Ben, I’ve just been diagnosed with 2x Morton’s neuromas in my right foot both 10 mm.
    I’ve not been out running for 5 months now and want to get back into it! I’m wearing pads and have insoles but it’s not getting any better. I’ve even had cortisone injections but still feels like I’ve got stones in my shoe. I wear safety boots all day at work and the only way I’m dealing with the pain is ibuprofen. Please advise. Kind regards David.

    • Ben Shatto July 20, 2018 at 8:58 pm #

      Hi David. It can be very difficult to deal with foot injuries. If the pain is not tolerable then you may need to try other medical management including a nerve ablation. As it relates to running you will want to start very slow and progress back into a running routine. Be sure to work through all the foot and ankle exercises to be sure your foot is as ready as possible to deal with the extra stress. Here is a link to a post I wrote on Morton’s Neuroma. https://www.thephysicaltherapyadvisor.com/2017/06/07/do-i-have-mortons-neuroma-in-my-foot/

  43. Dawn Abel July 27, 2018 at 8:30 pm #

    Hello Ben,

    As a result of bunion surgery, I now have metatarsalgia. I was wondering if foot exercises could possibly help my situation as this was directly a result of surgery gone wrong.
    Thank you for sharing your knowledge with us.
    Best Regards,
    Dawn

  44. Ben Shatto July 27, 2018 at 9:05 pm #

    Hi Dawn, I’m sorry to hear about the pain your having post bunion surgery. Often times once a bunion is corrected the foot has to adapt to a whole new movement pattern. Typically a person has a bunion for a long time and the foot adapts to it and alters its mechanics during ambulation. After the surgery the bunion has been fixed and now the foot has to once again alter its mechanics to adapt to the change. So yes I would definitely start doing the foot exercises, in most cases people will find some relief. Good luck!

  45. Abby August 4, 2018 at 1:24 pm #

    Hi ben! My name is Abby, and I am a soccer player! I play all year round and recently have been having extreme pain in the ball of my foot but only in my left foot. We asked my doctor and he suggested new shoes. We have tried ice, compression, heat, New shoes, less running…pretty much EVERYTHING! but yet, the pain is still there. I don’t know how to fix it i have googled everything and the doctor thinks that I’m just growing! HELP!

    • Ben Shatto August 5, 2018 at 9:03 pm #

      Hi Abby, I’m so sorry to hear about the foot pain. Without seeing you personally it is tough. I assume you have had x-rays to rule out a stress fracture? Also you may want to read my post on Morton’s Neuroma. https://www.thephysicaltherapyadvisor.com/2017/06/07/do-i-have-mortons-neuroma-in-my-foot/

      Have you been working through the exercise protocol with foot mobilizations and ankle/foot mobility and strength work? I would start there. If you are still having issues after that I would find a good manual therapy based PT that also does sports medicine. Hope this helps you.

      Ben

  46. Charlotte Dorris August 7, 2018 at 6:48 am #

    Hi Ben,

    Thank you for all of your responses so far – I’ve learned a lot already but have a few questions of my own. I’ve worked hard to strengthen my calves and will do more for my ankles. Im a runner training for my first full marathon. I have been experiencing metatarsalgia for the last three weeks or so…and this week I’m supposed to begin my twelve week training plan! I have a slight bunion on my right foot and fairly wide feet and high ish arches to begin with. I’ve been using a small piece of a soft foam makeup pad between my first and second toes in an attempt at better aligning my foot for running and cutting down on blisters. It works sometimes. In doing this am I exposing my metatarsals instead? When squished the pad is probably 1/8 inch thick. My big toe nails also point up a little more than normal so I find this helps there too.

    I’ve been following the 10% rule judiciously. I’m wondering how much pain I should tolerate as I get back to running? Is running with a metatarsal pad a good idea? I’ve taken three weeks off with a few 3 miler test runs. It’s all I can do to not go out running. Agh!

    Thank you so much.

    Charlotte

    • Ben Shatto August 7, 2018 at 9:05 pm #

      Hi Charlotte, Great questions. It is a little hard to know if you are exposing the metatarsals more with the make shift pad. My guess is that you are not. The bunion can also be painful and may need to be shaved or filed down. Given that you have a bunion an some spacing issues with the toes I would trial a metatarsal pad. The issue is that you have to slowly taper into running with one. For example in a 3 mile run, I may wear it for 1 mile the first time, then take it out and complete the run. Pain as you taper up your mileage to a marathon distance is not uncommon. It is a lot for the body to adjust to. The trick is being able to distinguish typical pain you will feel as your body accommodates or is this pain that is the first sign of injury. You may look into some some semi custom orthotics. You would want full length and semi ridgid most likely. Too rigid and your pain is likely to worsen. Keep working on the foot and calf mobility, the more the force can be spread out throughout the entire foot as you run the better. Hope that answered the question. Let us know how your progressing.

  47. Joan August 9, 2018 at 3:22 pm #

    I have either Morton’s neuroma and or metatarsalgia in both feet. Was fitted for orthotics by a very reputable local foot surgeon and received them 4 months ago. I wear the orthotics in my Brooks Adrenaline running sneakers daily. The pain in forefoot is now tolerable. I have recently developed hip pain in both hips. Could the orthotics be causing this pain? Should I wean off of the orthotics? I certainly don’t want to aggravate the metatarsalgia and don’t want hip pain to progress. I walk for exercise.

    • Ben Shatto August 9, 2018 at 9:02 pm #

      Hi Joan, this is a great question. I often talk about how hip weakness can cause foot problems but yes foot problems can cause knee or hip issues as well. It maybe that the hip was the culprit for the feet all along. If you haven’t done so already I would have some test the strength and range of motion of the hips to determine if the feet and hip pain maybe related.

