The symptoms of Metatarsalgia include pain under the balls of the feet and swelling and inflammation at the heads of the metatarsal bones. (The metatarsal heads form the balls of the feet.)

Joint tissues, or capsules and ligaments, become increasingly painful during episodes of prolonged walking and weight bearing activity. Gradually and with repetition, fibrotic scar tissue can develop.

 Symptoms       Causes        Solutions

Dr. Sam Dubé discusses metatarsalgia

Learn about the symptoms, causes, and benefits of different treatment options.


 What causes metatarsalgia?

Poor foot mechanics caused by footwear use is the leading cause of metatarsalgia.

There are three main contributing causes:

  1. Wearing footwear that presents a concave surface under the metatarsal heads: In essence, this causes the second, third, and fourth metatarsal heads to drop, significantly increasing the load they bear. The concave supportive surface of the footwear may be a result of footwear design or it may be caused by midsole/insole material breakdown or compression due to long-term use.

  2. Long-term use of footwear or insoles that provide excessive cushioning: This causes the body to stop producing robust soft tissue padding under the metatarsal heads, which creates a highly sensitized area.

  3. Failure of the foot muscles to correctly align the bones of the feet into strong and dynamically adaptable arches: This leads to foot instability and torsional forces on the metatarsal bones.

These causes can present simultaneously and can worsen the severity of the symptoms and difficulty in eliminating the causes.

Modern science has identified that the nervous system plays a critical role in stabilizing the feet and ankles when walking or running. It is now understood that poor foot function are a symptom of inefficient neuromuscular function caused by conventional footwear use. In fact, conventional footwear use causes poor neuromuscular function throughout the feet, legs, hips, and back, when:

  • the soles of the feet don’t receive the subtle, varied stimulus that the nervous system requires for healthy function,

  • snug toe boxes, stiff midsoles/outsoles/uppers and tight lacing restrict healthy foot movement, and

  • footwear midsoles / outsoles feature a concave supporting surface under the metatarsal heads.

To understand the relationship between footwear and lower limb pathologies, click HERE.




The best way to prevent and treat metatarsalgia is to retrain healthy neuromuscular function and to use footwear that has a flat supporting surface under the metatarsal heads and that is soft, flexible, and roomier in the forefoot.

Conventional treatment methods for metatarsalgia

Since the late 1890s, the standard treatment for poor foot mechanics has been to artificially support the arches with an orthotic. Other conventional treatment options include:

  • Cushioning

  • Ice

Modern science has transitioned away from using long-term support and cushioning on any body part because it causes a progressive weakening of the body part being supported or cushioned.

The modern approach to treating metatarsalgia

Science has shown that merely challenging the body to “do its job” is the best way to restore and enhance function.

The modern approach to address poor neuromuscular function is to employ a “Proper Technique” rehabilitative therapy to regain healthy function. This approach is extensively used pre- and post-surgery and is also the foundation of virtually all sports training/rehabilitation programs. By employing a therapeutic approach, the feet become stronger and more stable, thereby addressing the cause of the poor foot mechanics that contribute to metatarsalgia. Proper Technique therapies employ exercise that focuses on safely training healthy neuromuscular function, i.e., optimal mobility, muscle strength, stability, and alignment.

Proper Technique therapies require both Right Stimulus and Right Movement.

Right Stimulus occurs when the information that the brain receives from the senses triggers an efficient protective reflex function or Right Movement. The nerve endings in the soles of the feet play a critical role in providing the brain with the information required for optimal Right Movement throughout the feet, legs, hips, and back. When the brain receives insufficient or inaccurate information from the soles of the feet, the protective reflex function Right Movement will be ineffective or absent altogether. This is what happens when conventional footwear is worn. For more information on Right Stimulus and Right Movement, click HERE.

To therapeutically address the cause of oversupination and to prevent it from reoccurring, do the following:

  • Walk barefoot on natural terrain as much as possible. This provides the optimal Right Stimulus and allows for the Right Movement required for healthy neuromuscular function.
  • Use Biopods® Stimsoles® Footwear or Insoles. Biopods Footwear provides the ultimate Proper Technique shoe environment. Biopods Insoles improve the stimulus in your conventional footwear. Use in loosely laced, soft, flexible footwear with ample toe room that allows your arches and toes to rise easily for best results.
  • Consult with your healthcare practitioner to ask about employing soft tissue mobilization therapies to address the fibrotic scar tissue that may have formed prior to using Biopods.

For more information on what to expect when using Biopods, click HERE.


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