There are several common conditions that cause pain in the ball of the foot. The links below will help find specific and general treatment options for your ball of foot pain.

We are very successful at treating ball of foot pain conservatively. We can usually avoid surgery with conservative therapy;however, when necessary we have the expertise to surgically treat your condition . If you are experiencing ball of foot pain, call today for an appointment to see us in our Seattle office. Bring one or two pairs of your favorite shoes with you, but don’t buy new shoes prior to your visit.

Video: Best Orthotics for Ball of Foot Pain

Metatarsalgia is a general term for a painful foot condition in the metatarsal area of the foot (just before the toes), commonly referred to as the ball of the foot. This common disorder can affect bones and joints at the ball of the foot and cause pain. Capsulitis is the Most Common Type of Metatarsalgia The most common type of metatarsalgis is a condition called “capsulitis of the metatarsophalangeal joint (joint connecting toes to the forefoot)”. Joints consist of a capsule layer which surround the joint and hold in the joint fluid and ligaments which blend with the capsule and hold the bones in proper position. Inflammation of the joint structures is called capsulitis. Capsulitis of the ball of the foot is one of the top complaints we treat and usually responds to proper conservative treatment. Treatment is focused on decreasing pressure off the painful area allowing it to heal. Custom or prefabricated orthotics, and specific socks or shoes may help relieve the pressure.

Symptoms of Metatarsalgia / Capsulitis

Metatarsalgia is caused by too much pressure on a small area of the foot and in most cases due to biomechanical problems of the forefoot. You may have this condition if you are experiencing some or all of these symptoms:

  • Pain in the area of the ball of the forefoot
  • Pain that’s a dull ache and feels like a bruise
  • Pain is worse when walking barefoot, especially on hard surfaces (concrete, ceramic tile, etc.)
  • Pain that forces you to walk on the outside of the foot to avoid stepping on the ball of the foot
  • Pain is lessened when wearing good running shoes, especially with forefoot cushioning
  • Callus in the area of increased pressure and pain (in some cases)

Causes and Treatment of Metatarsalgia

Because most metatarsalgia is caused by excess pressure on the ball of the foot, we must find the cause of the pressure to properly treat this condition. Several conditions cause this increased pressure. These include:

Capsulitis of the ball of the foot usually comes on gradually but can be sudden in case of trauma (landing hard on the ball of the foot or stepping hard on an obstruction) or wearing non-cushioned shoes.

Custom Orthotics for Metatarsalgia Caused by Capsulitis

Orthotics for metatarsalgia are prescribed to take weight off the painful area of the foot. We will prescribe an orthotic that closely hugs the arch of your foot to transfer force off the metatarsal heads and onto the arch. These are called Total Contact Foot Orthotics – and function much better than prefabricated, over-the-counter orthotics at reducing pressure under the ball of the foot.


Figure 1: Pain under the ball-of-the-foot.

The pressure scans below show the effect of a total contact orthotic on forefoot pressure: Because many studies show that modifications such as metatarsal pads and cushioning can further reduce pressure under the painful area of the foot, depending on your exact condition, we will likely incorporate several modifications into your orthotics.

Prefabricated Orthotics for Metatarsalgia

Although not as effective at decreasing pressure, some patients may achieve pain relief with high-quality over-the-counter arch supports. We recommend the following over-the-counter inserts most commonly for metatarsalgia:

  • without orthotic

    Figure 2: Without orthotic: Red areas show extreme pressure.

    For atheletic shoes we recommend the ProLab P3 full length orthotic for athletic shoes. With one of the highest arches of any OTC arch support, it does an exceptional job of transferring pressure off of the ball of the foot. It also has cushioning for the metatarsal heads.

  • with orthotic

    Figure 3: With orthotic: Forefoot pressure reduced dramatically.

    For womens’ dress shoes we recommend the Powerstep SlenderFit.It’s the only effective OTC arch support we have found to fit in women’s heels and flats.

