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Possible Causes for Forefoot Pain: Metatarsalgia, Sesamoiditis, and More

Janik Sundstrom
By Janik Sundstrom
Joel Taylor
Reviewed by Joel Taylor

Published February 28, 2022.

Man rubbing underside of forefoot with highlighted red area

Identifying the true cause of forefoot pain is difficult due to the complexity of the structures in the region. Areas of the foot are divided into the forefoot, midfoot, and hindfoot. The forefoot is the third of your foot closest to your toes, consisting of ligaments, tendons, blood vessels, and nerves that supply function to the toes. Pain is most commonly reported in the metatarsal bones and the phalanges, which also fall under the forefoot area.

Due to the complexity of the structures in this area, many people experience forefoot pain daily. This article explores the common causes of forefoot pain and their diagnoses.

Symptoms and Diagnosis of Metatarsalgia

Metatarsalgia is a condition that affects the foot through prolonged abnormal loading of the lateral forefoot (outside of the foot), causing pain and inflammation. The condition is usually not serious, and adaptations can be made to remedy the symptoms, preventing future flare-ups.

Structural abnormalities are part of the primary classification of metatarsalgia, whereas system conditions altering foot anatomy and loading characteristics fall under the secondary classification of metatarsalgia. The diagnosis is usually made clinically, with remarkable pain and inflammation felt around the forefoot area. The foot is observed and palpated in sitting and standing positions in an attempt to determine the cause of the pain. The medical practitioner may require further diagnostic testing to rule out a stress fracture or other conditions.

Symptoms and Diagnosis of Sesamoiditis

Sesamoiditis arises when the sesamoid bones and the structures around them (tendons and soft tissue) in the forefoot area become inflamed and painful. Strenuous weight-bearing activities on the forefoot will contribute to pain and inflammation, commonly seen in runners, dancers, or athletes. Pain usually develops gradually with less noticeable swelling.

A diagnosis is made by a medical practitioner after an examination of the sesamoid bones through touch and movement tests. The medical practitioner is looking for the reproduction of pain symptoms experienced by the patient to determine if the sesamoid bones are the source of the symptoms. An X-ray may be conducted to assess associated structures in the foot for stress fractures or other conditions. Only then can your doctor prescribe suitable sesamoiditis treatments.

Symptoms and Diagnosis of Morton’s Neuroma

Morton’s neuroma is another condition that may cause pain in your forefoot. Pain is attributed to thickening of the nerve, usually between the 3rd and 4th toes, more commonly seen in women. A burning pain sensation is often reported after excessive loading or pressure has been applied to the foot. Numbness can also arise in the affected toes. Compression of the nerve through weight-bearing and also from the sides of the foot will lead to the onset of burning pain. Standing on the forefoot (high heels) or wearing narrow shoes will also prove to increase levels of pain.

Struggling to identify Morton's neuroma from metatarsalgia? Read Metatarsalgia vs. Morton’s Neuroma: How to Tell the Difference.

Other Causes of Forefoot Pain

Bunions (hallux valgus) and arthritis of the big toe (hallux rigidus) cause the majority of the force to be transferred through the smaller toes, causing inflammation and pain in the forefoot.

Systemic conditions such as Rheumatoid arthritis, gout, or Lupus could be a possible reason for the pain. Managing these conditions effectively will require the help of a medical practitioner, who may use medication as a treatment method. 

Plantar plate tears are also common causes of forefoot pain, usually associated with high load activity. Characterized by pain in the area immediately behind the toes and potentially a change in toe position as the tear progresses. Firstly, a sharp pain is commonly reported, which changes to a dull pain thereafter. If left untreated, pain increases, followed by deformity or arthritis.

Ruling out the presence of a stress fracture is important. If excessive pain levels are felt, contact a medical practitioner who can assist you with further examination regarding a possible stress fracture.

How to Identify the Cause of Your Forefoot Pain

Looking for obvious signs of physical issues or abnormalities as a possible cause of your pain is a good first step. Use your thumb to examine the underside of your foot, identifying the potential structures causing pain, bearing in mind the different conditions leading to forefoot pain. Knowledge of system conditions such as rheumatoid arthritis and gout is extremely helpful. If systemic conditions are thought to be present, consult with a medical professional for a management plan to prevent continual complications and abnormalities from arising. 

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