Pain occurring on the balls of the toes (metatarsal heads) is called metatarsalgia. Pain in the forefoot area is the predominant feature. Patient can also present with numbness, sharp shooting pain along the toes or a sensation of 'walking with marbles in the shoes' is felt. Gradually calluses develop over the prominences leading to pain and, rarely ulcers.
Causes include wearing narrow shoes; claw toes/hammer toes, obesity, cavus foot deformity and diabetes. Specifically, rheumatoid arthritis causes subluxation of joints, leading to prominence of ball of toes and eventual development of pain and calluses.
Soft insoles and pads for the metatarsal area to relieve pressure
Includes weight loss, wearing metatarsal cushions, or soft insoles, wide and well fitting shoes.
If conservative means fail to give relief, surgery including re-aligning osteotomy of metatarsals such as a Weil osteotomy, or in the case of severe rheumatoid arthritis excision of the metatarsal heads, should be considered. A wire is usually used to keep the toe corrected after surgery. It takes 6 weeks to recover from this surgery.