Hikers Guide to Metatarsal Pain

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 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 known as Morton’s neuroma, arthritis, bunions, hammertoe, or even gout can cause metatarsalgia-like symptoms. If in doubt or if the symptoms persist, consult medical attention.

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 time or another. 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 goes away with rest, icing, and taking anti-inflammatories 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 a number of measures you can take to lessen or eliminate Metatarsal pain. While you may have to change the shoes you wear eventually, you can try out a number of less expensive and drastic alternatives first. Longer-term, you may find it necessary to replace your hiking shoes or 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 any prevent foot rolling which can exacerbate the pain.

For example, when I switched from a pair of very beatdown and thin Superfeet Carbon insoles with a fairly low arch to a new pair of firm Superfeet Green insoles with a higher arch, I felt immediate pain relief in the ball of my foot. It took a little while to have my feet 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.

Proper met pad placement is important to relieve stress on the heads of the metatarsal bones
Proper met pad placement is important to relieve stress on the heads of the metatarsal bones.

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 the pads 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 anti0-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, although for permanent relief it may be necessary to change your footwear.

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About the author

Philip Werner has hiked and backpacked over 7500 miles in the United States and the UK and written over 2500 articles as the founder of SectionHiker.com, noted for its backpacking gear reviews and hiking FAQs. A devotee of New Hampshire and Maine hiking and backpacking, Philip is the 36th person to hike all 650 of the hiking trails in the White Mountain Guide, a distance of approximately 2500 miles, completing a second round in 2021. Philip is the author of Backpacking the White Mountain 4000 Footers, a free online guidebook of the best backpacking trips in the White Mountains in New Hampshire and Maine. He lives in New Hampshire.

18 comments

  1. 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.)

  2. 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.

  3. 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!

  4. 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.

  5. 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.

  6. 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 [email protected]

  7. Foot Logics Metatarsalgia Innersoles work wonders

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