Why do I have ball of foot pain when running? That’s probably the question that lead you here and one from an athlete I coach that lead to me do some digging.
Initially, I assumed it was all about foot strike.
Landing too far forward on the toes rather than with more of the mid-foot. But that alone is just one potential factor. After all, your foot is a complex structure of 26 bones, 33 joints and more than 100 muscles, tendons and ligaments.
Ball of foot pain may be caused by a variety of factors. In this article, we’ll go over what ball of foot pain is, what it feels like, possible causes and recommendations to make sure you never experience it again.
Read till the end of the article for some shoe recommendations as well!
Ready? Let’s get started!
What is Ball of Foot Pain (Metatarsalgia)?
Ball of foot pain can be a nuisance for many people, especially runners.
The medical term for pain in the ball of the foot is metatarsal pain or metatarsalgia. It’s an umbrella term for a symptom that can have many possible causes.
People who experience ball of foot pain feel aching pain and inflammation in the padding directly below the toes. This also happens to be the position where we place the most pressure when moving and standing.
This aching sensation is usually present in what’s known as the metatarsal heads, the joint that’s just under our toes.
The condition is especially common among athletes who play high-impact sports, such as running, due to the stress they place on the balls of their feet.
The great news is that because it’s common, we have a lot of great knowledge on how to treat it!!
Symptoms of Ball of Foot Pain
Ball of foot pain occurs in the padding right below your toes. Here are some of the main symptoms you might feel:
- Sharp or burning pain in the ball of your foot
- Shooting pain in the ball of your foot
- Pain that worsens when you stand, run, flex your feet or walk (stops hurting with rest)
- Pebble in your shoe sensation
- Numbness, or tingling in your toes
Runners with a tendency to land on the ball of their foot create massive amounts of pressure in the push-off phase which can inflame this area and there might also be some swelling. Bruising might also occur on your foot.
It’s also possible if you wear a lot of high heels as a runner that this area could be more sensitive due to that constant pressure.
Other Common Running Foot Pain
If you feel like the symptoms listed above don’t exactly describe what you’re experiencing then check out these other in-depth articles to help resolve foot pain while running issues:
- Achilles pain while running– learn how to treat it and the best shoes
- Plantar Fasciitis– ideas for managing this ongoing issue
- Running with bunions– how to keep going and shoes that help
- Stress fracture prevention– common in the foot due to the pounding
- Runner’s Toe – why you get black toenails and more
- Running on a broken toe– when you refuse to let anything stop you
8 Possible Causes of Ball of Foot Pain
There are various possible causes of ball of foot pain. Sometimes it’s due to one single factor, while other times it might be several issues that are compounding together to cause this condition.
Basically like everything in running, right?! It’s a combination of factors to explain any injury.
Here are the main possible causes.
#1 Intense Training
Being a distance runner can increase your risk of having metatarsalgia. The front of our feet absorb the impact of every single step we take, it’s not surprising that foot soreness and unfortunately sometimes pain are often reported.
Your feet have to absorb 7 times your body weight with every step. This means if anything is off and due to the repetitive nature of running, it’s very easy to end up with an injury.
The bones, tendons and ligaments all need time to adapt to this high impact activity.
Of course your feet are tired as they adjust to the new impact of running or the in wrong running shoe.
- You’ve heard it before, but increase intensity SLOWLY.
- Increase total endurance slowly.
- Give your body time to adapt to new stresses.
#2 Tight Calves From Ill-Fitted Shoes
Wearing high heels can transfer extra weight to the front of the foot and therefore it’s a common cause of metatarsalgia for women. It causes an increase in tight calves, which are then going to pull on all the foot muscles.
Additionally, shoes with a narrow toe box or shoes that lack sufficient cushioning and support can create issues. For new runners that cushion can help the feet adjust to the impact.
Furthermore, running in shoes that are old or worn down can change your gait which then contributes to ball of foot pain.
You definitely need to know when to replace running shoes and just as importantly to rotate running shoes.
#3 Certain Foot Shapes
Listen just because you can’t control the shape of your foot doesn’t mean you’re stuck with pain. You need to know which area applies to you and then focus on how to best care for your foot. That could be the right shoe, the exercises below or an insole.
Having a high arch can also put extra pressure on the metatarsals.
Having a second toe that is longer than the big toe is also another possible cause since it causes more weight than usual to be shifted to the second metatarsal head.
A hammertoe, i.e., a downward-curling toe, and bunions, i.e., swollen, painful bumps at the base of your big toes, can also cause ball of the foot pain.
Sometimes wearing high heels for extended periods or wearing shoes that are too small can also misshapen the feet which can lead to this condition.
In fact, we see that wearing heels all day lead to a number of issues like calf pain and Achilles pain, so if it’s possible to switch that up in your life…do it!
#4 Poor Footstrike
Runners who land too far forward on the foot are consistently running up on the ball of the foot. This creates a few issues:
- The fat pad is taking on the weight of each step
- Your calves are being over worked
- Overworked muscles become tight and thus pull on everything
#5 Lack of Ankle Mobility
“Restricted mobility through soft tissues in and around the ankle and foot can play a role. Flexibility and mobility exercises for the calves, both gastrocnemius, and soleus, as well as ankle mobility exercises and foot rolling, can help,” says Dr Asher.
Foot activation exercises such as foot yoga or simply adding in some movements to work on your range of ankle motion are key. We often overlook the ankles when thinking about the foot.
Checkout this great mobility move for runners.
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#6 Excess Weight
If you’re running overweight, more pressure is going to be put on your metatarsals because most of our body weight transfers to our forefoot when we move. Therefore, losing weight might help with the symptoms.
