Pain in the ball of your foot, the area between your arch and the toes, is called metatarsalgia (MET-ah-tar-SAL-gee-ah). The pain usually centers on one or more of the five bones (metatarsals) in this area under the toes.
Calluses: If one of your metatarsal bones is long, the bone may take on extra weight. This extra pressure on the metatarsal bone can cause a callus, or buildup of skin, to form. The combination of the extra weight on the bone and the callus can cause pain; however, a callus does not need to be present for the patient to have pain.
Bunions: Metatarsalgia often is associated with a bunion deformity of the big toe. In this case, the big toe metatarsal bone cannot support the weight it needs to, and the weight shifts to the smaller metatarsal bones.
Hammertoes: A hammertoe is an imbalance of the tendons that support the toes. Hammertoes can push the metatarsal bone into the ground, which increases the pressure on the bone and may cause metatarsalgia pain.
Another cause can be shoes that don’t fit properly. Tight shoes squeeze the foot and increase pressure, while loose shoes let the foot slide and rub, which creates friction. Torn ligaments or inflammation also can cause metatarsalgia. Pain on the underside of the foot may indicate a torn ligament or inflammation of the joint. Your foot and ankle orthopedic surgeon can do some simple tests to assess joint stability.
Most of the time, practical measures can help ease foot pain. Your doctor may recommend that you use a shoe insert (arch support) as a kind of shock absorber, or that you wear a different kind of shoe. Routinely, a pad is added to the orthotic to shift the weight off the painful metatarsal bones. Sometimes, simply buying shoes that fit properly can solve the problem. Shoes should have a wide toe box that doesn’t cramp your toes. Heels should never be higher than 2 1/4″ high.
Soaking your feet to soften calluses and then removing some of the dead skin with a pumice stone or callus file will relieve pressure. Note, however, that diabetics should not do this themselves. Calluses should be taken care of by your physician or someone your physician recommends for treating diabetic feet. This is a short-term solution that temporarily removes the callus but does not fix the problem.
Occasionally, surgery may be necessary to remove a bony prominence or correct a deformity.