Hikers Guide to Metatarsal Pain
Metatarsal pain, also called Metatarsalgia (met-uh-tahr-SAL-juh) occurs when the ball of your foot becomes inflamed as a result of jumping, running, or hiking. The feeling is similar to having a pebble in your shoe under the ball of your foot. This is a temporary condition that is usually treatable with ice, rest, and anti-inflammatories. Wearing a shoe insole or metatarsal pad can also relieve the pain and prevent a recurrence.
Symptoms
The key symptom is pain in the ball of your foot when walking barefoot or in shoes. It’s common among people athletes and people who lead an active lifestyle that involves jumping, climbing, and hiking. Metatarsal pain comes from the five bones at the bases of the toes, the metatarsals.
Other conditions, such as Morton’s neuroma, arthritis, bunions, hammertoe, or even gout, can cause metatarsalgia-like symptoms. If in doubt or if the symptoms persist, consult a medical professional.
Causes
Metatarsal pain can arise from placing too much weight and force on the ball of your foot. Considered an overuse injury, metatarsal pain often results from the repeated impacts that your feet take during sports, like running, hiking, and jumping.
There are a number of contributing factors that can cause metatarsal pain, including:
- Being overweight
- Tight calf muscles
- Weak ankle muscles, particularly after an injury
- Hammertoe deformity
- Poorly cushioned shoes
- Footwear that is too tight or too loose
Many of us suffer from one or more of the conditions listed above at some point. This can make the cause of metatarsal pain hard to pin down since multiple factors are often involved.
Treatment
Most metatarsal pain is temporary and resolves with rest, icing, and anti-inflammatory medication like ibuprofen until the pain dissipates. This can take some time, however. If you can’t wait for the symptoms to disappear completely, there are several measures you can take to lessen or eliminate Metatarsal pain. While you may eventually have to change the shoes you wear, you can try a number of less expensive, less drastic alternatives first. In the long term, you may find it necessary to replace your hiking shoes or to increase your foot flexibility and strength through exercise or physical therapy.
Replacement Insoles
Replacing your insoles with ones that have a higher arch can help dissipate the force of a footstrike over a greater surface area and away from the ball of your foot. It helps to get an insole with a pronounced heel cup to prevent foot rolling, which can exacerbate the pain.
For example, when I switched from a pair of very beat-down and thin Superfeet Carbon insoles (no longer made) with a fairly low arch to a new pair of firm Superfeet Green insoles (no longer made) with a higher arch, I felt immediate pain relief in the ball of my foot. It took a little while for my feet to get used to wearing the green insoles again (I wear them in winter), but it made the condition much more tolerable while I bombed my metatarsals with anti-inflammatories. TreadLabs also makes three grades of Firm insoles: Firm (called Ramble), Extra Firm (Pace), and Ultra-Firm (Dash). Treadlabs insoles are less expensive than Superfeet over the middle-to-long term because their foot covers are replaceable, and the entire insoles don’t have to be thrown out when they wear out.
Metatarsal Pads
Another option is to get metatarsal pads (also called met pads) that stick to your feet with adhesive or stick to the bottom of your insoles. For example, you can stick an adhesive-backed metatarsal felt footpad behind the ball of your foot to alleviate metatarsal pain. These felt pads, available in multiple thicknesses – 1/8″, 3/16″, and 1/4″ – reduce pressure on the ball of your foot by supporting the metatarsal bones just behind it. They’re also really sticky when applied to your skin, but they provide immediate relief, and you can get a sock over them.
Alternatively, when you find the sweet spot on your foot, you can stick them on the inside of your shoes, tape them on top of an orthotic insole, or on the underside of the insole and get multiple uses out of them. Treadlabs also sells velcro-backed foam metatarsal support pads that attach to the bottom of their insoles, allowing you to easily reposition them and remove them for cleaning.
Summary
Metatarsal pain, also called Metatarsalgia (met-uh-tahr-SAL-juh) occurs when the ball of your foot becomes inflamed as a result of jumping, running, or walking. It’s fairly common among hikers and runners and usually responds to rest, ice, and taking anti-inflammatories. Metatarsal pain is an overuse injury caused by repeated impacts. You can further relieve its symptoms by using more supportive insoles or metatarsal pads, though for permanent relief, you may need to change your footwear.
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After suffering for years, I got relief by simply using a different lacing pattern for my boots. I really loosened the first two rows, nearest the toes, then tied a surgeon’s knot. I laced the rest of the boots the regular way and tightened them. The looser toe box prevented the metatarsal bones from rubbing against each other and I have had no pain since. (Instead of Ibuprofen, my doctor had prescribed me Meloxicam. That gave me some relief, but not as much as the relacing.)
He’s alive! great to hear from you, Mark. Been years. Didn’t know about that lacing trick. Neat.