  48. Bella Williams August 12, 2018 at 9:18 pm #

    Hi Ben Shatto,

    My name is Bella, and I am a runner. I have been reading your advice on Metarsalgia and wanted to thank you. Your article is really helpful for me. However, If I want to choose shoes for my problem, what features should I look out for?

    Thank you so much!
    Bella

  49. Kim November 1, 2018 at 1:38 pm #

    Hello Ben,

    I have been having increasing pain to the ‘ball’ of my left foot. I recently saw a podiatrist who told me I have a “displaced” fat pad due to a dropped arch and slightly hammered toes. She recommended “Superfeet” inserts and after seeing a gait analyst, neutral sneakers were recommended. She also told me to get a 1/2 size bigger for a larger toe box area. I am a nurse on my feet for 12 hour shifts and my current ‘work shoes’ are causing significant pain by the end of my shift. Any recommendations on what a good shoe I should get? And…can I switch the Superfeet inserts back and forth between shoes or sneaks? Is it possible to get the fat pad back into normal alignment simply with inserts to “lift” my arch?? The pain has gotten markedly worse and has been slowing my walking and exercise routine down

    • Ben Shatto November 1, 2018 at 9:09 pm #

      Hi Kim, I know working 12 hrs on a hard tile and concrete floor is really tough. I like the suggestion for a slightly bigger shoe. And yes you can switch the superfeet from shoe to shoe. I like superfeet a lot as an over the counter product. However, to be honest I don’t know if it is the best choice in this situation. Superfeet are very hard and rigid which is great for the arch but not so great for a 12 hr shift. I highly recommend you find someone to make you a custom orthotic. I would not go to a podiatrist for this orthotic. Most podiatrists will made a very hard rigid style. And most patients cannot tolerate wearing them so they go unused and wasted. Instead look for a PT that makes orthotics and find out the style they make. There are several brands that have a rigid underside with a softer rubbery top side. This style is much easier to tolerate if you are on your feet a long time but still gives enough support to the arch. Best of luck!

  50. Chloen Faith Solomon November 5, 2018 at 12:04 am #

    It’s been a month since I hit my own foot on the wood wall,I suffered pain on the second ball of my foot,at first and second week I fell tingling,and it’s like my muscles inside is tighten,ans when flex is I fell tighten inside the sole of my foot,after two weeks I went to poadiatric surgeon had my xray and he give me celecoxib and he said there no fracture and all is normal,and also the result too is normal,but in the 3rd week I try to slightly massage my foot and feels like the tingling,and the tighten inside feels ok and the second ball of my foot it’s not so pain when I touch it or press is slightly.But my concern is when I walk and put weight on my right foot where the ball of my foot hurts it’s still had pain.

    • Ben Shatto November 5, 2018 at 10:04 pm #

      Chloen,

      It is possible that the impact was great enough to cause a deep bone bruise. These are very painful and can take a long time to recover from. I suggest continuing with the light massage and gentle foot and ankle exercises and give yourself some time to recover. I’ve had clients that take over 3 months to fully recover from a bone bruise.

  51. N.harikrishna December 27, 2018 at 5:21 am #

    I have metatarsalgia in 4 and 5th toe. It has been 5-6 months.what should I do. By foot hit the ground since then I have been suffering

    • Ben Shatto December 30, 2018 at 9:50 pm #

      If this injury occurred from trauma you could have sustained a bone bruise or other injury. I would work through the exercises noted in the article and do your best to limit strain on the foot and try to avoid really hard surfaces while you rehab. Be sure the mobility and strength of the foot is symmetrical with the other one….particularly the mobility of the mid and forefoot around the toes and ball of the foot but the calf as well. Also be sure toe strength is symmetrical. Hope this helps!

  52. Sandy Simmons February 2, 2019 at 3:07 am #

    I appreciate your caring responses to those of us in desperate need of information. I am a 58 year old male and I’m walking on rocks. After my family physician told me that it’s metatarsalgia, he suggested Prednisone in small doses…2.5mg 2xdaily, which is helping with the condition as well as my arthritis. I’m a server. I only work five hours at a time and just started wearing the gel pads but the pain is there two hours into my shift because I am a hard worker and find it hard to slow down. I have an insanely high arch but wear orthotics to help but the gel pads make my shoes feel too small on top of the orthotic. Is there such a thing as a half orthotic that would allow room for the gel pads? I’m wary of my feet sliding and rubbing toward the end of my shoes. I use Voltaren and have just read that it can blister the feet. Mine are very inflamed but I blamed it on work. I will stop using that but in the meantime will follow your advice from the article above.
    Thank you for helping not only me but the many who never knew such a condition existed.

    • Ben Shatto February 2, 2019 at 11:12 am #

      Hi Sandy. Metatarsalgia can be so painful. My suggestion would be to have a custom orthotic made for you. You will need one that has a little give not a really rigid style and then a metatarsal pad or sometimes called a button needs to be placed to help off load the painful area. It can be difficult to find podiatrists that make an orthotic that isn’t extremely rigid but I find many PT’s will make a style that is a little softer but still rigid enough to be helpful. You will just have to call around in your area to find a PT that does them and then look at the style. Also be sure you are working on calf mobility and first toe mobility as well as anything you can do to keep the arch of the foot as mobile as possible. Hope that helps!

  53. Susan April 17, 2019 at 1:21 pm #

    Hi Ben,

    Approximately April 1st I injured my R foot after doing sprints in my bootcamp class. I felt a “tear” under the ball of my foot, 2nd toe. It feels like a hard ball is under that toe when I bear weight, barefoot. Right away, initially, I iced the area, took motrin and tried to rest it x 3 days. By day 5, I went to the dr just to make sure there was no fracture. Xray negative for fracture. Ligament sprain/?capsulitis or metatarsalgia. He gave me metatarsal pads that I wear everyday (accept at my desk, I take them off and in bed). I continue to take motrin and ice maybe once a day. I have continued with my boot camp classes, modifying according to the trainers recommendations.

