Metatarsalgia is the name for pain in the metatarsal area: the part of the sole just behind the toes, which carries almost all the weight at the moment the foot pushes off the ground. It is described as walking on a stone or feeling the bone against the floor, and it increases when walking barefoot, in thin-soled shoes or in heels.
It is nearly always a load-distribution problem: if one metatarsal head takes more pressure than its neighbours, that area becomes irritated and painful, and over time hard skin appears as a marker of where the excess is. Behind it there may be a toe that has lost its contact with the ground, a wide forefoot, loss of the fat pad in the sole —very common with age—, narrow or high-heeled footwear, or activity that has increased suddenly.
How it is approached
- Locating the painful area and the hard skin that accompanies it.
- Assessment of how pressure is distributed across the forefoot.
- Examination of the toes and of joint mobility.
- Review of footwear: width, sole and heel height.
- Offloading of the area and, where appropriate, insoles to redistribute load.
Does it feel like you are walking on a stone in the front of your sole?
Book an appointmentFrequently asked questions
- Why does it hurt more barefoot at home?
- Because in that area the natural cushion under the metatarsal heads is the only thing between the bone and the floor, and barefoot — or in a very thin sole — there is nothing else helping. A hard floor does not give: all the pressure of push-off arrives at one small point. That is why many people report being better outdoors in shoes and worse at home, which is the opposite of what you would expect. In practice that observation is useful: it says the problem is one of pressure distribution and not something else. And a simple piece of advice follows: at home, footwear with some sole rather than barefoot or a flat slipper.
- I have a callus exactly where it hurts. Is the callus the problem?
- Almost always it is the other way round: the callus is the consequence, not the cause. Skin thickens where it takes more pressure than it should, so its role is to mark the spot — it is a map of where the excess is — and that is why it comes back to the same place. Removing it relieves a fair amount and immediately, because a hard plate over an irritated area adds pressure of its own, but if nothing changes it re-forms within weeks. Hence the appointment does not end with the callus removed: it ends by looking at why that area is loading more than it should, which is the only thing that stops it returning.