I finally went to a podiatrist after months of limping around including using crutches in the house since I had them. I thought I might have a fracture. He took an x-ray and said there was no fracture. But by that time it might have already been healed. He gave me a shot of cortisone but it didn’t do anything. His assistant made a do it yourself kind of orthotic. It was too high and I thought he would lower it somehow but instead he raised the back by adding more material. It was a cut and paste kind of job but it did the trick! Once I got home I made a template of it and created a few out of all the insert type things I had bought to alleviate the problem. I was diagnosed with metatarsalgia and arthritis of my big toe. This was my right foot and I never had a problem since. probably 15 years ago or more. Now I’m starting to have a problem with my left metatarsal area so I’ll be making an orthotic for my left foot before it gets bad. I don’t want to miss walking my favorite trail now that the weather is cooler. It was soooo nice out there today. I walked for 1 hr 50 min. I hope you all find solutions. It’s no fun being sidelined.
I run almost every day and have found relief by putting cotton balls between two toes. I sometimes cut large cotton balls in two if less separation is needed. Surprisingly they stay in place as I run and they can be reused until they get wet.
It’s great to find an easy, inexpensive way to fix a problem. That’s an awesome tip.
I’m not sure why that works since the metatarsals are a good ways back in the foot, but if it works, hey!
When my metatarsalgia flares up, I use a silicone toe separator. Philip, you wonder why it works since the metatarsals are a good way back from the toes? In my case, at least, the pain is caused by irritation of the nerve bundle between the metatarsals. The toe separator just creates a tiny extra bit of space between the metatarsals, thus taking pressure off the nerves. The pads under the foot do the same thing when placed correctly: weight applied on top of the pad spreads the metatarsals and takes pressure off the nerves.
I haven’t tried cotton balls, but I have used a folded up lump of toilet paper taped in between the toes. The silicone toe separator works well and lasts a long time. One design uses a ring that goes over the smaller of the two toes, which does keep the separator in place but I find the ring unbearably irritating, so I cut it off and tape the separator in place if it’s not staying put. The simplest separator design doesn’t have the toe ring and that’s the style I recommend. Here’s an example of that style, although I haven’t used this specific product: https://www.amazon.com/NatraCure-Gel-Toe-Separators-Spacers/dp/B076C2CQ2R
Interesting. Worth a try.
Wonder if toe socks, like Injinji, would work the same way. I use them when my little toe plays up and re-laced my Salomon shoes to ease problems with an arthritic big toe. Anything that keeps me moving is worth trying.
I’ve just done 200 miles in 8 days using injinjis plus my regular socks and I’m currently nursing a very painful ball of my left foot, right foot absolutely fine thank god! Used Altra Olympus 5s so very wide toe box, but since I started long distance hiking over 2 years ago I’ve never suffered from this one.. currently got my feet in a bucket of warm water but I’ll get on the RICE technique straight after.. last long distance hike I did I used hoka speed goats they caused the hard skin of the outside of my big toes to turn into callous/blister things as the toe box is far too narrow.. so I’m thinking this might have happened as the altras are zero drop? Less heel strike and more mid foot strike? Might be looking for an Altra Olympus alternative with a few mm’s of drop ?
Maybe, but if you’ve irritated the meta tarsals, changing your footwear isn’t going to make the pain go away. It takes a long time to heal. If you get a decent insole for metatarsals, it won’t matter what shoe you wear.
These insoles have been a game changer for me: https://www.amazon.com/gp/product/B06XCJPXQC/ref=ppx_yo_dt_b_asin_title_o06_s00?ie=UTF8&psc=1
They have metatarsal support built into them. Plus, they are super cheap!
Given the crappy insoles manufacturers put in their shoes, any 3rd party insole is an upgrade.
In 2016 my daughter and I hiked 420 miles from the French border through Spanish Basque Country along the coast then south west through the mountains finally to Santiago. I limped the last few days into Santiago with terrible ball of foot pain.
I think it was caused by many of the factors you list. When I returned to the States it wasn’t until I found Dr Scholl’s ball of foot pads that I felt some relief. They have an adhesive layer that I used to stick them to my super feet. Fortunately the problem hasn’t recurred.
Sounds it.
As there are various causes and contributing factors I would recommend anyone with serious pain that is not easily relieved to seek competent medical advice. There are many many stories by individuals, including myself and many suggestions of treatments. One May not know if one has a stress fracture if a bone or a crack in a sesimoid so be careful about injuries. Do not assume and see a doctor if there is serious pain or such.
Each case or story May be very different and any sample of 1 is most likely to give a wrong a anecdotal result. Self treatment puts you at risk of further injury or permanent reduction in hiking possibilities. Keep safe all!