    I am a runner also and was in the middle of training for a half marathon on May 11th. I had just done a 9 mile run the Saturday before the injury.

    My question is, is it normal to still be experiencing some pain(not sharp, but sore) with weight bearing and walking at this time in recovery on day 17(even making me limp a bit) ? I still feel like there is a bunched up sock under the 2nd toe in the ball of my foot when I am barefoot. Like I am stepping on something hard and it lifts up my second toe. Is that normal and will that feeling go away? There is no visible swelling that I see. This is the first time in my running career that I have had an injury like this. How long does this take to heal and should I be trying to stretch the area or will that tear it more?

    Can’t wait to get back to running! I love it so much! So tough not to be doing it but I want it to heal completely so I won’t permanently damage it and can’t run ever. When do you think I can try running again?

    Thank you so much for all of your advice and care!

    Susan

    • Ben Shatto April 17, 2019 at 9:24 pm #

      Hi Susan,

      I’m so sorry to hear about the injury. Since I have not assessed you I cannot say for sure what the cause of the sensation is. However, metatarsalgia is a likely cause. It can often feel as though there is a bump or lump on the bottom of the foot. I have found this to be especially true when it develops rapidly due to an injury. Unfortunately, 17 days is not a long time in a recovery process. The first phase of the inflammatory cycle is 14 days. The subacute phase can be 6-8 weeks. This type of injury can be serious as it can linger for a long period of time particularly if you try to push through it. I would recommend taking the slow road in your recovery. The important thing is to keep your long term goals in place and in most cases one race isn’t worth the risk of a lingering injury. If the pain does not significantly resolve in the next 1-2 weeks you may need to see additional assistance. One option is to unload the joint for a few weeks and give it a real chance to rest and heal. For now continue with the recommendations noted in the article and do your best to not aggravate the area. I would suggest limiting any movements that cause a lot of stress or load through the joint including jumping, running and pushing off. You may try cross training with a bike or swimming.

      Yes you will be able to run again but do take caution to address this issue right the first time. Hope this helps. All the best!

  54. Leanne May 6, 2019 at 2:14 am #

    HI

    I have been wearing heels for as long as i can remember. About two weeks ago my foot started hurting. its fine when im sitting but when i start to walk i feel like a jabbing pain in the front of my right foot. I need to limp a bit until my foot can withstand the weight on it then i can walk normal but i still feel the pain…I bought some voltaren which only works until it works out of my system then the pain is back

    • Ben Shatto May 6, 2019 at 8:51 pm #

      Hi Leanne,

      I would suggest starting with the basics and see how the foot responds. I would rest the foot and wear non-heel shoes, work on stretching the calves and icing the painful area along with still using the voltaren.

      Ben

  55. Susan Clark June 3, 2019 at 10:35 pm #

    Hi, I just want to say THANK YOU. I found your information on metatarsalgia just a few days ago and it has already helped me immensly. I have done your rehab exercises – just a few little, simple exercises – and my foot felt soooo much better after only one day. I started having pain two years ago and became pregnant shortly after. I sort of putmy foot on the back burner to deal with post pregnancy. I did go to a very good podiatrist who specializes in treating athletes especially runners, but for some reason all he gave me were some felt foot pads which did help but did not completely heal the pain. After having a baby and trying to get back into a better running / workout routine, I was just figuring I was going to have to live with this pain and swelling. I was so let down as I used to run a lot have even completed the Boston Marathon. I was afraid my marathon running day were over. I now feel like I can recover and have my foot back to feeling normal. Thank you so much for freely sharing this information. I truly am grateful. Sincerely, Susan

    • Ben Shatto June 4, 2019 at 8:57 pm #

      Susan…thank you so much for the kind words. I’m honored I could help.

  56. Monika September 2, 2019 at 1:19 pm #

    Hi Ben,
    I am a very active, lightweight runner, who clocks about 60km a week, in addition to doing weight sets and ballet. I integrated some high intensity interval training into my training to shake things up, namely, jumping jacks, skaters, stairs and jump touches – which was done in 20 to 30 minute training sessions. Within a week, I experienced sharp pain on the balls of the feet, and couldn’t even get down the stairs. I train in asics kayano shoes, and have no issue with shoe comfort. I’ve been icing now for 2 weeks, and switched to stair-master, and have tested out lighter running sets (about 20 – 30 minutes at a time). The pain is still present, though seems to be improving with the ice. I am wondering, in your opinion, how long this will take to go away, and if I should stop running altogether and go for physio? Thank you for taking the time.

    • Ben Shatto September 2, 2019 at 9:20 pm #

      Sorry to hear about the recent injury. Mostly likely this occur ed due to increase in training volume and the types of exercises. Lots of jumping onto the balls of the feet. If you can taper down the volume and work hard on the rehab side of things overuse injuries like this typically go 6-8 weeks. Though there can be a lot of variation in recovery times depending on your body type, health status and general volume of load on the feet. Hope that helps! Get well soon!

