Health guide · Podiatry
Ball of foot pain (metatarsalgia): causes, relief and when to worry
What causes ball of foot pain, from metatarsalgia and Morton’s neuroma to sesamoiditis and stress fractures, how to relieve it and when to worry.
The short answer
Pain in the ball of the foot, the padded area just behind your toes, is most often metatarsalgia: soreness under the ends of the long foot bones from too much pressure, often from thin-soled or high-heeled shoes, high-impact exercise or foot shape. Other common causes are Morton’s neuroma (burning or numb toes), an inflamed second toe joint, sesamoiditis under the big toe and stress fractures.
Most cases improve within a few weeks with roomy, cushioned shoes, a metatarsal pad placed just behind the sore spot and a break from impact. See a podiatrist if pain lasts more than 2 to 3 weeks, and promptly if you have diabetes or numb feet.
Want it checked? Find an Evolve Health podiatrist near you
This guide is for general information and is not a diagnosis. Some services may not be offered at every office; your provider will go over your treatment options at your appointment.
Where does it hurt? Ball of foot pain at a glance
The ball of the foot is the padded area on the sole just behind your toes. Underneath it are the ends of the five long bones of the foot, the metatarsal heads, which take a lot of your weight each time you push off. Pinpointing where it hurts is the best first clue to the cause.
| Where it hurts | What it often feels like | Likely cause |
|---|---|---|
| Under the second, third or fourth toe bones | An aching, bruised feeling, like walking on a pebble, worse barefoot or on hard floors | Metatarsalgia |
| Between two toes, most often the third and fourth | Burning, tingling or shooting pain into the toes, sometimes numb toes; eases when you take your shoe off | Morton’s neuroma |
| Under the second toe joint | Pain and swelling, like a bunched-up sock; the toe may drift toward the big toe or lift up | Capsulitis or a plantar plate tear |
| Under the big toe joint | Pain when pushing off, rising on your toes or wearing heels | Sesamoiditis or a sesamoid fracture |
| One spot along a long foot bone, often with swelling on top | Pain that builds with activity and eases with rest; one spot hurts to press | Stress fracture |
| Big toe joint itself | Stiff with a bump on top, or sudden red, hot and swollen | Arthritis (hallux rigidus) or gout |
| Both feet | Burning, pins and needles or numbness, often worse at night | Nerve damage (neuropathy) |
This is a guide, not a diagnosis. More than one problem can hurt in the same place. Our guides to sharp pain in the foot and nerve pain in the feet cover other causes.
Metatarsalgia
Metatarsalgia simply means pain in the metatarsal area. It isn’t one disease but a pattern: the tissues under one or more metatarsal heads get sore and inflamed from carrying too much pressure, again and again.
Common symptoms:
- an aching, burning or bruised feeling under the ball of the foot
- a feeling of walking on a pebble or a fold in your sock
- pain that’s worse when standing, walking or running, and when barefoot on hard floors
- pain that eases with rest
Common causes:
- Shoes: high heels shift your weight forward onto the ball of the foot. Thin, flexible soles and worn-out cushioning give it no protection.
- High-impact activity: running and jumping, especially after a sudden increase in distance or on hard surfaces.
- Foot shape: high arches, a second metatarsal that’s longer than the first, bunions and hammertoes all concentrate pressure on part of the forefoot.
- Tight calf muscles, which make the heel lift early and push more weight forward.
- Thinning of the fat pad under the ball of the foot, which happens with age. Years of high heels and conditions such as rheumatoid arthritis can speed it up.
- Extra body weight, which increases the load with every step.
Morton’s neuroma
A Morton’s neuroma is a thickening of the tissue around a nerve between two toes, most often the third and fourth. It feels like burning, tingling, shooting pain or numbness that spreads into those toes, or like standing on a marble. Tight, narrow shoes and heels make it worse, and it often eases when you take your shoe off and rub your foot.
Treatment starts with wider, lower shoes and a metatarsal pad. A podiatrist may suggest a steroid injection, and surgery is an option if other treatment fails. Our guide to Morton’s neuroma covers it in detail.
Capsulitis and plantar plate tears at the second toe
Capsulitis is inflammation of the capsule around a toe joint, most often the joint at the base of the second toe. Under that joint sits the plantar plate, a strong ligament that keeps the toe from drifting. Too much pressure over time can stretch or tear it.
Signs to look for:
- pain and swelling under the base of the second toe
- a feeling like a bunched-up sock under the toe
- the second toe starting to drift toward the big toe, lift up, or cross over, sometimes leaving a gap between the second and third toes
It’s more likely if your second metatarsal is long, you have a bunion, or you often wear heels. Early care matters, because once the toe starts drifting, it rarely straightens on its own. A podiatrist may tape the toe down, add padding, recommend a stiff-soled shoe or a boot, and treat the inflammation. Steroid injections are used cautiously here, if at all, because they can weaken the plantar plate. Surgery can repair a tear or realign the toe.
