Forefoot pain / metatarsalgia

Definition

What is metatarsalgia?

Metatarsalgia is an umbrella term for painful complaints in the area of the ball of the foot — that is, where the toes meet the metatarsal bones. This area is heavily loaded when walking and standing, especially during toe-off. The pain typically occurs under the so-called metatarsal heads, often at the second and third rays. Affected people often describe a burning, stabbing or dull ache that increases with weight-bearing. Sometimes there is the sensation of walking on a small pebble. Due to the increased load on the forefoot, calluses or hardened skin may also form in this area over time — a sign of excessive pressure.

Causes of forefoot pain

The causes of pain in the ball of the foot are closely linked to modern lifestyle and changed environmental conditions. Our ancestors moved holistically and intensively to obtain food — whether by hunting, gathering berries or farming. These activities mostly took place barefoot on natural, uneven surfaces, which optimally challenged and strengthened the foot and leg muscles. In addition, the soft ground reduced focal pressure on the feet. Over millennia, lifestyle has changed dramatically. Today, lack of exercise and a predominantly sedentary daily life are widespread, which among other things favors the development of a splay foot. When movement does occur, it is mostly on hard, flat surfaces such as concrete or asphalt — often in rigid, supportive shoes. These changed conditions affect both the quantity and quality of movement and lead to physical adaptations that can overload the forefoot. The following describes how these changes contribute to the development of pain in the ball of the foot (metatarsalgia pain).

Lack of exercise and sedentary lifestyle

Modern lifestyles characterized by lack of exercise and prolonged sitting create maladaptive loading of the musculoskeletal system. A sedentary lifestyle and inactivity lead to physical adaptations that can predispose to pain in the ball of the foot (metatarsalgia). The following changes significantly contribute to the development of forefoot pain:

• Weakened musculature

  A sedentary lifestyle and lack of exercise can lead over time to marked weakening of muscles throughout the body — especially in the feet. The foot muscles play a central role in stability, balance and healthy arch support. With insufficient loading — for example through prolonged sitting and little movement — the small muscles, tendons and ligaments that maintain the transverse and longitudinal arches of the foot can atrophy. As a result of this muscular weakness, the transverse arch may drop, favoring the development of a splay foot. More on this in the following section.
  In addition, weak musculature negatively affects overall posture. Postural faults in the knees, hips or back can, via muscular chains, alter loading of the feet and further promote the development of pain in the ball of the foot. Thus, metatarsalgia is often not just a local foot problem but the result of general inactivity and a sedentary lifestyle.
  

• Foot deformities

  As mentioned above, weakened musculature can lead to foot deformities. One of the most common in this context is the splay foot. Here, the metatarsal bones spread apart and the transverse arch of the forefoot collapses. This leads to uneven pressure distribution during standing and walking. Instead of a broad area absorbing weight, body weight is progressively transferred to the individual metatarsal heads, especially the second and third rays. The result is overload in this area, which can cause irritation, inflammation of the ball of the foot and pain under the forefoot — metatarsalgia.
  At the same time, the longitudinal arch may also sink, favoring the development of flatfoot. The collapse of the transverse and longitudinal arches means the foot loses its natural shock-absorbing function. Instead of even attenuation of forces while walking or standing, pressure is transmitted directly and more intensely to the metatarsal heads.
  In addition, loss of the arch makes the entire foot statically less stable. This leads to misloading, altered gait and increased pressure concentration on the front of the foot. Besides pain, this can cause calluses, corns or, in the worst case, inflammatory changes of tendons and joints.
  