  57. Sharon R October 2, 2019 at 9:48 am #

    Hi Ben
    Thanks for this article is really informative and helpful. I run around 50Km per week and have never experienced a foot problem before. 3 weeks ago for a short (6km) easy run I tried a new, more minamilst shoes with reduced drop of 3mm. During the run I experienced some low level pain in the ball of my foot. I jogged/walk home and haven’t been able to run since. Initially walking barefoot on hard floors caused discomfort and I couldn’t perform a heel raise. The top of the foot over the 2/3 metatarsal was swollen and painful to press. With rest, walking is now pain free and I can perform heel raises pain free. There is very mild pain if I press on the top of the foot but significantly less than a few weeks ago. Running is still out of the question. Short test runs result in pain in the ball of the foot followed by throbbing in the hours after. Does this sound like Metatarsalgia? I do have a quite pronounced bunion on this foot which I have had for several years but doesn’t cause me pain (since I ditched the heels). Thanks for you time

    • Ben Shatto October 2, 2019 at 9:00 pm #

      Hi Sharon, Sorry to hear you have been suffering with this. Its difficult to know if you truly have metatarsalgia or not without me examining you. And yes some of your symptoms do sound like metatarsalgia. However, the pain on the top of your foot is very suspect. It is possible you developed a minor stress fracture. Pain in the top of your foot like that is often a sign of a metatarsal stress fracture. You may consider getting an x-ray or a bone scan to confirm a diagnosis. Otherwise you would want to continue to manage this conservatively and do not return to running until you are pain free. Please keep us posted on how things go. Likely your story can be helpful to others. All the best!

  58. Sharon Rasmussen November 1, 2019 at 1:36 pm #

    Hi Ben

    Thanks so much for taking the time to respond. X-rays at 2 and 4 weeks didn’t find anything but an MRI at 7 weeks confirmed a metatarsal stress fracture. Your assessment was spot on – thanks very much for the advice.

    Sharon

    • Ben Shatto November 2, 2019 at 9:14 pm #

      Hi Sharon, I’m glad you were persistent in your follow up. But I’m sorry to hear you have a stress fracture. However, now that you know the cause of the pain you can treat it appropriately. Be sure you address any precipitating factors that lead to the fracture so you rehab well and get back to running. Just be sure to taper back slowly 🙂 Best of Luck!!

      And here is a link to an article on stress fractures I wrote for MTA. https://www.marathontrainingacademy.com/stress-fractures-runners

  59. Jo Brown November 25, 2019 at 5:14 am #

    Hi Ben,

    Thank you for your informative article, it’s been a huge help to me. I would normally run 30+ miles a week but unfortunately worn out and then new, poorly fitting safety shoes created metatarsalgia first in my left foot and now during recovery my right too.

    I was told that I have highly mobile ankles and forefeet but limited mobility in both big toes. The left worse than the right. I’ve seen 2 different physios, the second manipulated my stiff left toe and gave me exercises to work on both big toes, all the small toes as well as balance. I’ve also seen a podiatrist who has made custom orthotics for work. He recommends a flexible shoe as I do a lot of pushing/pulling, twisting etc. It was actually a very rigid shoe that created the pain to start with.

    I’m working on balance in general as well as all the other exercises. I’m suffering mentally through not being able to run. I’m not quite pain free yet but have done a couple of 20 min treadmill, slow runs in the past 10 days which don’t seem to make things any worse. My question is, if I’m working 10-12 hrs a day on my feet (on concrete) and seeing small improvement can I reasonably do a few small runs like this which help my mental state enormously. I want to work towards 3 a week for now. I’m sensible enough to know I won’t be back to where I was anytime soon and all previous goals are on hold…

    Also I would normally massage my feet, the area which is painful is no longer swollen but it is “grainy” in there. I don’t know if massage would help or hinder repair?

    Any advice welcomed. Thank you!

    • Ben Shatto November 25, 2019 at 10:09 pm #

      Hi Jo, situations like yours are tough. You have to remember that it is the whole volume of load you are fighting against. Your feet are really doing a lot if you are on them 10-12 hours a day on concrete. So it’s not just the running its all the time on concrete. If you are going to taper back into some running you need to go much slower than you might first anticipate to insure your body(feet) can take the extra load. I would be careful about any aggressive massage as it can make the pain worse. I usually don’t advise massage over the painful area only the non-painful portion of the foot. Hope that helps! Keep after the rehab exercises and the advise from the PT and podiatrist. Your recovery may take a little longer given your working conditions. If at all possible see if you can add a rubber mat to the concrete floor you stand on. That will help. All the best.

      • Jo Brown November 26, 2019 at 3:56 am #

        Thank you Ben, I won’t do any massage around that area then and stick with rolling the fascia.

        The majority of the hard work is done in the first 6 to 7 hrs and then I try to get off my feet as much as possible. Mat isn’t an option unfortunately as I’m on the move the whole time but I am searching for more cushioned shoes and my orthotics are thicker than usual.

        I’ll try to lower my running expectations for now, I’m on my 6th week of almost nothing but will hold back. Fingers crossed!

  60. Grant Werth December 4, 2019 at 12:07 am #

    Greetings, 71 year old have had a very painful #3 Met. Head problem for years in left foot. I do construction work so am on my feet 8 hours a day. It’ used to be 10-12 hours put I have had to reduce my activity time do to Met Head Pain. I’m not or ever have been a runner! Rx Orthotics no longer help as well as OTC ones. MD foot surgeon says he can open up the skin over that one Met head and reduce the size of it (i.e. grind it down slightly) as the other adjoining Met Heads are in fair condition. I’m wondering how common such procedures are and how successful they are? Also what would the approximate healing time be? Lastly would this be a procedure you would or would not recommend! Thanks for your impute it’s greatly appreciated from Alpena Michigan 🙂 🙂

  61. rishi February 4, 2020 at 12:15 am #

    I had heel pain and was using insoles. but as i got some relief by stretching and massaging. I stopped using insoles and couple of days later developed metatarsalgia. Now, even I am using insoles but pain is not subsiding. After 15/20 minutes of standing/walking pain resurfaces and sometimes its very bad. My insoles had metatarsal pad as well but now they are of no help. However, i have added an extra pad which helps me to walk and stand.

    How should I address this problem?

    • Ben Shatto February 4, 2020 at 10:12 pm #

      Hi Rishi,

      Most likely the heel pain and metatarsalgia pain is linked. Most likely there is a biomechanical issue either in the foot or up the leg that has caused the pain and likely an inflammatory response in the metatarsal region. You need to continue to rehab the foot/ankle complex working on appropriate ankle and foot range of motion and strength and do what you can to reduce pain and inflammation. Additional rest and time off your feet may also be needed. Wish you all the best!

