Stone bruise – Metatarsalgia

What it is:

Many runners have different types of problems and pain localised to the forefoot. Stone bruise – metatarsalgia – is a common notion for pain that occurs in a part of the foot known as the metatarsal (ball of foot). It often occurs in the metatarsal heads – where the three middle toes meet the ball of the foot. It is a common problem which can affect all the bones and joints of the metatarsals, normally located to 2., 3. and 4th. toe joint.


  • Pain under the forefoot / toe balls.
  • Soreness when pressing the toe balls.
  • Pain between the toe joints.

Caused by:

Metatarsalgia is a result of uneven load in the forefoot that leads to irritation of joint capsules, muscles and tendons under the foot. It is the pain that is the problem, the condition itself is normally not serious or threatening in any way. The reason for the condition is normally one or more of the following:

  • In a normal foot, the forefoot will carry around 1/3 of the body weight. If however too much load is distributed to the forefoot, the front foot arch/transverse arch will flatten, leading to low front arch/transverse flatfoot and consequently too much pressure on the lower side of the middle toe joints. This increased load on the toe joints and the lower side of the foot leads to an irritation, which, if sustained over a longer period, develops a condition of pain under the toe balls.
  • Incorrect shoes is a normal reason for pain in the forefoot. High heels, e.g. 5 cm heels, increases the pressure on the forefoot with 50%! High heeled shoes are often combined with a narrow front part of the shoe, which is squeezing the forefoot and in this way preventing the front arch to maintain the right position.
  • A high longitudinal arch contributes to curling of the toes upwards, which gives an unbalance in the muscles in the foot, since the toes then will carry little or no weight. The weight will then be placed on the joints between the middle foot and the toes, which may cause pain in the forefoot.
  • Activity level and age influences the  pads of fat in our foot. Low activity level and high age makes the fat tissue thinner, and pain can occur if the fat tissue is shifted/moved around.
  • Wrong positioning of the knuckles in the forefoot may contribute to pain. One particular form of wrong positioning – toe off – may contribute to longer time before the big toe joint achieves resistance from the surface, and thereby allowing the toe joints number 1, 2 and 3 to rotate more medial than normally. By this, the front transverse arch is flattened more than it should. This can be clearly seen by observing a characteristic twist at toe off.
  • Nerval disruption/squeezing, fat tissue loss or sesamoiditis may also be reasons for the condition. This can be revealed through ultra sound scanning of the forefoot.

A thorough investigation of the “foot root knuckles” and an analysis of the movement pattern in the foot during running and walking will demonstrate the biomechanical conditions and will normally reveal the reason for the pain.

Treatment and recovery:

  • Most importantly, any wrong positioning in the foot should be corrected. This may be uplift of the front transverse arch, correction of the rear arch, support of the medial longitudinal arch or support /correction of the forefoot. See video below about using metatarsalgia pads in your running shoes. Anyway it is important to consult professionals to analyse and do this. The target is to distribute the pressure on a larger area, in order to relieve the affected, overloaded knuckle. It may also be necessary to apply soft tissue techniques to loosen scar tissue and tight muscles.
  • In many cases, in particular for runners, it is beneficial to apply adapted soles in the running shoes.
  • The foot consists of 26 knuckles and has 35 joints. Wrong positioning of one of these knuckles may lead to stiffness or locking of other joints. Mobilising of the knuckles has demonstrated good effect on pain in the forefoot.
  • Roll you foot over a 1/2 litre bottle of frozen water, after every training activity.


  • Keep your foot muscles strong. Train the muscles around the toe joints by for example putting your forefoot on a small ball, the heel touching the floor, curl the toes over the ball and at the same time widen the toes as much as you can. Keep on for 3 minutes on each foot.
  • Avoid high heels or shoes with bad (thin/flat) or worn out soles. Use shoes with good cushioning and good support for the longitudinal arch.
  • Walk a lot in uneven terrain, like (natural) paths in the nature, in order to train the foot muscles and to maintain good joint flexibility.

See more about running injuries, preventive exercises and videos here:

Author: Hege Erichsen

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