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Foot Bone or Joint Injury

Causes of Pain in the Ball of Foot

Minute Read


Posted 2 years ago


Last updated: 06/09/2023


by James McCormack

Pain in the ball of the foot can be caused by numerous conditions such as Metatarsalgia, Fractures, Bunions, Morton’s Neuroma, Sesamoiditis and Fat Pad Atrophy.

Several factors can lead to pain in the ball of the foot, such as poorly fitted shoes, foot abnormalities, overload through repetitive activities such as running, or rheumatological conditions. This article will discuss the most common causes of ball of foot pain based on our clinical experience as foot specialists.

Pain in the ball of foot:


The metatarsals are the long bones in the ball of your foot. They play a crucial role in propulsion and balance when standing or walking but if they become overloaded, it can result in inflammation and pain which is known as Metatarsalgia.

Metatarsal pain can result from poorly fitted shoes, foot deformities or issues with gait.

Walking or putting pressure on the ball of your foot can be painful, while pain usually eases with rest. Gait analysis by a physical therapist is typically recommended to address biomechanical causes.

Cushioned shoes can provide pain relief alongside ice massage. Custom insoles and exercises can be part of the solution, while in irritable conditions, you may require a steroid injection.

Mortons Neuroma

Mortons Neuroma is a common cause of pain in the ball of the foot. Between each toe in the foot, there is web space, and within this web space, there are the common digital plantar nerves.

These nerves provide sensation to the surrounding areas of the forefoot. Shoes that are too tight, foot deformities, or poor biomechanics can overload and irritate these nerves, making them inflamed. Neuromas occur most often in the web space between the 2/3/4 toes; the nerve becomes inflamed to a pea or ball shape.

Patients often describe the sensation of a pebble in their shoe alongside a burning sensation in the ball of their foot. On examination by a Physical Therapist, one might expect to find a click upon squeezing the metatarsal heads together.

Treatment includes physical therapy, exercises, custom orthotics, and footwear changes. Steroid injections can work well to reduce inflammation within the nerve, while extremely irritable neuroma may need to be excised through surgery.

Metatarsal Fracture

Repetitive overload of the forefoot can irritate the long bones of your forefoot. If this continues, it can lead to a metatarsal stress fracture. The most common metatarsal fracture is the 5th metatarsal stress fracture.

Other causes of metatarsal fractures are trips or objects falling on the forefoot. Running is a common cause, but fractures can occur spontaneously in those with low vitamin D levels.

Symptoms are commonly sharp when weight-bearing and made worse by impact activities such as running or hopping. There may be some swelling or bruising in acute cases.

An x-ray is required to confirm the diagnosis. Further examination may require an MRI or CT Scan.

Treatment for a fractured metatarsal usually requires a patient to spend 4-6 weeks in a walker boot followed by 4-6 weeks of Physical Therapy.


Pain in the ball of your foot towards the inside of your foot may result from a bunion. Your big toe is a sizeable weight-bearing bone primarily designed for propulsion. Your biomechanics can cause deviation of the big toe joint; this is typically a prolonged process over time, or some people are born with a stiff big toe (Hallux Rigidus).

The development of a bunion or hallux rigidus may mean that you cannot move the big toe fully, and as a result, it is common to place excess pressure on toes 2-5. This can cause forefoot pain and conditions like Metatarsalgia or Morton’s Neuroma.

Assessment from a medical professional is advised. Exercises, custom insoles, improvements in footwear, and gait analysis can help reduce pain levels and address biomechanical issues. Bunion correctors are not advised as there is little evidence for their use.

In severe cases, a consultant may suggest a bunionectomy if the symptoms are relieved from conservative management.


Under the ball of your big toe, there are two small, floating bones called sesamoids.

These sesamoid bones sit within the tendon of the big toe, and repetitive overload can cause inflammation and pain, resulting in sesamoiditis. This can be a severe and debilitating condition as it can be painful to stand or walk.

Treatment for this condition should include a biomechanical assessment, alongside strengthening exercises to correct any muscular imbalances that may have caused the condition.

Offloading with corrective insoles and improved footwear can make a significant difference.

In irritable cases, patients may require a steroid injection to reduce inflammation levels, while surgical removal of the sesamoids is a rare treatment option.

Fat Pad Atrophy

Under the ball of the floor and the heel of the foot, there is a fat pad which cushions the ball of the foot and reduces the force that goes through the bones in these areas.

Age-related change can cause this fat pad to thin over time (Fat Pad Atrophy), exposing the bones to greater impact, while rheumatoid arthritis and a history of steroid injections can make you more susceptible to this condition.

Symptoms include pain when walking, especially when barefoot. Running, jumping and walking on uneven floors can also irritate the symptoms of fat pad syndrome.

Treatment is unfortunately limited to cushioned insoles and supportive trainers while trying to avoid uneven terrain. Some surgeries can involve fatty tissue grafts, but their success rates are low.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments weekly.

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