  62. Sophia February 28, 2020 at 7:14 pm #

    Hi,
    I have what feels like a marble or small seed on the bone under my little toe. I run and walk quite a bit. What can I do to reduce the seed like area.

    • Ben Shatto February 28, 2020 at 10:02 pm #

      Hi Sophia, this could be many things. People get all sorts of callus, or callus with a plug or even plantar warts. It could even be a bone spur or a secondary bone called a sesmoid bone forming. If its a callus then just trialing a new shoe may help or even trying the socks that fit like gloves (a sleeve for each toe). But you may want to have it checked out to know what it is fore sure then you can decide on the proper way to treat. Ben

  63. Ash May 29, 2020 at 3:29 am #

    Hi Ben

    6 weeks ago, I was told to do some exercises to help with a herniated disc. I did planks and also the cat camel exercise. I noticed after a short while I started feeling a lot of pain in both my feet and inflammation. It seems like it started from these exercises and having excess pressure due to this on my feet. And both my 4 toes seem to have the “hammer toe” condition. I felt a stone like object and pain in the ball of the feet. And also a tingling between 3rd and fourth toe on both feet. Most of the time the tingling was mild but rarely it would flare up (perhaps due walking more on it, as I tried to rest and stay bes bound for as long as able).

    I went to the doctors and they told me to rest and gave me anti inflammatories.

    It’s been 6 weeks now. I decided to go for a walk yesterday as the pain I had in the ball and also around my big toe (this may have been because I was walking on my heels to avoid the pain being caused) had lessened. But after the walk it feels as though the mild pain between 4th and 5th toe on the right foot has slightly increased and that the ball has started aching more.

    I’m thinking that maybe I need to give it more time, as I read somewhere that it can take months to fully heal. And that perhaps I need to be resting more.

    Is there anything that you can advise?

    Thank you

    • Ben Shatto May 29, 2020 at 9:23 pm #

      Hi Ash….yes rest is definitely part of it. You may also benefit from what is called a metatarsal pad that you can place in your shoes. You can buy them on amazon.com Often times one needs to avoid being barefoot for a while to as the hard surfaces will worsen the pain over the metatarsal heads. Finally try to normalize anything in the ankle foot complex that seems different. For example lack of ankle or big toe mobility or maybe poor strength or balance. Anything that could be contributing to the symptoms. And of course avoid all painful activities. Hope that helps.

      Ben

  64. Barb Alli July 18, 2020 at 8:50 am #

    The question Can/should the foot/ankle exercises be started when some pain still exists?

    60ish woman here. Went through ACL reconstruction in Nov ’19, long slow road back. Restarted playing tennis in Oct ’19, down again in Jan-May ’20 w/small meniscus tear. Knees are okay now, but I’m pretty sure I’ve gotten metatarsalgia about 4-6 weeks ago, just slowly came on. I haven’t regained a consistent exercise pattern, as every time I start up, something gets tweaked (and yes, I AM BEING CAREFUL). However, I was attempting to get back to tennis twice a week, along with lots of walking (my 10,000 steps), and had ramped DOWN running from 12 miles or so a week (no long-for-me runs) to a few short warm-ups and a few hills. Now, I’m icing & using Voltaren on my forefoot (can’t take ibuprofen or aspirin–allergies). It’s not bad, but it’s not right either. I can’t find a specific tender spot.

    I’m all over trying the foot/ankle strengthening but the real question here is, when do I start? If I have to wait for the pain to go entirely away, well, I’ve been continuing to ratchet DOWN everything to where I’m about to cease all walking, even, and the pain isn’t entirely gone.

    I’ve added cushioning to my usual shoes (Hokas for running, NB court shoes–no other choice w/a 2E foot), and birkies around the house. Have successfully used orthotics for years for hallux limitus. THANK YOU FOR YOUR RESPONSES! This article & your answers are MOST helpful.

    • Ben Shatto July 18, 2020 at 3:02 pm #

      HI Barb….Great question….No you do not have to wait for all the pain to be gone. The general rule of thumb is to avoid any severe or moderate to severe pain. If the exercises cause more than a mild increase in discomfort then you need to taper down the exercises some. A little pain or discomfort is okay. Given your history of foot and knee issues you really need to concentrate on hip strengthening particularly the deep hip external rotator muscles. Here is a link to my First exercise I usually recommend. I hope to have some more advanced exercises posted on my Channel in a few weeks. Also the Resilient Runner Program found on this website has a lot of in depth exercises and videos for exercises and about this topic. https://www.youtube.com/watch?v=k2-Wq7WCS0I

  65. Forde July 22, 2020 at 2:22 am #

    Hi Ben,

    I’m a cyclist (no judgement, please) and I previously had metatarsalgia on my left foot. Cause was hammer toe. After trying a few different treatments (pads, soft foot brace…and being told I needed surgery…by a surgeon :-)) I treated it by using toe spacers (https://www.correcttoes.com/) which I found through a marathon blog. No more pain there! Hurrah. Now I have what appears to be a similar problem on the right foot, however, it’s not yet responding to the spacers despite a month of reduced activity and elevation. I’ve also adjusted my cleat position. No luck. Are there any other hacks you’ve seen work?

  66. Ben Shatto July 22, 2020 at 8:23 pm #

    Hi Frode, Hammer toe can definitely cause metatarsalgia. This can be a difficult thing to control as the hammer toe position is likely causing the heads of the metatarsals to push down into the pad of the foot. As we age this pad will naturally decrease in thickness worsening the problem. The key is to keep pressure off the area as you get the inflammation down which controls the pain then work on positioning to prevent it from reoccurring. There isn’t any good hacks just a slow process of finding the right position to minimize stress on the metatarsal heads and then trying to get the inflammation down which is likely keeping the pain higher than you like. Keep after it, you might have to taper down your activity more until you find a balance your foot can handle. I’m sorry I don’t have more for you, but I hope that helps!

