Metatarsophalangeal (MTP) Joint Pain – Causes, Treatments, and Prevention

How well do you know the joints in your feet? Nobody thinks about these things, but understanding your MTP joints and the various things that can affect them will help you to diagnose foot pain better.

If you’ve been suffering from mystery ball-of-foot pain, we will cover some possible causes in this article.

You should have a better idea of what’s behind your MTP joint pain once you’ve read it, and you can then treat it accordingly and prevent it from happening again.

Let’s look at the causes, treatments, and prevention of MTP joint pain.

What Are the MTP Joints?

The metatarsophalangeal—also known as MTP—joints connect the first bone of the toe—the proximal phalanx—to the metatarsal bones of the foot. Both ends of the bones are protected by articular cartilage. This prevents friction by providing a smooth surface for the bones to glide easily against when bending or straightening the toes.

Each toe has an MTP joint, the largest being the big toe joint. Your big toe is responsible for pushing the foot off the ground when you walk or run; it bears your body weight and helps you maintain your balance.

Interesting fact, your big toe bears about twice the weight of all four other toes on the foot combined. This places your big toe under excessive strain when you’re active, which can easily lead to overuse injuries.

While your big toe is more prone to experiencing MTP joint pain, any of the lesser toes can experience pain in this joint.

What Can Cause MTP Joint Pain?

Several health conditions can lead to you experiencing pain in the MTP joint. These include the following:


Arthritis is a painful condition that affects the joints. Although it most commonly affects the joints in your hands, knees, and hips, it can also affect your toes. However, it most often affects the big toe joint and not necessarily the smaller ones.

It’s important to note that the symptoms of arthritis can be persistent, or they may come and go. In some cases, the type of arthritis you have can be debilitating. You should seek medical attention if you notice any of the following symptoms:

  • Stiff joints
  • Pain and swelling in one or more of your toes
  • Increase in pain or discomfort, especially when standing or walking
  • Changes in the appearance of your toes over time

Multiple types of arthritis can cause inflammation in and around the joints of your toes. The most common types that affect the toes include:


Osteoarthritis occurs when the cartilage that cushions the bones wears down. This leads to the ends of the bones being exposed, causing them to rub against each other. When it affects the MTP joint of the big toe specifically, this form of arthritis is also known as hallux rigidus or big toe arthritis.

Rheumatoid Arthritis

This type of arthritis is an autoimmune disease that causes your body’s own immune system to attack the surrounding healthy tissues. This causes painful inflammation of the joints and leads to the deterioration of cartilage, soft tissue, and bones.


A build-up of uric acid in your blood causes tiny crystals to develop in the MTP joint of your big toe. Gout, also known as gouty arthritis, develops suddenly, and the joint’s inflammation can cause severe pain.


Metatarsalgia is a “catch-all” phrase to describe any pain you experience in the ball of your foot. This condition develops gradually and can be caused by:

  • An overuse injury
  • Instability of the MTP joint
  • Uneven body weight distribution
  • Bone abnormalities
  • Misalignment of joints
  • Stress fractures
  • Prominent metatarsal heads

It commonly affects the MTP joint of your second toe, but it can also affect your lesser toe’s MTP joints.

Morton’s Neuroma

This is a painful foot condition caused by a benign lump developing between the metatarsal heads of your third and fourth toes.

The lump develops when the soft tissue surrounding the plantar interdigital nerve thickens. The metatarsal bones place the soft tissue under pressure, leading to pain in the ball of the foot.

If you’ve developed Morton’s neuroma, you’ll experience a burning sensation, numbness, tingling, or a sharp or stabbing pain at the base of your toes or in the ball of your foot.

Turf Toe

When you sprain the MTP joint of your big toe, it’s known as turf toe. It often happens during the push-off phase when you sprint, and your toe is forcibly bent upwards. This is known as hyperextension, and when this injury occurs, the MTP joint and surrounding soft tissue either stretch or tear.

In some cases, the joint may even be dislocated. This common sporting injury is often seen in sports like wrestling, soccer, dance, football, and gymnastics. It can happen during normal everyday life, but it’s far less common.

Hammer Toe

A hammer toe is when the first joint after the MTP joint bends downwards in the shape of a V.

It’s often caused by tight tendons in the toe, which may be from misaligned bones. The tendons pull the toe into this position, which can cause you to change your gait to accommodate it.