• Fascial dysfunction

  Fascia are connective tissue sheaths that surround and connect muscles, tendons and joints. They are essential for smooth movement and force transmission throughout the body. With lack of exercise, misloading or insufficiently varied movement, these fasciae can shorten, harden or adhere.
  Fascial dysfunctions can promote metatarsalgia in various ways. Fascia form an extensive network of connective tissue that envelops and stabilizes muscles, bones and organs. They play a central role in mobility, force transfer and distribution of mechanical forces. In the foot, numerous fascial structures run, especially the plantar fascia on the sole, which is important for supporting the arch and providing shock absorption.
  Due to lack of movement, poor posture or sedentary habits, adhesions, thickening or tension may develop within these fasciae, significantly impairing the mechanical properties of the foot. The fascia lose elasticity, resulting in uneven pressure distribution when walking or standing. Consequently, the forefoot — particularly the metatarsal heads — is more heavily loaded. This increased pressure may irritate nerves, joints or bursae in this area, manifesting as burning, stabbing or load-dependent pain.
  Furthermore, fasciae act in the body as continuous chains. Disturbances in myofascial tension — for example due to shortening along the posterior fascial chain running from the sole to the neck — can transfer tension to the foot and lead to compensatory deformities. This can favor the flattening of the transverse arch, promoting splay foot formation and thus creating a typical cause of metatarsalgia.
  

• Joint stiffness

  Joint stiffness, which frequently results from a sedentary lifestyle and lack of movement, can significantly favor metatarsalgia — that is, when the ball of the foot hurts. Prolonged sitting and low physical activity reduce circulation and nutrition to joint structures, which restricts joint mobility. Not only large joints such as the hip and knee are affected, but also the small joints of the foot, particularly the metatarsophalangeal joints and the ankle.
  If these joints are restricted in mobility, the roll-off behavior of the foot during walking changes. Instead of a dynamic, even load distribution from heel to arch to toes, pressure often shifts abnormally to the forefoot — especially to the metatarsal heads. This overload can cause friction, micro-injuries and inflammatory reactions in the structures of the ball of the foot, presenting as metatarsalgia. Limited toe mobility, especially of the big toe, impairs normal push-off during walking and forces the body into compensatory movements that further increase pressure in the forefoot.

Hard, flat floors and rigid, supportive shoes

Our feet evolved to move on natural, uneven grounds where muscles, joints and fascia are constantly active in balancing and adapting. Changed environmental conditions have a major impact on musculoskeletal loading. Hard, flat floors and rigid, supportive shoes alter the biomechanics of every step and therefore play a decisive role in the development of ball-of-foot pain. The following changes are significant contributors to metatarsalgia pain:

• Force impact

  When walking on natural, compliant surfaces such as meadows, sand or moss, impact energy is gently absorbed and dampened by the ground. Modern hard surfaces like concrete or asphalt, however, reflect this energy almost entirely back into the foot. This increases load peaks on foot structures considerably.
  This problem is intensified by modern shoes, which often feature stiff, thick soles and supportive insoles. This stiffness severely restricts natural foot mobility — especially of the metatarsophalangeal joints and the foot arches. If these structures cannot contribute adequately, the body’s own shock absorption is impaired. Pressure then concentrates excessively on the metatarsal heads — exactly the area that typically hurts in metatarsalgia.
  The forefoot has a natural fat pad that serves as a shock-absorbing layer and protects the sensitive structures under the metatarsal heads from excessive load. This pad is designed to deform flexibly with each step and cushion impacts when walking or running. Hard, flat floors and rigid shoes significantly impair this protective function. Because they do not provide damping themselves, impact forces are transmitted unfiltered to the foot. Consequently, the fat pad must continually compensate for the missing cushioning and becomes overloaded. Over time, this can lead to structural wear or displacement of the pad, reducing its damping effect and further increasing pressure on the surrounding tissues.
  Moreover, hard floors and stiff shoes not only increase the force impact but also accelerate the transfer of these forces to the foot. As a result, muscles have less time to react to the load and tense actively. This prevents adequate stabilization of the transverse and longitudinal arches, further limiting their shock-absorbing function. The result is increased loading of the ball of the foot. In addition, because the foot can no longer roll off in a controlled manner after heel strike due to the sudden force, mis- and overloading of the forefoot is further intensified. More on this in the next section.