  67. Bill October 14, 2020 at 10:15 am #

    I’m a 51 year old trail runner and my left foot pain has been labeled metatarsalgia by a podiatrist but I’m not sure. I’ve seen two different doctors so far who haven’t really done anything yet except persuading me to visit a running store and get analyzed and fitted for new shoes and superfeet insoles that I didn’t really need. I’ve tried various insoles and styles of shoes before with no luck and it has been 6 weeks in these superfeets, with no improvement. I’ve had this issue now for a very long year and a half. I’ve had to cut my miles down 50-80% most months and I’m much slower. I’ve even taken long stretches (weeks) off from running to see if it heals but it never does. I get weakness in my ankle and 1/2 mile or a mile in to my runs, I notice a slight limp begin every single time. It is so in my head that I’m ready to stop trail running forever, which I hate to give up because I love getting out in the woods to relieve stress. My main symptom is like that of people with plantar fasciitis. I wake up with pain in my foot every single morning all this time, or if I set at the computer a long while and get up to walk, I notice the pain. But it is not plantar fasciitis, as I’ve had that in the past. This pain is mostly below the little toe at the ball of my left foot (different area from everything I read about for most people) and if I take my hand and pull in on each side of my foot base, I feel some pain on that outside edge underneath. Once up, it mostly goes away but the ankle weakness is always sort of there it seems and when I run, that night or a day later, the pain is more noticeable. I usually can’t run multiple days in a row now. My pain is never super intense (more of an ache) but enough that it impacts me and it is so chronic. It just never heals, whatever is wrong and I can’t figure it out. I do have semi-flat feet and I’ve rolled that left side ankle a few (3 or 4) times, maybe once every 2 years, as I only started running in my mid 40s. The rolls have always healed up fine in 2 weeks or so. I’ve tried some exercises but I haven’t stuck to them yet. I shall try yours but if you have a magic word for me, boy will I listen. Desperate! Oh yes, if I go back to my doctor, I think his next move is ART (Active Release Technique), he said that anyway.

    • Ben Shatto October 14, 2020 at 9:31 pm #

      Hey Bill…Thanks for question….Based on this information things are not adding up. There is likely a combination of things happening. There are at least 3 things that I would want to screen out if you were my patient….1. Is there some kind of underlying lumbar condition that is causing the minor ankle weakness, 2. Do you have a muscle imbalance in the deep hip rotators of the hip that is affecting how the foot impacts the ground 3. Is there ligament laxity in the ankle that is affecting how the foot impacts the ground leading to compensation and pain. I don’t think you will find a single perfect diagnosis. And you definitely are unlikely to find one specific magical technique. However, a solid evaluation from a PT that specializes in manual therapy and running should result in a comprehensive plan to help build you back up. Don’t give up, you just need someone to come along side you and help guide you down the right path. I hope that helps!

    • Vivian November 7, 2020 at 8:25 am #

      Hey Bill,

      I have exactly what you described! Would love to just share what worked/didn’t work. Sure you can relate, but I am tired of googling solutions to this mysterious but chronic foot problem.

      1 – dull “inflamed” pain in the middle to ball of foot
      2 – light “clicking” in my ankles and the feeling of weak ankles
      3 – I also had pain in one hip due to sitting in a non-ergonomic chair (PT said I had one hip rotated outward causing leg length discrepancy)
      4 – pain during first few steps in morning

  68. Bill Reed October 18, 2020 at 7:32 pm #

    Dr. Shatto…I so much appreciate your response. At least it gives me a little bit of hope, which I was beginning to lose. If I was in your area, I would be in your office, but I’m in the Columbus, OH area. I don’t understand the body much but you may be on to something. I didn’t mention it in my question before, but I also had pain in my right hip for a long while and it was going on in conjunction with the left foot pain. In fact, it was so bad that I addressed it only after that initial podiatrist visit. I always thought the left foot/right hip problems were related but when I mentioned this, the doctors never seemed to focus on that any. They just focused on the hip and now foot. The doctor spotted weakness in the hip muscles when he would push that right leg down. I couldn’t hold it up as tight as the left side. The pain was intense exactly on the ilac Crest (very localized) it seemed but eventually it got better after weeks of the PT exercises and then the foot got worse. I also used to visit chiropractors a lot in my 20s and 30s due to lower back lumbar issues but in my 40s-50, felt like I haven’t needed that. So 2 of the 3 things you mention could be an issue I guess. I might try to share your response to my current Doctor, who is supposed to be one of the best in the Columbus area for runners, according to my Doc. I guess I won’t give up just yet. Thanks again and I will check out your resources here! – Bill

    • Ben Shatto October 18, 2020 at 9:09 pm #

      Hey Bill….These types of issues are almost always related. Medicine loves to niche down and specialize. That has advantages but not in cases like this. You have to step back and look at the whole person and how the parts interrelate to each other. So trying to address issues individually rarely works that well or for the long term. Have your PT take a step back and look at the whole you and then address those issues. You will likely find many lingering aches and pains will slowly go away. Keep us posted and best of luck!!!!

    • Vivian November 7, 2020 at 8:34 am #

      Just to add on, I also had localized pain in my left hip, which complemented pain in my right foot. It is mostly gone but would come back if I sit for a long period of time. Deadlifting helped with the hip problem.

      Happy to chat more Bill & thanks Ben for the forum and advice!

