Metatarsalgia (pain in the ball of the foot): causes, treatment and when to see a GP

The NHS says you might be able to treat pain in the ball of the foot yourself, and nidirect says the condition will often improve with simple self-help measures. The measures below come from the two pages. The NHS also says not to try to diagnose the cause of the pain yourself, which is a reason to see a GP or pharmacist rather than keep guessing.

• Rest and raise your foot when you can, and avoid the activity that makes the pain worse. nidirect suggests low-impact activity such as cycling or swimming instead of running or jumping.

• Put an ice pack (or a bag of frozen peas in a towel) on the painful area for up to 20 minutes every 2 to 3 hours, wrapped so it does not damage the skin.

• Wear shoes with plenty of room for your feet, a low heel and a soft, well-cushioned sole, and replace worn-out shoes.

• Use soft insoles or pads in your shoes. nidirect says shock-absorbing pads or insoles are available from pharmacies and sports shops.

• Try to lose weight if you are overweight, as it reduces the pressure on the feet.

• Try regular, gentle foot and ankle stretching exercises.

• Use painkillers such as paracetamol, or ibuprofen gel (or ibuprofen tablets if needed) for pain and swelling.

The NHS says not to do any sports or other activity that you think is causing the pain, not to walk or stand for long periods, and not to wear high heels or tight, pointy shoes. The NHS Morton's neuroma page adds avoiding shoes with thin soles and reducing impact activities such as running and jumping. A pharmacist can advise on the best painkiller to take and on insoles and pads for your shoes.

nidirect says metatarsalgia tends to develop gradually over time, may be felt in a small area or across the whole width of the foot, and can affect one or both feet. The pain is sometimes described as burning or aching, shooting, tingling or numbness in the toes, or like a small stone under the foot. It tends to be worse when you are standing, walking or running.

Because several different problems cause pain in the same area, the NHS gives a quick guide to what the pattern of symptoms might suggest. It also says not to try to diagnose the cause of pain yourself.

Metatarsalgia is a descriptive term rather than a single disease. nidirect says it is the name for pain in the ball of the foot, which involves the metatarsals. These bones support your weight when you are standing, walking and running, which nidirect gives as the reason they are a common source of pain.

In practice it means that something is putting too much pressure on the front of the foot. nidirect says it is usually the result of increased pressure on the ball of the foot. The aim of treatment is to take that pressure off and treat any underlying problem.

The NHS says pain in the ball of the foot is often caused by exercise such as running, wearing shoes that are too tight, or a condition such as arthritis. Some people also have a foot shape that puts extra pressure on the ball of the foot, and hard or cracked skin or a verruca can cause the same type of pain. nidirect gives a longer list.

• Badly fitting footwear. High-heeled or restrictive shoes can force the ball of the foot into a small space and put more pressure on it.

• High-impact sports, such as running or tennis.

• Being overweight or obese.

• An unusual bone structure in the feet, such as narrow, high-arched or flat feet.

• Joint and foot conditions, including arthritis, gout, bunions, bursitis, Morton's neuroma, hammer toes and stress fractures.

• Older age and diabetes, which nidirect says make it more common.

None of the NHS or nidirect pages gives a fixed recovery time, because it depends on the cause. What they do give is a timeline for when to expect progress. nidirect says to try the self-help measures for a few weeks to see if your symptoms improve, and the NHS says to see a GP if the pain has not improved after treating it at home for 2 weeks.

If the cause is a long-standing foot shape, footwear habit or a joint condition, the pain can come back unless that is addressed. The NHS also says to see a GP if the pain keeps coming back, which is a prompt to look for the underlying reason and not simply repeat the same measures.

The NHS says to see a GP if the pain is stopping you doing normal activities, is getting worse or keeps coming back, has not improved after 2 weeks of home treatment, comes with any tingling or loss of sensation in the foot, or if you have diabetes and foot pain, as foot problems can be more serious with diabetes. nidirect adds that sudden and very severe foot pain, or a change in the shape of your foot, could be a sign of a more serious problem that needs immediate treatment.

The NHS says to contact NHS 111 if any of the following apply, as they may be signs of a broken bone after an injury or an infection.

• You have severe pain in the ball of your foot.

• You are not able to walk.

• Your foot has changed shape.

• You heard a snap, grinding or popping noise at the time of injury.

• You feel faint, dizzy or sick from the pain.

• Your foot is hot, swollen and painful.

• You have pain in the ball of the foot and feel hot, cold or shivery.

nidirect says your GP can arrange tests to check for underlying problems, such as X-rays, scans or blood tests, and can refer you to a health professional who specialises in foot care: a podiatrist (also known as a chiropodist), a physiotherapist or a foot and ankle surgeon. These specialists may recommend custom-made insoles (orthotics), foot and ankle exercises, steroid injections or, in rare cases, surgery.

For Morton's neuroma, a common cause of pain in this area, the NHS says a foot specialist may use specially made soft pads or insoles to take pressure off the painful area, and steroid or alcohol injections or foot surgery are for very severe symptoms or when other treatments are not working.

On the NHS, a GP can assess pain in the ball of the foot and refer you on. The NHS notes that in many areas you can self-refer to community musculoskeletal (MSK) services for help such as physiotherapy without a GP referral, and a pharmacist can advise on painkillers, insoles and pads. For Morton's neuroma the NHS says referral to a podiatrist on the NHS may not be available to everyone and waiting times can be long, and that you can pay to see a podiatrist privately.

If you go privately, the same assessment and treatment options apply: a check of the foot, advice on footwear and activity, insoles or orthotics, and onward referral if needed. Tell your GP what has been done so that your records are complete.