When was the last time you got a doctor’s appointment within 8 weeks of asking to see one? It’s even worse with a specialist. I’ll self-treat until then. I have to say that most of the doctor’s advice I’ve gotten about hiking injuries and complaints has been miserably wrong.
You are so right about doctors. I got ball of foot pain after a long winter Bonds hike. I’ve been to the podiatrist and orthopedic. They offered no suggestions. I’ve tried numerous insoles and really feel you have to do your own research. Still trying to get the right fix for me.
I had really bad pain before I started hiking. I couldn’t make it around an outdoor fair without sitting down by the time I was in my mid 50’s. Over a period of time I got better at shoe selection and went through a ton of insoles. I went to a MGH podiatrist and got a cortisone shot. That didn’t help. Once I did start hiking, I’d have to stop a lot and take my shoes off and rub my feet. It kept from going on many group hikes not knowing how my feet would hold up. Then I discovered low drop heel to toe shoes with a wide toe box and combined them with an altered stock Artrex insert,with a met pad and I’m pain free 90% of the time and can do 15+ mile days backpacking in the Whites. I was lucky, the small shoe store I went to also makes custom footbeds. The owner told me more about what was going on with my feet in five minutes than three visits to MGH. It’s a combination, right shoes, right inserts and right socks.
Anyone with this issue, I can highly recommend Gary@Footworks
Great story.
Where is Gary?
Footworks sounds like it’s in Boston.
Hi Pete
Im suffering with forefoot pain. I saw your note about Gary@footworks. I took an appointment for upcoming Saturday. I’m driving all the way from NJ. I hike from April – November. Are you able to hike now with the right foot ware? Any other suggestions or questions that I need to ask Gary?
I really want to start my hikes.
Foot Logics Metatarsalgia Innersoles work wonders
Do you use this 3/4 size? Sounds interestimg
https://www.amazon.com/Footlogics-Orthotic-Insoles-Mortons-Neuroma/dp/B07KFNPR53
I have been dealing with pain at the bottom of the metatarsals and the ball of my feet for quite some time now I tried new inserts went out and bought really good expensive boots. Now tonight they just it’s like a burning pain and it always feels like it’s my socks causing me trouble to the point where I actually stop readjust them but I find that it’s not the case.
Not sure what to tell you. Mine is slowly going away and I only take Vitamin I when it gets bad.
Some great advice on metatarsal pain. Thank you for displaying where people should put the metatarsal pad as this can be trickier than it looks. Other recommendations to improve metatarsalgia may include rocker bottom shoes, or topical pain creams like diclofenac. Thanks!
Insoles for your footwear work great. I have the metamarsal and toe fractures from running for 40 yrs. Doc said they are old and won’t heal. Had to finally thrown in the towel. So sad. So now on the quest for a fall winter hiking boot. Need the toe room now.
Great article.
Thanks for the information. Having metatarsalgia can be such a pain for hikers. I have been using Tread Labs Pacer insoles along with metatarsal pads. Along with changing my lacing pattern and stretching out my claves, this has made a huge difference. Tread Labs make a great product and I have learned that they are FSA eligible. Happy trails.
Maybe look into a shoe insole with a metatarsal pad. I’ve found relief using Icebug Slim Insoles. They take a little time for adaptation, and may feel unstable at first as your foot muscles adapt. No affiliation.
Found this after three days hillwalking in Scotland with a very heavy pack. Pain in the ball of my foot and also blisters between toes (which have also been developing concerning “pinch calluses” in recent months. You don’t mention in the article where toe separators come in? I’m considering trying them and the pads you recommend. (I literally never heard about this stuff until googling this morning so thank you!)
You could try toe separators, but they don’t really address the metatarsal problem which requires taking pressure off metatarsal joints. I believe toe separators are really best for hammer toe where you want more lateral separation, but I think you have to wear them for a very long time to change the bone structure. Maybe you should try carrying a very lightweight pack (I’m serious) as that may have a better and faster impact.
I have what I call “8 mile feet.” I do strenuous hiking but right around the 8 mile mark the balls of my feet start hurting – really makes things miserable. I have narrow feet so am limited to the hiking shoes I can wear; La Sportiva is my go-to brand. I don’t see in the comments (as far as a read, tbh) anything from those whose feet are fine overall, but become painful after miles into a hike. Any suggestions?
It sound slike your metatarsal bones are becoming irritated – they’re located at the front of the balls of your feet. I would try getting the thinnest insole that Treadlbs makes and attaching a metatarsal pad to it. The pad elevates your metatarsals so they don’t slam into the footbed when you walk. I’ve had similar pain and this was one of the tactics I took. Another was to use this half insole which has a built-in metatarsal pad. https://amzn.to/4nVUgH3
The problem with it in La Sportiva, is that you won’t have any cushioning in the front for your toes – but play around with them. They might be the ticket.