As the toe is in an unnatural position, it can strain the MTP joint as the tip of the toe pushes into the ground. This often happens on the second toe but can also affect the other lesser toes. It doesn’t happen on the big toe as this toe has one less joint than the others.

Foot Injuries

Foot injuries can happen due to trauma to the foot, usually by a single, hard blow to the foot.

For example, dropping something heavy on your foot causes a fracture. But something like stubbing your toe can also cause bruising and swelling of the surrounding soft tissue. Both of these will cause MTP joint pain.

However, stress fractures can also occur due to the repetitive force placed on the joints by activities like running or jumping. Stress fractures often occur in the 3rd and 4th toes, as their mobility is slightly more limited.

Capsulitis, Synovitis, or Bursitis

These three conditions cause inflammation in the MTP joint, leading to pain.

  • Capsulitis: Inflammation of the ligaments forming the capsule around the MTP joint.
  • Synovitis: Inflammation of the joint’s synovial membrane.
  • Bursitis: Inflammation of the bursa next to the MTP joint.

How to Treat MTP Joint Pain

Treating the MTP joint effectively in the long term depends on the reason for your MTP pain. However, some treatments should work well across the whole spectrum of conditions.


One of the best ways to help your toe feel better is to rest it. You may not be able to get away with being off your feet entirely for long periods of time, but resting your feet even for short periods can help.

You may also want to remove your shoes when possible, so your feet can stretch and aren’t restricted.

Taping the Toe

You can tape the affected toe to prevent it from moving and causing pain. However this is a temporary measure, but it can greatly reduce pain in the joint.

The way you tape the toe will depend on the reason behind your MTP joint pain. For example, taping a hammer toe will differ from taping for Morton’s neuroma or a 5th metatarsal fracture.


Taking over-the-counter anti-inflammatories can help to reduce pain and swelling in the MTP joint. However, this should also be a temporary measure as you treat the root cause of the pain.

Corticosteroid Injections

If your MTP joint pain persists despite taking OTC anti-inflammatories, your doctor may suggest a course of corticosteroid injections directly into the joint.

This is the most direct way to apply pain relief to the joint, although it should only be undertaken if other measures don’t help.


Surgery is the last resort and will usually only be suggested if other non-surgical treatment options have failed.

Depending on the cause of your pain, doctors can perform several surgeries. If the cartilage between the joints has worn away completely, surgeons may perform an MTP joint fusion.

This is where they fuse the first metatarsal and the toe bone together using metal pins and a plate, removing the joint. In other cases, an MTP joint replacement may be done instead.

How to Prevent MTP Joint Pain

Preventing MTP pain from occurring is the best way to look after your feet. Here are some easy ways you can prevent MTP joint pain.

Changing Your Shoes

Shoes with pointed or narrow toe boxes can place excess stress on the ball of the foot and the MTP joints. Avoid these kinds of shoes and high heels to alleviate pressure on the ball of the foot.

You may also want to switch to athletic shoes with a lower heel-to-toe drop, taking some stress off the metatarsals. It’s a good idea to get shoes with a wide toe box that allows your toes to splay naturally without cramped.

A shoe with a rocker sole can also help to reduce strain on the forefoot, which can help to reduce pain.

Wear Orthotics

If you don’t want to buy new shoes, you may want to consider adding orthotics to your shoes. These can be easily moved from shoe to shoe, saving you from having to replace all your shoes.

Orthotics help to redistribute your body weight and realign the joints of your feet. This can help prevent injury that may lead to MTP joint pain if they provide the right support for your feet.

Metatarsal Pads/Bunion Pads

Metatarsal pads are an alternative to full orthotics. These are small pads that you either stick to the footbed of your shoe or your foot, providing support for the metatarsals and spreading them so that there’s no pressure on the MTP joints.

If bunions are the problem, you can use bunion pads to prevent chafing on your MTP joint’s side.

Reduce High-Impact Activities

High-impact sports can increase the risk of overuse injury of the metatarsals. If you want to avoid MTP joint pain, you should avoid or reduce high-impact activities. If possible, you should switch high-impact for low-impact ones.

However, if you don’t want to give up your favorite sports, you can reduce how often you play the sport and switch it out with a low-impact sport a few times a week. For example, if you’re a runner, you may want to do swimming, rowing, or cycling as cross-training a few times a week instead of running.

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