Forefoot Pain: Prevention and Treatment for Metatarsalgia

Forefoot pain can be caused by many different disorders. The most common condition is metatarsalgia, a painful disorder associated with the metatarsal (ball of foot) region of the foot. Metatarsalgia affects the bones and joints at the ball of the foot, and symptoms are generally located under the 2nd, 3rd and 4th metatarsal heads, which are the knobby tips of your metatarsal bones, located just under the fat pad. Often times, metatarsalgia is also thought of as a symptom of other ailments, such as hallux rigidus, bunions, hammertoes, Morton’s neuroma, diabetes, and Achilles tendonitis.

Excessive pressure over a long period of time causes the affected areas of the foot to become inflamed and painful. Most often, the pain comes on over several months, rather than all at once. The pain is usually recurrent or chronic and is quite acute. The root cause is often improper fitting shoes, such as those with pointed toes, high heels, and other restrictive-type footwear. Those who participate in high-impact sports are also likely to be affected.

Footcare specialists recommend wearing shoes with ample room around the toes so that the toes are not forced into a cramped environment. Poorly fitted footwear can (and often does) inhibit walking and running and can lead to severe foot discomfort.

Forefoot Pain Prevention, Causes, and Treatment

Typically, forefoot pain is a direct result of persistent and excessive pressure and stress resulting from sports activities, abnormal weight distribution, and an alteration of the normal foot

metatarsal pad

biomechanics that can create inflammation and irritation of the skin, ligaments, and tendons of the forefoot region of the foot. Additionally, the fat pads that provide cushion and shock absorption for the foot tend to thin out with age, making the ball of the foot more vulnerable to shock, damage, and pain.

The following factors often contribute to excessive localized pressure over the forefoot:

• High level of activity
• Tight-fitting shoes or high heels
• Over-pronation
• High-arched feet
• Tight Achilles tendon
• Weak toe muscles (flexors)
• Tight toe muscles (extensors)
• Being overweight
• Protruding metatarsal heads
• Hammertoes
• Morton’s Toe

In the early stages of metatarsalgia, it is important to restrict usage of the foot and to use ice to help decrease foot swelling and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are also useful; however, these suggestions rarely provide a long-term solution. A podiatrist may recommend trying range of motion (ROM) exercises, but it is important to not disrupt the recovery process by over-using the foot while it heals. Stretching and strengthening exercises should be done carefully, and returning to high-level activities should be done gradually and with caution to prevent re-injury.

Changing to footwear that allows for more free movement in the toe area will help to relieve undue stress on the forefoot, and adding a good quality pair of replacement insoles designed to relieve ball of foot pain, usually through a biomechanical support with metatarsal pad, will not only help relieve pain from the affected area but will also serve to prevent other forefoot disorders from occurring.

Orthotic arch support insoles constructed with a pad placed behind the ball-of-foot will relieve pressure and help properly distribute weight across the foot. For example, the Powerstep Pinnacle Plus Orthotic Insoles provide a deep heel cup for support, a cushioned top-coat material, semi-rigid orthotic arch support, and a metatarsal pad to relieve pain and reduce pressure on the metatarsal heads. The Pinnacle Plus is the most versatile orthotic on the market that features a built-in metatarsal pad; however, there are many styles of shoe insoles (in both cushioned and semi-rigid metatarsal padding variations) for forefoot pain relief, such as insert pads, ¾-length shoe inserts, and full-length replacement insoles:

Insoles for Forefoot Pain

Cushioned Full-Length Insoles – Insoles designed with a footbed which focuses on cushioning the entire length of the foot to relieve fatigue and achiness.

• New Balance Pressure Relief with Met Pad Insoles (3030) – This full-length cushioned insole offers one of the most cushioning metatarsal support on the market.  This is a thick insole (1/2 inch thick at the heel and 1/4 inch thick at the toes), so roomier shoes are needed to accommodate the insoles. The IPR3030 insoles also come in a wide size, and the memory foam used in the construction of the insole is suitable for those with diabetes, arthritis, and those with sensitive feet.
Sof Sole Airr Performance Insoles – These insoles are popular for athletics, especially in sports where the forefoot is subjected to strain and impact, such as tennis or volleyball. The insoles feature a built-in gel metatarsal pad to assist with shock absorption at the ball-of-foot.
Pedag Siesta Leather Insoles – A very thin insole featuring arch and metatarsal support, making them ideal for thinner athletic, casual, and dress shoes.

