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Soreness can affect any part of the foot, but often it can be traced to the weight-bearing areas--the forefoot (ball), and the rear foot (heel). By age 50, people can lose as much as half of their fat padding in the ball and heel areas. Use this tool to determine what condition(s) may be causing your foot pain or other symptoms, and which foot-health professionals might help.
The pain that is experienced in metatarsalagia typically occurs in the forefoot, at the base of the second or third toes (under the second or third metatarsal head). Hammertoe crest pad: For patients with an associated clawtoe deformity, it may be helpful to use a hammertoe crest pad, or toe taping, to help bring the toe back into an improved position. According to the 2012 National Foot Health Assessment conducted by the NPD Group for the Institute for Preventive Foot Health, 61 percent of adults in the United States ages 21 and older (135 million people) have experienced foot pain, soreness or discomfort.
Combined with fat pad loss, other physiological changes in the feet (weakening of muscles, loss of resiliency of tendons and ligaments, and spreading of the feet due to weight gain) make the feet more vulnerable to soreness and pain. If an ink imprint of the weight bearing sole of the foot is obtained, such as with a Harris mat (a device that assesses how force is distributed throughout the foot), there is often an intense uptake in the area corresponding to the involved metatarsal head(s) (Figure 2).

If the underlying cause can be addressed, non-operative treatment will be successful in the longterm. When metatarsal pads are fitted appropriately, they will help bear weight away from the metatarsal heads that are involved. This may serve to help reposition the thick plantar fat pad under the prominent metatarsal head. Surgery that corrects a claw toe or moves one of the metatarsal bones, may alter the loading characteristics of the front of the foot. Although these fat pads are thick and protective during infancy and childhood, by the time we reach our mid-thirties, they begin to deteriorate and lose their protective capability.
After the joints become irritated, the small muscles (intrinsic muscles) of the foot often become weak, which serves to spreads the symptoms. By successfully correcting the toe deformity, the shock-absorbing plantar fat pad can be reduced under the metatarsal heads.
There is a certain amount of tissue damage that has already been done and can not be undone.

Individuals should always consult a licensed and qualified health care provider for recommendations regarding their specific foot and ankle problems. Patients with metatarsalgia present with pain in their forefoot, usually in the ball? of the foot (Figure 1). This can be done with a combination of comfort shoes, metatarsal pads, soft accommodative orthotics, activity modifications, calf stretching, foot muscle strengthening, and NSAIDS (Non-steroidal anti-inflammatory drugs). Strengthening these muscles through foot specific exercises will improve the contraction, and lead to better more tolerated loading through the foot. The irritation of the MTP joint is due to repetitive overload, and can lead to swelling of the joint itself. Patients are unable to bend the toes completely and show the ‘knuckles’ on the top. Factors that may predispose to the development of metatarsalgia include: a bunion deformity, arthritis of the great toe, ligament instability of the midfoot, an excessively tight calf muscle, a congenital foot deformity, and claw toe deformities.

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