  69. Nikhat Kamal October 24, 2020 at 12:04 am #

    Hi Ben,

    Seven months back, when I was wearing safety shoes and walking inside a workshop, I hit my toe badly with some obstruction and my second toe got hurt. The pain was immense, but not that bad that I wouldn’t be able to walk. So I continued my job and kept on wearing heavy safety shoes with still having pain. For two months, I did that till my layoff, and then at home, I realized that I had been enduring too much pain. I never went to see a doctor, Now at home, the pain in toe is gone but my second metatarsal still hurts while stepping down of stairs, and also if I take a long walk. By the way I have completely flat feet. Can you please advice, how to treat this pain in my second metatarsal. Does this have any treatment. I shall be extremely thankful

  70. Ben Shatto October 24, 2020 at 9:55 am #

    Hi Nikhat….it is hard to say exactly what maybe the cause of the pain with the second toe without personally evaluating you. It could be that the joint was damaged with the injury. But just as likely you could have changed your walking pattern after the injury which lead to an over use injury at the head of the second metatarsal. Possibly that joint was not ready or prepared for that type of use and load causing inflammation and now pain. With that being said the two things I would advise would be to insure the second toe and particularly the joint where the metatarsal connects into the toe has normal motion. I would also trial a metatarsal pad to change the forces over the joint. These should be easily found on line. The metatarsal pad is usually only needed for a month or two then taper out of it. Hope that helps.

  71. Ryan Mckenzie November 16, 2020 at 1:44 pm #

    Ben –
    I have been dealing with a extremely nagging foot issue for 2 years now. Started one day out of the blue with no obvious injury. I started to get the feeling of a “lump” right around my 2nd metatarsal head on the bottom right foot. I also have an increased sensitivity when wearing socks around my toes. The pain and “lump” feeling increases throughout the day and lessens when off my feet. Both of my heels get very sore throughout the day as well. I have seen countless doctors and ruled out neuroma and many other typical foot conditions. Blood work and scans do not show anything and we have ruled out autoimmune disorders. So I’m back to square one with a diagnosis of metatarsalgia. I’ve tried metatarsal pads and inserts, ice, rest and all the typical conservative treatments. Nothing ever helps! I feel like I’m going to be walking on a mysterious lump for the rest of my life! Any thoughts on where to go from here? One doctor recommended getting orthotics made but I’m not convinced of anything anymore.

    • Ben Shatto November 16, 2020 at 10:15 pm #

      Hi Ryan….you didn’t mention your age, but sometimes as we get a little older the pads of the feet will thin and so the bones have less cushion. Has anyone ever mentioned if you have thin foot pad? I actually would try a custom orthotic. In fact its something I would have done before the scans personally. The trick is to find a semi rigid orthotic that also has some cushion. I would advise against a very hard rigid orthotic. Hope that helps!

      • Ryan Mckenzie November 17, 2020 at 1:02 pm #

        Sorry about that…. I’m 34. The padding is definitely thinner on my problem foot compared to the other. I can feel my bones much easier. Not sure if I’ve always been like that or if it’s thinned out over the last couple years. Is it odd for one foot to thin and the other foot not to? Some doctors have acknowledged that the padding is thin, but say they don’t believe it should be enough to cause any issues. I recently thought maybe these problems developed after years of wearing crocs on a daily basis. I hope I didn’t do long term damage to my feet! It’s hard to imagine have to live with this issue forever. Thanks for getting back.

        • Ben Shatto November 17, 2020 at 10:17 pm #

          Hi Ryan…34 is a little young to have significant thinning. Yes one foot can be different than the other. I would suggest starting with the orthotics as I described in the other reply. At 34 you definitely should be able to recover from this. Its just a matter of finding the right combination of things. Likely it will involve orthotics and exercises to correct muscle imbalances that lead to over use of the metatarsals and ultimately inflammation. Hang in there and best of luck!

  72. Lucie March 31, 2021 at 1:34 am #

    Hi Ben
    I found this post extremely helpful. I run 25-30 miles a week and have been using a Mizuno trail shoe due to the terrain I run on. I have on instances found the shoe to feel too tight on my left foot and with some loosening of the laces it has improved. For the last week or so I’ve been running a different route which is undulating and more of a road terrain. I experienced pain in my foot after my run at the weekend on the top of my foot under my toes. I rested it for a day and the pain subsided and I ran again the day after. However the pain is considerably more today/difficult to fully weight bear. It feels like it is my second metatarsal.
    Would it be my shoes being too firm/perhaps too tight and the terrain I have been running on?
    Thanks

    • Ben Shatto March 31, 2021 at 7:41 am #

      Hi Lucie…the easy answer is that it is the shoe combined with the different running terrain started a metatarsalgia. That can be dealt with by changing the shoes, rest and rehab. It is possible you are developing a neuroma or even stress fracture. So I would definitely take this serious and make some adjustments. Do some self care and rest. Then start off with less mileage and do a taper up. Sometimes these little things are just that….little…sometimes they can blow up into big things. Best of Luck!

      • Lucie March 31, 2021 at 9:56 am #

        Thank you Ben – really appreciate the reply and guidance.

  73. Sab April 9, 2021 at 9:51 am #

    Hi Ben
    Thank you so much for all your information, really. I saw a doctor that confirmed I have all the 3rd, 4th and 5th metatarse inflammed on both feet, so it’s hard to walk without feeling burning under the ball or pain in the toes. It has been 3 weeks. He said I just need pain killers. I had stopped walking completely (not going out at all) but he told me I should keep walking to the store etc. But everytime I try to walk even 500 meters, the pain worsen. What should I do then ?? does it sound normal after 3 weeks that there is no improvement ? I don’t have a fixed home so I’ll have to move in the end of the month, very scared if I can’t use my feet correctly.
    Thanks again for all your help

    • Ben Shatto April 9, 2021 at 9:26 pm #

      Hi Sab…So sorry to hear about this. After 3 weeks I would expect at least some improvement. I would definitely be changing my treatment plan some. Maybe icing, or using crutches while you walk? Maybe a medication change? Also keep trying the recommendations above as long as it doesn’t worsen your pain. Good Luck!