Insoles offering Rigid Raised Metatarsal Support – Insoles designed with a solid, raised support beneath the ball-of-foot to alleviate metatarsal pain.

Birkenstock BirkoBalance Leather Insoles – A ¾-length leather shoe insert in a Birkenstock ‘classic feel’ that offers solid support by raising the metatarsal region of the foot. Also available in wide width.
Pedag Relax ¾-length Insoles – An ultra-thin insole ideal for tight shoes, offering cushioned support with semi-rigid metatarsal support.
Powerstep Flexiarch ¾-length Orthotic Arch Supports – A ¾-length shoe insert offering a rigid orthotic support and metatarsal arch support.

Thin 3/4 Length Cushioned Shoe Inserts – Insoles designed with a footbed which focuses on cushioning the front ¾ length of the foot to relieve fatigue and achiness.

Pedag Comfort Insoles – Supports the metatarsal bones while keeping them in the anatomically correct position.  A thin leather insert designed for tighter-fitting shoes.
Pedag De Luxe Metatarsal Insoles – A thin, leather ¾-length insole with a sturdy support for the longitudinal arch and the latitudinal arch. Alleviates pain caused by a flattened metatarsal arch.
Pedag Lady Insoles – A thin, narrow insole specifically designed for women’s  pumps, high heels, slippers, and open-toed footwear.

Orthotic Arch Supports with Metatarsal Cushioning – Insoles designed with an additional cushioned padding to support the foot’s metatarsals.

New Balance Ultra Arch Support Insoles 3810 (formerly the New Balance Supportive Cushioning Insoles) – A semi-rigid orthotic ideal for neutral to high arched feet. Features a large, padded metatarsal support that stretches from the arch to the forefoot.
Pedag Viva Insoles – Ideal for low to neutral arches, this is a semi-rigid, thin orthotic ideal for tighter-fitting shoes. Comes in 6 versions for everyday life, sports, winter, and summer. Also available in a high-arched version.
Powerstep Pinnacle Plus Orthotic Insoles – A semi-rigid orthotic with a padded metatarsal pad. Ideal for neutral to high arched feet.
Spenco Total Support Original Insoles – A semi-rigid orthotic ideal for everyday activity and athletics.Also available in a rigid orthotic version(Spenco Total Support Original Insoles) as well as a thinner, more flexible semi-rigid style (Spenco Total Support Thin Insoles).

If you’re just looking for a Ball of Foot Cushioning Pad insert versus a full shoe insole, consider one of the following metatarsal pads:

Pedag T-Form Metatarsal Pad – Suitable for athletic, casual, and dress shoes, as well as high heels, sandals, and slippers. Leather pads provide added support to minimize ball-of-foot pain while also taking pressure off of the foot’s metatarsal pads.
Powerstep IPK Ball of Foot Cushions – Pads designed to be placed under the ball-of-foot to alleviate pressure from second or third ray dropped metatarsal heads and deep calluses. A hollow pressure relief area allows the IPK to remain suspended, eliminating pressure and pain incurred through normal walking.
Spenco RX Ball of Foot CushionsThese cushions provide support and comfort for the metatarsal arch. The SpenCore material is ¼-inch thick and provides superior cushioning and energy-return for great cushioning performance in any type of footwear.

Wearing quality insoles, arch supports, or inserts in addition to with correctly-fitting shoes will offer significant relief from forefoot pain. For additional, detailed information about Birkenstock, New Balance, Pedag, Powerstep, Sof Sole, and Spenco footcare products, and to view all our metatarsal inserts, please visit TheInsoleStore.com. For additional help, consider viewing our Footcare Glossary of Medical Conditions.