It is a painful condition affecting ball of foot. Ball of the foot anatomically represents head of the metatarsals. Metatarsals are the long bone of foot which form the major part of foot arch and transfer body weight from hind foot to fore foot and then to ground. It is a symptomatic presentation of different disease condition affecting fore foot rather than a specific disease.

Various factors like activity, foot anatomy and disease condition can cause metatarsalgia.

• Activity: Athletes who participate in high impact sports like, long distance runner, after intense training
• Foot wear: Tight shoe, high heel shoe, old shoe which have lost its contour and padding
• Old age: Planter fat pad degeneration with aging can cause loss of cushioning effect at metatarsal head
• Deformity: Hallux valgus, hammer toe, claw toe, high arch foot, tight gastrocnemius, tight extensor tendons.
• Anatomical variation: Short 1^st metatarsal, long 2^nd metatarsal causing abnormal weight transfer through lesser metatarsal heads.
• Injury: Stress fracture of metatarsal, planter plate injury,
• Degenerative condition: Osteoarthritis, capsulitis, AVN of metatarsal head, sesamoiditis.
• Inflammatory systemic disease like Rheumatoid arthritis

Usually it presents with sharp aching or burning pain at ball of the foot which worsens when stand, walk or run for long and improves after rest. One can also feel numbness and tingling of toes or having pebbles inside shoe.

If you feel difficulty in wearing shoe for long or unable to walk, stand or run due to pain at ball of toes you should visit a specialist foot & ankle surgeon.

concluding the cause of metatarsalgia is one of the difficult situations in foot & ankle. It requires an extensive evaluation of patient symptoms, clinical examination to gradually rule out systemic inflammatory condition, obvious foot deformity, provoking activity, faulty foot wear and gait anomalies. After initial evaluation the required basic radiological imaging is weight bearing x-ray of foot both in A/P and lateral plane to evaluate anatomical anomalies, deformity and other conditions of metatarsophalangeal area. Foot pressure analysis and MRI plays addition role in determine abnormal weight distribution, joint and soft tissue inflammation and other neurological condition of the pain.

Initial treatment is conservative and can start at home with cold pack, rest, changing foot wear. Off-loading the ball of foot with metatarsal bar, custom made insoles plays a great role in symptomatic relief. Surgical treatment is required when there is underlying predisposing factors like, hallux valgus, hammer toe, claw toe, AVN of metatarsal head or tight gastrocnemius muscle. Surgical correction of toe deformity, length adjustment of metatarsals, release of tight extensor and gastrocnemius tendon are the common procedures.