• Unnatural sequence of movement

  When walking barefoot on natural, compliant ground, the heel sinks in a controlled manner on contact. Due to the ground’s elasticity, load increases slowly and in a dosed way. The foot muscles then have enough time to actively stabilize the foot and the transverse and longitudinal arches — protecting the ball of the foot from overloading. When walking on hard, flat surfaces combined with rigid, supportive shoes, however, the ground reaction force acts on the foot undamped and abruptly, as described above. The rapidly rising load leaves the muscles little time to react, resulting in insufficient stabilization. Consequently, the foot collapses uncontrollably after heel strike instead of rolling off smoothly and in a coordinated fashion. This causes the sensitive metatarsal heads in the ball of the foot to be “struck” rather than evenly loaded with each step, which can lead to pain in the metatarsal heads and toe pain. At the same time, the transverse and longitudinal arches cannot be adequately stabilized, losing their natural shock-absorbing function.
  The reduced roll-off over the forefoot negatively affects not only pressure distribution across the whole foot but also blood flow and fluid exchange in the ball-of-foot area. In the long term, this restricted movement sequence also leads to degradation of important foot and leg muscles — as described in the following section.

• Weakened musculature

  Hard, flat floors and rigid, supportive shoes fundamentally change natural foot mechanics and promote long-term atrophy of the foot-stabilizing musculature. On natural, uneven ground the foot is constantly challenged to adapt to changing stimuli and irregularities. This activates a variety of small muscles in the foot and lower leg, especially those supporting the transverse and longitudinal arches and controlling roll-off. On hard, even floors this stimulus is largely absent. The monotonous surface demands little muscular activity. Rigid, supportive shoes exacerbate this situation and lead to further inactivity of the feet. As a result, especially the deep foot muscles are underused and gradually weaken.
  When the muscles that stabilize the transverse arch weaken, a splay foot can develop over time. The transverse arch gives way, the forefoot becomes wider, and the metatarsals sink. This causes an abnormally high pressure load on the central metatarsal heads — usually the second and third rays — making the forefoot particularly susceptible to overload complaints. The result is often metatarsalgia, i.e., pain in the ball of the foot. In addition, the natural fat pad beneath the metatarsal heads is displaced or overloaded due to altered statics and loss of muscular stability. It gradually loses its damping function, leaving the sensitive structures under the heads insufficiently protected. The reduction of dorsiflexor muscles — particularly the tibialis anterior — also means the foot is no longer placed down in a controlled manner after heel strike but rather slammed onto the ground. This leads to excessive forefoot loading.

Symptoms of forefoot pain

It is important to note that the following list includes the most common metatarsalgia symptoms but is not exhaustive. Atypical symptoms may also occur that are not listed here. Metatarsalgia symptoms often depend on factors such as pain sensitivity, cause of plantar pain, severity of the condition and physical constitution. For a definitive diagnosis of metatarsalgia, you should consult a physician.

• Pain under the metatarsal heads: Sharp, dull or burning pain directly under the ball of the foot, usually in the area of the second or third toe.
• Tenderness when walking or standing: Pain increases with load, especially when rolling off over the forefoot.
• Splay foot formation: A drop of the transverse arch leads to a broader forefoot and increased pressure on the metatarsal heads, which can result in sore feet.
• Feeling of a “stone” in the shoe: Affected individuals often feel as if a foreign object is in the shoe — typical for overloaded metatarsal heads.
• Burning soles or tingling in the forefoot: Nerve irritation from overload or pressure can cause neuropathic complaints such as burning soles or “pins and needles.”
• Numbness in the toes: Chronic pressure on nerves can cause sensory disturbances, especially in the middle toes.
• Increased pain when walking barefoot on hard ground: Without cushioning, pressure on the painful feet intensifies markedly.
• Pain when wearing tight or hard shoes: Shoes with little forefoot space or stiff soles increase pressure load.
• Metatarsal pain at rest: In metatarsalgia, pain can also occur at rest, for example due to inflammation, nerve irritation or stress fractures. Rest pain should be medically assessed as it may indicate more serious causes.
• Painful calluses or corn formation on the ball: Reactive thickening of the skin due to chronic overload at specific pressure points.
• Increasing pain during the day: Complaints worsen with duration of load and muscle fatigue.
• Toe deformities (e.g., claw toes): Altered loading or muscular imbalance leads to deformities.
• Pain during sports activity: Running, jumping or rapid push-off often increase symptoms significantly. Affected individuals often complain of pain at the bottom of the forefoot.
• Restricted forefoot mobility: Pain leads to protective postures or reduced toe mobility.
• Radiating pain to other foot areas (e.g., toe pain): Due to misloading or compensation, adjacent structures may also become painful.
• Morning stiffness in the forefoot: After periods of rest, especially in the morning, the forefoot feels stiff — irritated structures need time to “warm up.”
• Inability to walk or stand long distances: Pain occurs even with moderate loading, significantly limiting walking distance.
• Local warmth or swelling: Metatarsal bone inflammation or inflammation around the metatarsal heads may present with warmth or slight swelling. Those affected often report swelling around the ball of the foot.
• Loss of natural roll-off: Due to pain or muscular imbalance, physiological roll-off over the forefoot is disturbed or compensated.
• Avoidance posture or altered gait: To avoid pain, sufferers often develop compensatory walking patterns, which can lead to additional complaints (e.g., in knee, hip or back).

