Metatarsal Pads and Insoles: How They Relieve Ball of Foot Pain

Reviewed by Carla Benson, DPM

Carla Benson is a podiatrist with experience treating a wide range of foot and ankle conditions. She is also a medical and health writer with published research on lower-extremity conditions.

Pain and discomfort in the ball of the foot can affect your life in many ways, interfering with walking, exercise, and general movement throughout your day. Pain in this region, generally referred to as metatarsalgia, can develop for a variety of reasons. Many people attempt to get relief by cushioning the affected area. However, another approach is to use metatarsal pads.

Metatarsal pads change how pressure spreads across the forefoot. Rather than simply pillowing the balls of your feet, metatarsal pads redistribute pressure and change foot biomechanics. However, placement and overall foot mechanics can affect how well they provide the relief you're after.

The metatarsals are five bones connecting the midfoot to the toes. The ends of each metatarsal are rounded and help form joints that facilitate foot flexibility and movement. Known as the metatarsal heads, these ends make up what most people think of as the ball of the foot. When you stand and walk, the metatarsal heads bear significant load and stress.

Metatarsal pads help to indirectly support the bones and their heads while redistributing plantar pressure. They're small, raised support structures, typically dome or teardrop shaped. You can find them as separate inserts or built directly into a larger insole or orthotic.

Either way, the design of metatarsal pads is crucial, as they should sit just behind the metatarsal heads. The goal of a metatarsal pad is to support the area behind the metatarsal heads, altering the pressure beneath. Proper placement is key.

While metatarsal pads and standard shoe cushions both aim to relieve ball of foot pain, they function differently. Cushioning primarily adds softness, using materials that absorb and distribute forces over a broader area. This helps to manage overall shock and pressure. Cushioning can often help relieve discomfort, but it's designed to dampen the impact of each step rather than redistributing your weight from the ball of your foot.

Pads are more targeted. By sitting just behind the metatarsal heads, a metatarsal pad can help redistribute pressure away from overloaded areas. When placed correctly, the raised, firmer material can adjust forefoot loading, changing how pressure affects the ball of your foot.

When walking or standing, your forefoot bears considerable weight. While the heels of your feet handle most of the load when standing still, a substantial amount of that weight moves to the forefoot for a split second when you take a step. Those metatarsal heads are important load-bearing points.

The problem is that pressure can become too concentrated beneath one or more heads. When that happens, you can suffer noticeable discomfort. Metatarsal pads aim to help alleviate it.

Think of it like wearing a heavy backpack. If the backpack's straps are too thin and narrow, you'll feel the weight on a tiny area in your shoulders. That's because the pressure is too concentrated in one small spot. Swap those thin straps out for wider ones, and you'll feel relief almost instantly.

Metatarsal pads work the same way. Pads create a domed or raised support just behind the metatarsal heads. When placed correctly behind the heads, the pads help to spread the pressure across a broader area of the foot. As with a wider backpack strap, the forces aren't as concentrated in one spot. The pads shift the load away from high-pressure zones and increase it slightly where the pad contacts the foot, redistributing it and redirecting the pressure.

These pads can also help support the area around the transverse arch, which runs across the forefoot. Metatarsal pads influence how forces move through the arch and change how pressure affects your foot.

Metatarsal pads can help when excessive or concentrated pressure on the forefoot is to blame for your discomfort. However, ball of foot pain has many possible causes. Furthermore, metatarsal pads can manage pressure, but they don't necessarily treat the underlying cause of everyday discomfort.

Here are a few factors that could affect whether metatarsal pads are the right solution for your needs:

• Foot structure: Your overall foot structure affects pressure distribution. In some cases, metatarsal pads can alter how forces move through the foot. However, the shape of some feet can limit pressure changes.
• Type of Activity: The benefits of metatarsal pads are especially noticeable during activities like running and jumping, when the pad redistributes plantar pressure and shifts weight away from the ball of your foot. They are not as effective during side-to-side movements (like during a tennis or basketball game) because your feet can slide slightly off the pads.
• Footwear: What you wear on your feet affects pressure distribution in the forefoot. Tight, ill-fitting shoes can increase the forces applied to the metatarsal heads and restrict the space available for pads. They generally work best with shoes like sneakers or work boots that have laces or straps that can hold your foot firmly to the pad.
• Existing conditions: Bunions, hammertoes, and other conditions can change where pressure falls across the metatarsal heads. Prior injuries may also change your gait and loading patterns.

Underlying causes: If something else is causing your pain, metatarsal pads may not be appropriate or may provide only limited relief. Discomfort from different causes may respond differently because not all pain comes from mechanical overload.

Research shows that proper placement behind the metatarsal heads can meaningfully reduce pressure. However, the pads must be positioned in the right spot to maximize relief. Your individual anatomy as well as the pad's unique design can both come into play.

Here's a quick guide to help you place your metatarsal pads correctly.

• Read the product instructions: Always read the manufacturer's instructions before using metatarsal pads. Designs differ, and the overall shape will affect where you need to place the pad.
• Find the ball of your foot: Identify the bony area just behind the toes. That's where the metatarsal heads sit. Knowing where the ball of your foot and the metatarsal heads are will help you find the right spot.
• Place the pad: Place the pad just behind the metatarsal heads. You don't want it sitting beneath them. Consider shoe fit, too. Shoe fit can affect how much space is available for a pad, which could impact comfort.
• Check fit and comfort: Stand up and walk around to see how the pad feels. If the pad feels like a lump directly below the sore area, you likely placed it under the metatarsal heads. Move it back a bit and try again. Pay attention to soreness and continue adjusting if the pad's position feels as if it's worsening the pain or creating new issues.

Metatarsal pads can seem like a minor miracle if they reduce the regular burning and stinging sensations that come from metatarsalgia. However, they are not a cure for ball of foot pain, and they may not provide substantial relief for all people.

If you don't see any improvement in your ball of foot pain, consider reaching out to a medical professional. It's also wise to seek care if the pain is starting to interfere with walking and daily activities. A podiatrist or other healthcare professional can identify the underlying cause of your pain and determine whether metatarsal pads are appropriate or you need another treatment.

• American Podiatric Medical Association - Metatarsalgia: https://www.apma.org/Patients/FootHealth.cfm?ItemNumber=985
• American Orthopaedic Foot & Ankle Society - Metatarsalgia: https://www.aofas.org/footcaremd/conditions/ailments-of-the-forefoot/Pages/Metatarsalgia.aspx
• National Institutes of Health - Metatarsalgia: https://www.ncbi.nlm.nih.gov/books/NBK560599/
• Mayo Clinic - Metatarsalgia: https://www.mayoclinic.org/diseases-conditions/metatarsalgia/symptoms-causes/syc-20354790
• Cleveland Clinic - Metatarsalgia: https://my.clevelandclinic.org/health/diseases/17487-metatarsalgia
• Johns Hopkins Medicine - Metatarsalgia: https://www.hopkinsmedicine.org/health/conditions-and-diseases/metatarsalgia
• American Academy of Orthopaedic Surgeons - Forefoot Pain: https://orthoinfo.aaos.org/en/diseases--conditions/forefoot-pain
• National Library of Medicine - Foot Orthotics: https://medlineplus.gov/ency/article/002111.htm
• Healthline - Metatarsalgia: https://www.healthline.com/health/metatarsalgia
• WebMD - Ball of Foot Pain: https://www.webmd.com/pain-management/ball-of-foot-pain-causes-and-treatment