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MetatarsalgiaWhat is Metatarsalgia?

Metatarsalgia (literally metatarsal pain, colloquially known as stone bruise) is a general term used to refer to any painful foot condition affecting the metatarsal region of the foot. This is a common problem that can affect the joints and bones of the metatarsals. Metatarsalgia is most often localized to the first metatarsal head (the ball of the foot just behind the big toe). There are two small sesamoid bones under the first metatarsal head. The next most frequent site of metatarsal head pain is under the second metatarsal. This can be due to either too short a first metatarsal bone or to “hypermobility of the first ray” (metatarsal bone + medial cuneiform bone behind it), both of which result in excess pressure being transmitted into the second metatarsal head.


The foot frequently is injured during sports activities.

  • As in many other overuse syndromes, the condition may be the result of an alteration in normal biomechanics that has caused an abnormal weight distribution among the metatarsal heads.
  • Persistent stress can lead to chronic irritation and inflammation of the periosteum and adjacent tissues.

The following factors can contribute to excessive localized pressure over the forefoot:High level of activity

  • Prominent metatarsal heads
  • Tight toe extensors
  • Weak toe flexors
  • Hammertoe deformity
  • Hypermobile first ray
  • Tight Achilles tendon
  • Excessive pronation

Some anatomical conditions such as High Arch & Hammer Toes may predispose individuals to forefoot problems.


Physical Therapy

Initial treatment includes regular icing and application of a pressure bandage. Recommend non-weight-bearing ambulation for the first 24 hours, after which passive range of motion (ROM) and ultrasound treatments can be initiated. The use of metatarsal pads and other orthotic devices may provide relief, even in the early phases of treatment.

Rehabilitation begins on the first day of injury, with the goal of restoring normal ROM, strength, and function. Long-axis distraction and dorsal/plantar glides of the metatarsophalangeal joint are self-mobilization techniques that can be used throughout the treatment process.

Occupational Therapy

Semirigid orthoses worn in supportive shoes have been shown to be effective treatment for metatarsalgia. Supportive shoes worn alone, with or without soft orthoses, did not provide adequate pain relief.

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