      • Sab April 16, 2021 at 11:12 am #

        Thanks I can’t use crutches it caused me carpal tunnel syndrome. I doesn’t get better or for a day or two and back to square one. I’m so desperate. I don’t ice or elevate anymore I did that for week no improvements.

        • Ben Shatto April 16, 2021 at 7:50 pm #

          Sab, it sounds like you should seek a second opinion from a medical professional that can re-evaluate your situation. There are obviously many compounding factors here. Ben

  74. Millie April 25, 2021 at 8:23 am #

    Hello Ben,
    Thank you so much for your thoughtful and kind expert advice! I am a beginning runner who increased from about 9 miles/ week to 23 miles/ week over about 6 months. About 6 weeks ago, I ran on a gravel, hilly road and felt some pain in my 2nd toe (which is longer than my big toe). After that, I noticed that when I stood on my tip toes with bare feet in a hardwood floor, there was some pain in my left foot right at the base of my 2nd toe. Since it didn’t hurt while I was running, I kept running but then recently went hiking in a rocky area and the base of my 2nd toe started to ache (top and bottom of my foot).

    I stopped running, followed RICE protocol and have since seen a PT and a podiatrist. Oh and I got new shoes. My PT has prescribed several exercises including side-lying leg lifts and foot strengthening exercises to strengthen my abductors, my hip stability, and my feet. I was over protenating and have very weak hip stability apparently. The podiatrist recommended a pad insert. My new shoes have a reduction in heel drop of 4mm, are a 1/2 size bigger and are stability shoes (saucony vs ASICS).

    The podiatrist said I could run a little bit. My PT says no running until I can do 10 single-leg heel raises without pain (I cannot even do one heel raise in my left leg on a hardwood floor without some pain) Yesterday I followed my podiatrists advice bc I wanted to get back out there after 16 days of rest and ran 3 miles to try out my new shoes.

    My question is- what does easing back into running mean in terms of miles? How fast is too fast to increase mileage? 10% increase per week? I will stop running again if my foot hurts while running, but I also want to get back on the road! It seems like 16 days rest is a lot for a minor injury but perhaps I’m just being impatient. I am doing PT every day and can already see my feet are behaving differently when I walk (not collapsing).

    Thank you again!

    -Millie

  75. Ben Shatto April 25, 2021 at 1:43 pm #

    Hi Millie…..Lots to unpack here. If you were my client I would start your mileage back at no more than 50% of prior baseline. I would also not run on any surface you know has aggravated the toe in the past. I would also slow the increase in mileage to 5% a week for now. Continue with the PT exercises and be very diligent about recovery. Hope that helps a bit. I would discuss with the PT your intentions so they can help you in your progression. All the best!

  76. Millie April 26, 2021 at 4:42 pm #

    Thank you so much for this guidance! I really appreciate your reply. Thank you for your support.

    -Millie

  77. Penny July 8, 2021 at 7:52 am #

    What exercise can you do while metatarsalgia is healing? I think mine was caused or aggregated by walking 3 to 4 miles daily to lose a few pounds. Would you recommend elliptical or stationary bike or what?

    • Ben Shatto July 8, 2021 at 8:49 pm #

      Hi Penny….Great question…..It really depends on the person. Some people can do one or the other, both or neither. You won’t know till you try it. My advice is always avoid exercises that exacerbates the pain but otherwise stay active. If elliptical or stationary bike cause worsening pain then try swimming. Also during this time be sure to keep weight training upper and lower body just try to avoid making the symptoms worse. Best of Luck!

  78. Will August 7, 2021 at 11:48 pm #

    Hi Ben – thanks for keeping up this thread for this long. I have had idiopathic gout since 2012. Managed to get it under control by diet change for a bit over a year with a super restrictive diet but it eventually started flaring up after a while – he diet was too restrictive to maintain. However I haven’t had another flare up since I prescribe all optimal in 2016. However about mid 2015, i started noticing bad pain in the balls of my feet and heels if I walked a lot or was standing for long periods of time. It has progressive gotten worse, prevent any kind of walking for exercise, leading to some weight gain. After seeing a friend who is a massage therapist, she suggested metatarsalgia which lead me here. Her instense calf and foot massage alleviated most of the acute pain but there is still a swollen tender feeling. This site and and other things I’ve read suggest might be the corrrect diagnosis…

    My question to you is how best to communicate to my doctor that I’d like to investigate treatment for this without sounding like I’ve self diagnosed? Obviously I want the correct diagnosis but this is finally the best description of my situation I’ve ever found. Have dealt with some severe gout pain (mostly in the toes and balls of the big toes) as well is very tight calves and hips, do you have and suggestions? Should I ask for a referral to a podiatrist? Thank you!

  79. Will August 7, 2021 at 11:50 pm #

    * allopurinol

    • Ben Shatto August 8, 2021 at 4:49 pm #

      Hi Will….Sorry you have struggled with this so long. I think a podiatrist is a good place to start. There are other reasons one may develop metatarsalgia including bony abnormalities so an x-ray maybe in order and a podiatrist can do that. But as far as worrying about “self diagnosis”…I would not be concerned about that anymore. I think most providers expect you have consulted Dr. Google already. If you come into the appointment respectful and seeking his or hers expertise then most providers should welcome your thoughts. If a provider does not respect you or your thoughts about your own body then you should very quickly find someone else. As far as metatarsalgia goes yes working the calves can be helpful and I’m a big believer in addressing hips muscle imbalances as well. It may also be worth your time to do a few sessions with a physical therapist to have the lower extremity screened and a thorough home program developed to address any and all muscle imbalances that may impact the foot. Wish you all the best and be sure to give the tread an update as you progress. Take care! Ben

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