Sesamoiditis
The sesamoids are two pea-sized bones under the big toe joint, inside the tendon that bends the big toe. They act like pulleys and take a lot of force when you push off. Sesamoiditis is irritation of these bones and the tissue around them.
- Who gets it: runners, dancers, people who play court sports, people with high arches and people who wear heels.
- What it feels like: pain under the big toe joint that comes on gradually and is worse when pushing off or rising onto your toes.
- What helps: less push-off activity, a pad with a cut-out that takes pressure off the big toe joint, stiff-soled shoes, taping to limit how much the big toe bends, and ice.
Pain that starts suddenly after a landing or an impact can be a sesamoid fracture, which needs an X-ray and often weeks to months in a stiff shoe or boot.
Stress fractures of the metatarsals
A stress fracture is a small crack in a bone from repeated impact rather than one injury. In the forefoot, it most often affects the second or third metatarsal.
- Typical signs: pain that builds during activity and eases with rest, swelling on the top of the foot, and one spot along the bone that hurts to press.
- Common triggers: a sudden jump in walking, running or standing, new or worn-out shoes, and low bone density.
- Diagnosis: the crack often doesn’t show on an X-ray for the first 2 to 3 weeks, so an MRI is sometimes needed.
- Treatment: a stiff-soled shoe or walking boot and a break from impact, usually for about 6 to 8 weeks, then a gradual return.
In athletes, and in anyone who gets more than one stress fracture, it’s worth checking vitamin D and bone health, and whether you’re eating enough for your activity level. See foot fracture or sprain? for more on telling injuries apart.
A less common cause in teens and young adults, more often girls and young women, is Freiberg’s disease, where the end of a metatarsal, usually the second, softens and flattens. It causes lasting pain and swelling at the base of the toe and needs a podiatrist’s care.
How to relieve ball of foot pain at home
Most mild to moderate ball of foot pain settles within a few weeks once you take the pressure off.
- Take a break from impact. Swap running, jumping and long walks for cycling or swimming for 1 to 2 weeks.
- Change your shoes (see below). This is often the single biggest fix.
- Add a metatarsal pad, placed just behind the sore spot.
- Ice the area for 15 to 20 minutes after activity, with a cloth between the ice and your skin.
- Take an over-the-counter pain reliever such as ibuprofen (Advil, Motrin), naproxen (Aleve) or acetaminophen (Tylenol), if it’s safe for you. Check with your doctor first if you have kidney disease, stomach ulcers or take a blood thinner.
- Stretch your calves twice a day: lean into a wall with your back leg straight and heel down, hold for 30 seconds, and repeat 3 times on each side.
- Don’t go barefoot on hard floors, including at home. Wear a cushioned house shoe or sandal.
If you have diabetes, numbness or poor circulation: don’t use ice or heat on feet you can’t feel well, don’t cut or file calluses yourself, and check your feet every day. Have ball of foot pain checked promptly, because pressure spots can turn into wounds. See diabetic foot care.
Metatarsal pads: where to put them
A metatarsal pad is a small, dome-shaped pad that sits under the foot just behind the metatarsal heads, toward the heel. It lifts and spreads the bones slightly so the sore ends carry less weight.
- Place it just behind the painful spot, not on top of it.
- If it feels like a lump under the sore area, move it back a little.
- Pads that stick to an insole are easier to position than pads that stick to your foot.
- Give it a few days. It should feel supportive, not like a stone in your shoe.
Shoes for ball of foot pain
Look for:
- a thick, cushioned sole
- a stiff or rocker-shaped sole that doesn’t bend much at the ball of the foot, so the foot rolls forward instead of flexing
- a wide, deep toe box, so the toes and forefoot aren’t squeezed
- a low heel, ideally about an inch or less
- a removable insole, so you can use a pad or orthotic
Avoid: high heels, thin and flexible flats, flip-flops, and any shoe whose cushioning has worn out. Running shoes generally need replacing every 300 to 500 miles. Many of the features that help heel pain also help the forefoot; see the best shoes for plantar fasciitis.
How a podiatrist treats ball of foot pain
Finding the cause
A podiatrist will ask about your shoes, activity and symptoms, press on each joint and the spaces between the toes, check whether a toe is unstable, look at your foot shape and calf flexibility, and watch you walk. Evolve Health podiatrists have digital X-ray on site to look for stress fractures, arthritis and joint problems. An ultrasound or MRI may be needed for a neuroma, a plantar plate tear or an early stress fracture.
Treatment options
- Padding and taping, placed precisely for your problem.
- Orthotics: a store-bought insert with a metatarsal pad often helps. Custom orthotics can add pads and cut-outs exactly where you need them, and are worth considering if pain keeps returning. See do I need orthotics?
- Shoe changes, including rocker-sole shoes.
- A walking boot for a stress fracture, a sesamoid fracture or a plantar plate tear.
- Physical therapy to improve calf flexibility, foot strength and walking mechanics.
- Steroid injections, used sparingly, for a neuroma or an inflamed joint. Repeated injections can thin the fat pad and weaken the ligaments under the toe joints.