A number of studies have shown that even a minor amount of weight loss, resulted in less discomfort in all lower extremity areas from the plantar fascia to the ball of foot.
#7 Stress Fractures
If you have stress fractures in the metatarsals or toe bones, it can change the way you put weight on your foot which can also further exacerbate the condition and lead to metatarsalgia.
Generally, you are going to be feeling sharp pain in the area of the stress fracture. Many runners will try to push through this, but the result is either a full break or that the stress fracture can’t heal.
#8 Morton’s Neuroma
This is a painful condition that affects the ball of your foot, usually between the third and fourth metatarsals. It’s usually a result of a non-cancerous growth of fibrous tissue around a nerve in the foot.
The pain and symptoms are similar to metatarsalgia and can also contribute to stress in the metatarsals, thereby causing metatarsalgia on top of Morton’s neuroma.
How is Ball of Foot Pain Diagnosed?
Sometimes ball of foot pain goes away on its own after a few days. If your pain persists for more than a few days after resting and changing your footwear, or the pain is severe and you can see signs of swelling or discoloration, it may be time to get checked.
To get diagnosed correctly, head to your doctor’s office where they will begin an exam for metatarsalgia by asking about your symptoms. Your doctor will also physically examine your foot.
To rule out any stress fracture or other problems that may be causing your pain, you may need an X-ray. Alternatively, an ultrasound or MRI may be ordered to access the soft tissues surrounding the metatarsal joints.
They can quickly reveal whether a problem such as Morton’s neuroma, stress fractures, or a sesamoid injury is to blame instead of metatarsalgia so you can get the correct diagnosis and then treatment.
How to Treat Ball of Foot Pain
If you’re wondering what can help with foot pain from running due to ball of foot pain (metatarsalgia), you’ve come to the right place.
First of all, the good news is that it can be easily treated without the need for surgery.
Depending on the level of severity of your condition, your doctor may prescribe orthotic inserts, such as metatarsal pads or shoe inserts to minimize the pain you’re feeling in your foot. These are made to help align the foot and provide extra cushioning.
For swelling in the area, an ice pack wrapped in a towel can ease things up. You may also be advised to take over-the-counter painkillers such as ibuprofen. But you should only take it if your doctor tells you to.
Immediate Pain Relief for Foot Pain
Here are a few ways to help in immediate pain relief if you’re experiencing foot pain:
- Utilize a heat pack to help release tight muscles (ice only dulls pain, doesn’t help to heal)
- CBD Sports cream(totally used this on my IT Band and post knee surgery)
- Eliminate weight-bearing exercises for a few days (try pool running workouts!)
- Eat an anti-inflammatory dietto help the body speed up the healing
- Try turmeric or other herbs that can cut feelings of pain (we try to avoid NSAIDs because they aren’t good if taken while running)
Long Term Tools to Help Foot Pain
In order to ensure you never experience ball of foot pain again and to help assist recovery, a long-term approach is necessary to back the short-term approach.
Dr. Asher Henry, PT, DPT, CSCS has some useful suggestions:
“I would suggest those with metatarsalgia seek out PT, especially if they’re having any sharp, shooting pain or lingering numbness”, she explains.
The importance of wearing the right shoes can never be emphasized enough.
“With runners, shoe selection can impact sensations they’re having in the foot. So, if they’re running, shoes are too tight. This can cause discomfort similar to diagnosable metatarsalgia. Testing out wider shoes Is a good idea as well as looking at how tight they’re cinching down the laces,” Dr. Asher recommends.
Understanding the cause behind your metatarsalgia can greatly assist in recovery as well.
Other long-term tools you can incorporate to reduce the risk of such conditions or to resolve it if you’re currently experiencing it are:
- Improving your foot strike (see video below.)
- Wearing a well-cushioned shoe (recommendations below)
- Learning to replace your shoesto prevent top of foot pain
- Foam rolling to release tight calvesor rolling foot on a PT ball to release tension
- Continuing to spend time on strengthening your calves, glutes, and core for better running form
- Avoiding walking barefoot
- Soak and use a pumice stone on your feet to help remove calluses to relieve pain.
Improving your foot strike takes a little bit of practice, but is well worth it for the benefits. Watch this video to help you better visualize how you want to land ideally.
Improving your foot strike takes a little bit of practices, but is well worth it for the benefits. Watch this video to help you better visualize how you want to land ideally.
Best Shoes for Ball of Foot Pain
When looking for shoes to help there are a few features that really help:
- Cushioning
- A wider toebox
- A low heel to toe drop (reducing that forward push
Hopefully these shoe options will give you a place to start in making your selection.
As always when I recommend shoes, I’ve either run in them myself or chatted with others to understand what they like and I’ve researched why they’re a good suggestion for ball of foot pain.
Hoka Bondi
When you think cushion, this should be on the top of the list. It’s actually a shoe I’ve been using for this round of marathon training and seriously enjoy.
Some have reported these shoes feel a little more narrow, so if you like a wider shoe these are out. I have a more narrow foot, so I’m not a good judge, but I do LOVE the cushion.
Saucony Kinvara
Another shoe that I’ve run in for many years. It’s not anywhere near as cushioned as the Bondi, but has that lower heel to toe drop and is super lightweight.
I think these lower drop shoes can help to encourage a good foot strike.
Additionally, the insole is easily removed to put in your own orthotic or insole. Since knee surgery, I often wear an insole that helps to ensure my feet don’t fall inwards (overpronation). That’s kept my knees, ankles and feet very happy.
Altra Torrin
These shoes have more of foot shaped design than other brands which means your toes have plenty of room to spread out and the zero drop cushioned shoe is truly helpful for many runners trying to improve their foot strike.
Ball of foot pain while running may not be uncommon, but it is an injury you can prevent and recover from!
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