There are five metatarsal bones in the feet. They are the long bones in the feet that join with the toes. Metatarsalgia is a condition where the metatarsals have “dropped” or “fallen” (just like a “fallen arch” in the foot) causing compression and pain. The patient complains of pain on this bottom of the foot, specifically at the sole.

Metatarsal pain may be due to the number of factors. It appears that chronic stretching of the transverse ligaments may be the underlying reason. The transverse ligaments may be the underlying reason. The transverse ligaments help to form the arch that goes from the inside to the outside at the front portion of the foot. This may be the result of excessive weight, repetitive activity, hammer toes, over-pronation or over-supination. Direct trauma from jumping or landing on the toes with running or standing for long periods of time in high-heeled shoes may contribute to metatarsal pain. Shoes with too narrow a toe box will also cause compression and pain.

Treatment is aimed at removing or modifying any underlying problems such as repetitive microtrauma or inappropriate footwear. Orthotics are often successful in treating this condition. The addition of a metatarsal pad to the orthotics is used to correct the fallen or dropped metatarsals. The metatarsal pad is a dome-shaped pad designed to lift and spread the metatarsals, recreating the transverse arch. Persistent pain that does not respond to treatment should be evaluated for a potential fracture.