- Surgery, rarely, when other treatment hasn’t worked: removing a neuroma, repairing a plantar plate, reshaping or shortening a metatarsal, or correcting a bunion or hammertoe.
How long does ball of foot pain take to heal?
| Cause | Typical recovery with treatment |
|---|---|
| Mild metatarsalgia | A few weeks once pressure is reduced |
| Capsulitis of the second toe | Several weeks to a few months |
| Sesamoiditis | Several weeks to a few months |
| Metatarsal stress fracture | About 6 to 8 weeks of protection, then a gradual return |
| Sesamoid fracture | Often 2 to 3 months or longer |
| Morton’s neuroma | Varies. Many people manage well with shoe changes and padding; some need an injection or surgery. |
When to see a podiatrist
Get seen the same day if:
- you can’t put weight on your foot
- your foot is very swollen or bruised after a fall, a twist or something landing on it
- the foot or a joint is red, hot and swollen, especially with a fever
- you have diabetes and notice a sore, blister, open skin or color change
Go to the emergency room if your foot or toes suddenly turn cold, pale or blue.
Book a visit if:
- the pain lasts more than 2 to 3 weeks despite better shoes and rest
- it keeps coming back
- you have burning, tingling or numbness in your toes
- a toe is starting to drift, lift or cross over
- there’s swelling on the top of your foot, or one spot on a bone hurts to press
- you have painful calluses under the ball of the foot
Preventing ball of foot pain
- Replace athletic shoes before the cushioning wears out.
- Save high heels for short periods, and choose a lower, wider heel when you can.
- Build up running or walking distance gradually, rather than jumping ahead.
- Keep your calves flexible with regular stretching.
- Use cushioned insoles or orthotics if you stand on hard floors for work.
- Deal with bunions, hammertoes and calluses early, before they change how your foot takes weight.
If ball of foot pain is changing the way you walk or keeps coming back, you can find a podiatrist near you and book online.
Questions, answered
The most common cause is metatarsalgia, pressure-related pain under the ends of the long foot bones. Other causes include Morton’s neuroma, a pinched nerve between the toes; capsulitis or a plantar plate tear at the second toe joint; sesamoiditis under the big toe; stress fractures; arthritis and gout; and nerve damage. High heels, thin or worn-out shoes, and a sudden increase in running or walking are common triggers.
Take a break from running and jumping for a week or two, and wear cushioned shoes with a thick or rocker-shaped sole, a wide toe box and a low heel. Add a metatarsal pad just behind the sore spot, ice for 15 to 20 minutes after activity, stretch your calves, and take an over-the-counter pain reliever if it’s safe for you. Avoid going barefoot on hard floors.
Mild metatarsalgia often settles within a few weeks once the pressure is reduced with better shoes, padding and less impact. It can last months, or keep coming back, if the cause, such as worn-out shoes, high heels or a foot shape problem, isn’t dealt with. See a podiatrist if it hasn’t improved after 2 to 3 weeks.
A metatarsal pad goes just behind the painful area, toward the heel, not directly under it. It lifts and spreads the long foot bones so the sore ends take less pressure. If it feels like standing on a lump under the painful spot, move it back a little. Pads stuck to an insole are easiest to position before you put them in your shoe.
Look for a well-cushioned shoe with a thick or rocker-shaped sole that doesn’t bend easily at the ball of the foot, a wide, deep toe box and a low heel. Running or walking shoes with a rocker sole often work well. Avoid high heels, thin flexible flats, flip-flops and worn-out shoes.
Yes. A stress fracture of one of the long foot bones, most often the second or third, causes pain that builds with activity, swelling on the top of the foot and one spot that hurts to press. It often follows a sudden increase in walking or running. The crack may not show on an X-ray for the first 2 to 3 weeks, so see a podiatrist if you suspect one.
Morton’s neuroma usually causes burning, tingling, shooting pain or numbness between two toes, most often the third and fourth, and it often eases when you take your shoe off and rub your foot. Metatarsalgia is more of an aching, bruised feeling under the ball of the foot that’s worse when walking on hard surfaces. You can have both, and a podiatrist can tell them apart.
Pain under the big toe joint, especially when you push off, is often sesamoiditis, irritation of two small bones under the joint. It’s common in runners, dancers and people who wear high heels. Sudden pain there after a landing or impact can be a sesamoid fracture. Arthritis in the big toe joint and gout can also cause pain in this area.
Book a visit if the pain lasts more than 2 to 3 weeks, keeps coming back, causes numbness or tingling, or a toe is starting to drift or lift. Get seen the same day if you can’t put weight on your foot, it’s very swollen or bruised after an injury, or it’s red, hot and swollen. If you have diabetes, have any sore, blister or color change checked promptly.
This guide is for general education and doesn’t replace advice from your own doctor. Everyone’s situation is different, so talk to a healthcare provider about symptoms that are new, getting worse or worrying you. If you think you may have a medical emergency, call 911. Reading this guide doesn’t make you a patient of Evolve Health.
Want a specialist to take a look?
A guide can explain, but it can’t examine you. Evolve Health providers see patients across Florida and Texas, and you can book online any time.
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