Finding Relief from Metatarsalgia: A Physiotherapist’s Guide to Treating Forefoot Pain
Metatarsalgia is a common yet often misunderstood condition that causes pain in the forefoot, specifically under the metatarsal heads, the bones just behind your toes. It can feel like you’re “walking on pebbles” or like there's a burning or aching discomfort when standing, walking, or running.
Thankfully, metatarsalgia is very treatable with physiotherapy and some simple lifestyle adjustments.
What Is Metatarsalgia?
Metatarsalgia is a general term for pain and inflammation in the ball of the foot, often caused by excess pressure or impact on the metatarsal bones. It’s not a diagnosis in itself, but rather a symptom of an underlying issue.
What Causes Metatarsalgia?
Common contributing factors include:
Poor footwear (especially high heels or shoes with thin soles)
Foot mechanics issues (e.g. flat feet, high arches, overpronation)
Excessive impact activities (running, jumping)
Tight calves or Achilles tendons
Toe deformities like bunions or hammertoes
Being overweight or carrying excess load
Weak intrinsic foot and ankle muscles
Symptoms of Metatarsalgia
Sharp, aching, or burning pain under the ball of the foot
Pain that worsens with activity and improves with rest
Tingling or numbness in the toes
A feeling like there’s a small stone in your shoe
Swelling or inflammation in the forefoot
How Physiotherapy Can Help
Physiotherapy targets the root cause of the pressure on your forefoot, helping reduce pain and improve long-term foot mechanics.
1. Load Management & Footwear Advice
We’ll help you adjust your activity levels and recommend proper footwear:
Supportive shoes with cushioned soles and wide toe boxes
Avoiding high heels or flat, unsupportive shoes
Temporary metatarsal pads or orthotic inserts to offload pressure
2. Manual Therapy & Pain Relief
Physios use techniques to reduce discomfort and improve mobility:
Soft tissue massage for tight plantar fascia or calves
Joint mobilisations of the foot and ankle
Ice therapy or taping for inflammation
3. Strengthening & Mobility Exercises
Strengthening the foot and improving biomechanics is key for long-term relief.
Toe flexor and foot intrinsic muscle exercises (e.g. towel scrunches, marble pickups)
Calf and Achilles stretches to reduce downward pressure
Balance and proprioception training
Glute and core strengthening to improve lower limb alignment
4. Gait & Running Analysis
If you’re active or a runner, we’ll assess your gait and suggest technique changes to reduce forefoot loading. This may include:
Stride modifications
Hip/knee alignment corrections
Gradual return-to-running plans
When to See a Physio
If your foot pain is lasting more than a couple of weeks or keeps coming back when you increase your activity, don’t ignore it. Physiotherapy can help prevent further complications like Morton’s neuroma or chronic biomechanical issues.
Final Word from the Physio
Metatarsalgia can make walking and staying active a real challenge, but it’s highly treatable with the right care. Our goal is not just to reduce your pain, but to restore your confidence on your feet.
Lesley Lowe leads the Sports Physio Clinic. She has worked with multiple sports clubs over the years including rugby, football, hurling and hockey clubs and she has worked at the Dublin city Marathon.
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