Jordi Cervera | www.jordicervera.comIf pain can be localized mainly in the front part of the foot under the forefoot, it is called metatarsalgia. The term is composed of the Greek-Latin word "metatarsus" (metatarsus) and the Greek word "algos" (pain). The metatarsus consists of the five metatarsal bones (metatarsalia). In addition to these metatarsal bones, the forefoot also includes the five toe bones.
Midfoot pain can occur due to overuse, foot malposition or injury. As a first step, you should have the cause of the pain clarified by an experienced foot specialist. Depending on what is causing the metatarsalgia, both conservative and surgical treatment methods are available.

In this article we have compiled all the important information on the subject of metatarsalgia:

Navigate to the individual points here:

Our feet carry us through our lives. They are the foundation on which we stand. However, pain in the metatarsus can greatly impair quality of life and mobility. It is therefore all the more important to pay attention to the health of our feet and to get to the bottom of the cause of the pain in good time.

Do you have pain in the metatarsus? The foot surgeon Dr. Tonio Gottlieb, MD, is your experienced foot specialist and the right person to talk to about metatarsalgia. In his practice in Berlin-Zehlendorf, he will examine you with the utmost care and discuss your individual symptoms with you in detail.

Arrange your personal consultation appointment now!

The symptoms appear mainly in the front part of the foot

When pain occurs in the front part of the foot, especially under the forefoot, it is called metatarsalgia. Classic signs of this are burning and a feeling of heat under the sole of the foot. The complaints often occur in these areas:

  • pain in the forefoot
  • Pain under the forefoot (general)
  • Pain under the forefoot when rolling
  • Pain on the sole of the foot, under the metatarsophalangeal joints of the toes
  • Pain in the big toe and under the forefoot (due to malformation of the toes, e.g. hammertoes)

Other typical symptoms can be severe calluses or plantar warts that form in the area of the midfoot. The complaints may occur in connection with incorrect footwear or manifest as electrifying pain, which indicates nerve irritation (Morton's neuroma).

What triggers can cause the pain under the forefoot?

Pain in the midfoot can have very different causes. Basically, it must be clarified whether the pain is triggered by deformations or other problems in the foot area or whether the complaints are due to general diseases.
Metatarsalgia as a consequence of deformations in the foot area
Metatarsalgia can occur as a typical result of deformities in the foot area. These can be, for example:

  • tarsal instabilities with hallux valgus (bunion):
    When the big toe is crooked (hallux valgus), the load distribution of the body weight changes, which can lead to pain in the forefoot (metatarsalgia).
  • tarsal instabilities with hallux rigidus (arthrosis):
    Arthrosis (joint wear) in the metatarsophalangeal joint of the big toe (hallux rigidus) can also be the cause of pain in the front part of the foot.
  • Nerve irritation (Morton's neuroma or Morton's neuralgia):
    Morton's neuroma is a nerve irritation between the metatarsophalangeal joints of the forefoot. It often manifests as pain in the forefoot that is perceived as electrifying.
  • Malposition of the feet due to flat or hollow foot:
    Also, if the longitudinal arch of the foot is either pathologically sunken (flat foot) or too high (high arch), this can trigger pain in the forefoot (metatarsalgia).
  • Length disproportions of the metatarsal bones:
    If a metatarsal bone that is too short bears too little load, the other bones are overloaded. Pain in the midfoot is the result.

Other diseases can also trigger pain in the midfoot

If the discomfort in the midfoot is due to certain general diseases, these clinical pictures could apply:

  • Disturbet bloodflow
  • Polyneuropathy (damage to the nerves)
  • Rheumatoid arthritis (rheumatism)

How a foot surgeon diagnoses metatarsalgia

arthrose 1In the case of pain in the metatarsus, the foot surgeon will first examine the foot manually. For a reliable diagnosis of metatarsalgia, additional pedobarographic examination procedures are available. This is the representation of the pressure load on the foot while standing or walking. In this way, the foot surgeon can see how the foot behaves when stepping and where the reason for the pain may lie. For further clarification, an X-ray under stress and in rare cases an MRI (magnetic resonance imaging) is often useful.

 An MRI may be useful to differentiate the symptoms

In many cases, an MRI (magnetic resonance imaging) can be helpful for pain in the midfoot. Here, for example, the foot specialist can have an X-ray taken under load in a certain foot position in order to make a specific diagnosis.

For patients with metatarsalgia, the foot surgeon Dr. Tonio Gottlieb, MD, is the ideal contact in the southwest of Berlin. As a foot specialist, he offers you a precise diagnosis and attaches great importance to a cause-oriented treatment. Whether initial diagnosis or second opinion - arrange a private consultation with Dr. Gottlieb now!

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The different possibilities for the therapy of metatarsalgia

Jordi Cervera | www.jordicervera.comIn order to alleviate pain under the forefoot, various treatment options are available. These range from shoe inserts, foot exercises or injections to surgical treatment.

Acute pain relief through injections and insoles

To diagnose pain under the forefoot, it is first necessary to clarify where the pain comes from. In most cases, the pain is caused by the metatarsal bones bearing too much weight. However, it may also be the case that the pain is caused by nerve irritation (Morton's neuroma).

By placing an anaesthetic injection, the foot surgeon can localise the origin of the pain. An additional injection of cortisone can lead to decongestion of the irritated nerve, for example. Acute foot pain can thus be relieved immediately. If the metatarsal bones are localized as the cause, shoe inserts can also be used for acute pain relief.

Dr. Tonio Gottlieb, MD, advises:

"Sometimes it's not sure if the pain is coming from the metatarsals or the nerve. To find the cause, you can put numbing injections. Through the effects of those numbing shots, you get to find out which is the area that contains the problem."

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The conservative treatment of metatarsalgia

Dr.Gottlieb Fuss

If pain occurs in the front part of the foot, conservative treatment methods can also bring relief. Custom-made shoe inserts or orthopaedic shoes are suitable aids for metatarsalgia.

However, physiotherapy in the form of muscle training is also an important therapy option. Targeted foot gymnastics exercises can improve the clinical picture and thus reduce pain.

When does the use of surgical procedures make sense?

If conservative treatment methods do not achieve their goal and the patient continues to suffer, surgery should be considered. Depending on the cause and diagnosis of metatarsalgia, various surgical procedures are available.

The cause has a decisive influence on the type of therapy: case studies on the treatment of metatarsalgia

Case study 1.

Instability with hallux valgus
a) conservative: relief of the feet with shoe inserts
b) operative: increase of the load-bearing capacity of the foot by operative treatment of the instability

 Case study 2.

Rheumatoid arthritis
a) Treating rheumatoid arthritis as a systemic disease with medication

b) conservative: relief of the feet with shoe inserts
c) operative: increase of the load-bearing capacity of the foot by operative treatment of the instability


That is why you should consult an expert for a precise diagnosis

The diagnosis and treatment of metatarsalgia is complex and requires special expertise.

In his private practice for foot surgery and foot therapy in southwest Berlin, foot surgeon Dr. Tonio Gottlieb, MD, takes the time to get to the bottom of the causes of your pain problem. In a comprehensive primary examination, he discusses the personal symptoms with each patient and advises you in detail on all treatment options. In case of surgery, he will be at your disposal from the preliminary examination, indication and operation to further outpatient follow-up treatment in his practice.

Thus, you will be accompanied by him personally and comprehensively from the diagnosis to the healing.