In addition, proper socks and shoes can provide pain-relieving cushioning. We will work with you to ensure you get the relief you need for your painful foot condition.

Treating Metatarsalgia Inflammation

Once we have reduced the pressure on the ball of the foot with custom or prefabricated orthotics, we will work with you to decrease the inflammation that is often associated with this condition. We may recommend or more of the following treatments:

  • Ice
  • Medication
  • Rest
  • Physical therapy
  • Injection

Other Ball of Foot Pain Conditions

While capsulitis is the most common type of ball of foot pain, the following conditions also cause ball of foot pain:

  • Neuroma Neuromas usually cause pain in the forefoot, especially in the area of the 3rd and 4th toes. The pain may be shooting, burning, stabbing, radiating or just an “odd” feeling in the area. Many patients experience relief of symptoms after they remove their shoe and massage the area. A complete guide to neuroma treatment can be found here.
  • Sesamoiditis The sesamoids are small bones under the first metatarsal head and are prone to overuse and inflammation. This condition is called sesamoiditis and treatment is focused on removing force from the area and reducing inflammation. Our Sesamoiditis treatment guide can be found here.
  • Callus A callus is a thickening of skin, often found under the ball of the foot.  It can cause significant pain – much like having a rock in your shoe.
  • Plantar plate tear
    • This is a tear in the ligaments of the one of the joints of the ball of the foot. It often causes chronic ball of foot pain. You may need an MRI arthrogram to diagnose the condition.

Home Treatment of Ball of Foot Pain

Most of the time you can treat pain under the ball of the foot with simple self-treatments. We have complete guide to self-treatment of ball of foot pain here. Try these treatments for a couple weeks. If you don’t see improvement, contact us for an appointment. You don’t have to live with ball-of-foot pain. For the most effective and long-lasting treatment, make an appointment to see us in our Seattle office. CLICK HERE FOR SELF TREATMENT HINTS Medical Literature on Metatarsalgia and Orthotics 1 Stanton P., “Metatarsalgia: Diagnosis and Treatment,” Journal of Bone & Joint Surgery, 62 (1980): 722-732. 2 Woodburn J, Nelson K, et al, “Multisegment foot motion during gait: proof of concept in Rheumatoid Arthritis,” Journal of Rheumatology 31 (2004): 1918-27. 3 Postema K, Burm P, et al, “Primary metatarsalgia: The influence of a custom moulded insole and a rockerbar on plantar pressure,” Prosthet Orthot Int 22 (1998): 35-44. 4 Hodge MC, Bach TM, Carter GM, “Orthotic Management of Plantar Pressure and Pain in Rheumatoid Arthritis,” Clinical Biomechanics 14 (1999): 567-75. 5 Chalmers AC, Busby C, et al,”Metatarsalgia and rheumatoid arthritis-a randomized, single blind, sequential trial comparing two types of foot orthoses and supportive shoes,” J Rheumatology 27 (2000): 1643-7. 6 Magalhaes EP, Davitt M, et al, “The effect of foot orthoses in rheumatoid arthritis,” Rheumatology 45 (2006): 449-453. 7 Holmes G, Timmerman L., “A Quantitative Assessment of the Effect of Metatarsal Pads on Plantar Pressures,” Foot & Ankle 11 (1990): 141-45 8 Chang A, Abu-Faraj Z, et al, “Multistep measurement of plantar pressure alterations using metatarsal pads,” Foot Ankle Int. 15 (1994): 654-60. 9 Hsi WL, Kang JH, Lee XX, “Optimum Position of Metatarsal Pad in Metatarsalgia for Pressure Relief,” Am J Phys Med Rehab 84 (2005): 514-20. 10 Kang JH, Chen MD, et al, “Correlations between subjective treatment responses and plantar pressure parameters of metatarsal pad treatment in metatarsalgia patients: a prospective study,” BMC Musc Disor 7 (2006): 95.