Merck Manual

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Metatarsal Joint Pain


James C. Connors

, DPM, Kent State University College of Podiatric Medicine

Reviewed/Revised Dec 2023

Pain in the joints of the ball of the foot (metatarsophalangeal joints) may originate within the joints themselves.

  • Symptoms include pain and swelling.

  • The diagnosis is based on symptoms and an examination of the foot.

  • Orthoses and special shoes can help relieve pain.

Causes of Metatarsal Joint Pain

Metatarsal joint pain commonly results from misalignment of the joint surfaces, which puts pressure on the joint lining and destroys cartilage in the joints.

Metatarsophalangeal joint misalignment can be caused by disorders, such as rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more Rheumatoid Arthritis (RA) , that inflame the joints. In rheumatoid arthritis, hammer toes Hammer Toe Hammer toe is a toe that is bent in a fixed Z-shaped position. Pain may be felt when people wear certain shoes, and some people have pain in the ball of the foot. Diagnosis is based on an examination... read more Hammer Toe can develop, which can worsen joint pain and misalignment. Fat tissue, which helps cushion the joints when bearing weight, can be pushed forward under the toes, resulting in a loss of cushioning in the ball of the foot. This loss of cushioning normally occurs as many people age but makes people more susceptible to pain when the ball of the foot is stressed or injured repeatedly (for example, by running or by walking excessively). This loss of cushioning may lead to damage to the nerves of the foot Damage to Nerves in the Foot Irritation of interdigital nerves (in the balls of the feet) may cause enlargement of those nerves, causing pain in the balls of the feet. Typical symptoms include a mild ache around the third... read more and to the development of calluses Corns and Calluses Corns are hard cone-shaped bumps of skin commonly found on the top surface of the smaller toes, particularly over a joint. Calluses are broader, flat thickenings of the skin usually located... read more Corns and Calluses and small bursae (fluid-filled sacs).

Metatarsophalangeal joint pain can also result from osteoarthritis Osteoarthritis (OA) Osteoarthritis is a chronic disorder that causes damage to the cartilage and surrounding tissues and is characterized by pain, stiffness, and loss of function. Arthritis due to damage of joint... read more Osteoarthritis (OA) or stiffening of the joints of the ball of the foot, often at the big toe joint. Most people with these disorders have an abnormal motion of the foot when bearing weight and walking.

Symptoms of Metatarsal Joint Pain

Walking is painful for people with metatarsal joint pain. The skin over the joint may feel mildly warm to the touch, and swelling may be present. Over time, pain and stiffening can be disabling.

Diagnosis of Metatarsal Joint Pain

  • A doctor's examination of the foot

Doctors usually can diagnose metatarsal joint pain based on the person’s symptoms and an examination, but testing is done if an infection or arthritis is suspected.

Treatment of Metatarsal Joint Pain

  • Orthoses

  • If present, treatment of underlying condition

Orthoses (devices placed in the shoe) usually provide effective treatment for metatarsal joint pain. Shoes that have thicker soles than normal and rounded heels (called rocker sole modifications) also help reduce pressure and abnormal motion.

Occasionally, when these measures are ineffective, surgery is needed.

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