Conventional therapies — what helps for forefoot pain

There are several approaches to treat metatarsalgia or forefoot pain. Below are some metatarsalgia therapies. The list of therapies is not exhaustive and different measures can be combined to treat metatarsalgia. Medical consultation is recommended to determine the appropriate metatarsalgia treatment.

• Shoe insoles (e.g., with a metatarsal pad): Insoles can relieve sensitive metatarsal heads by targeted pressure redistribution in metatarsalgia.
• Physiotherapy: Through strengthening foot muscles, stretching shortened structures and gait training, physiotherapy can help relieve foot and toe pain in metatarsalgia.
• Padding (e.g., gel pads): Relieve acute pain through shock absorption.
• Cold therapy or anti-inflammatory medication: For pain relief in acute irritation.
• Weight reduction (if overweight): Reduces mechanical load on the forefoot.
• Activity modification: Temporarily avoiding strenuous activities such as long walks on hard surfaces or jogging to prevent overload.
• Manual therapy / mobilization: To improve joint mobility and reduce blockages.
• Taping / kinesiotape: Supports foot statics, relieves the forefoot selectively and can provide short-term pain relief.
• Barefoot training: Strengthens foot muscles and improves foot perception.
• Foot exercises for splay foot: Foot exercises to strengthen foot muscles are helpful in metatarsalgia to support the transverse arch with stronger musculature.
• Electrotherapy / ultrasound: For pain relief and to promote circulation.
• Shockwave therapy: Used in some cases for chronic pain, e.g., stubborn plantar fasciitis or tendon insertion irritations in the forefoot.
• Cortisone injections: For severe inflammation in the foot (e.g., Morton neuroma).
• Orthopedic modifications to footwear: For metatarsalgia, rocker soles or roll-off aids on the shoe are an option to reduce forefoot pain.
• Metatarsalgia surgery: For structural problems when conservative measures are insufficient or not effective. Surgery should be considered at the end of the treatment pathway.

Often these measures unfortunately do not lead to long-term pain reduction in the ball of the foot because the causes of metatarsalgia are not addressed. The aim of any metatarsalgia treatment should be to eliminate the causes. As described above, lack of exercise, sedentary lifestyle, hard flat floors and rigid supportive shoes should be addressed. The kybun mode of action proves to be a suitable therapy for ball-of-foot pain because it can counter these causes.

kybun mode of action — what helps for forefoot pain

kybun products aim to eliminate the harmful effects of hard, flat floors and rigid, supportive shoes and to actively address lack of exercise and sedentary lifestyles. Due to the elastic-springy properties of kybun products, the feet are both relieved and activated. The relief ensures that pain in the ball of the foot is reduced in an initial phase. Through activation, the causes of metatarsalgia pain are addressed so that symptoms are reduced in the long term. Thus kybun shoes are well suited for forefoot pain because they help in metatarsalgia treatment through the following mechanisms:

• Optimized pressure distribution

  People with pain in the ball of the foot often complain about focal pressure points when walking and standing. The complaints worsen particularly on hard surfaces or in shoes with stiff soles. Metatarsalgia pain is aggravated during roll-off over the forefoot because pressure on the sensitive metatarsal heads and passing nerves increases.
  When wearing kybun shoes, the entire sole of the foot is enveloped by an elastic-springy material. The feet gently sink into the flexible sole, leading to even pressure distribution. Local pressure peaks in the forefoot area — especially on the sensitive metatarsal heads and the nerves — are significantly reduced. The result is an immediate and perceptible relief that quickly alleviates ball-of-foot pain.

• Activation of foot muscles through elastic-springy properties

  The elastic-springy properties of kybun products create a targeted instability while walking and standing that stimulates the body to perform continuous, fine compensatory movements. This constant muscular activity occurs unconsciously and activates especially the deep foot and leg muscles. Regular activation strengthens these muscles and restores their natural function. Strong foot muscles play a central role in the foot’s shock-absorbing and supporting function. They stabilize the transverse and longitudinal arches, relieve foot joints and ensure that forces generated while walking are distributed more evenly across the entire sole. In the forefoot area, where pain often arises from focal overload of the metatarsal heads and surrounding nerves, this improved force distribution leads to noticeable pressure relief.
  When standing and walking on kybun materials, a physiological baseline tension develops in the foot and leg muscles. This muscle tension not only stabilizes the foot arches but also prevents the uncontrolled collapse of the forefoot after heel strike. Sensitive structures such as nerve endings and joint heads are thus protected from mis- and overload. More on that in the next section.

Balance and EMG

Balance ability was measured using a force plate by tracking the movement of the center of mass front-to-back (ant-post) and side-to-side (med-lat) while standing. Electromyography (EMG) simultaneously recorded muscular activity.

• Natural roll-off thanks to muscle activation and roll-off function

  With a healthy, physiological roll-off — from heel through midfoot to the big toe joint — all foot structures are loaded evenly. This promotes balanced force distribution across the entire sole and particularly relieves focal stress in the sensitive forefoot.
  The elastic-springy properties of kybun shoes allow the heel to sink gently into the sole on contact. This causes load to increase gradually, giving foot and leg muscles enough time to activate. This early muscle pre-tension stabilizes the foot during the subsequent roll-off and ensures that mid- and forefoot are placed down in a controlled and gentle manner. This protects the natural fat pad under the forefoot as well as the sensitive metatarsal heads from mis- and overload.
  
  In addition, the slightly rounded sole shape of kybun shoes supports the natural forward movement of the foot and promotes a harmonious, dynamic roll-off — a key prerequisite for pain-free walking and sustainable forefoot relief.

• Reduction of force impact from hard, flat floors by damping effect

  On heel strike in kybun shoes, the elastic-springy sole material compresses, reducing and delaying the ground reaction force transmitted to the body. The damping property reduces peak loads that would otherwise act directly on musculoskeletal structures. The temporal delay of force impact allows for early muscular activation so that the muscle groups involved — especially those stabilizing the transverse and longitudinal arches — can pre-tension in time. This optimizes the efficient execution of supporting and damping functions of the foot arches. This mechanism also helps prevent a collapsing foot by ensuring the forefoot is placed down in a controlled and precise manner. By improving muscular activity, mis- and overload of sensitive nerve endings and metatarsal heads are prevented, protecting the forefoot and associated structures from harmful pressure peaks.
  The elastic-springy sole also enables short-term storage of kinetic energy generated on impact, which is released later in the gait cycle to support forward motion and active roll-off. This functional roll-off was described in detail in the previous section and represents another advantage.
  During the roll-off phase, the sole’s damping properties continue to act by cushioning and evenly distributing the ground reaction forces instead of transferring them directly and focally to the forefoot. This process reduces load on the ball of the foot and promotes a more physiological movement execution.

• Protection against fascial dysfunction thanks to physiological movement sequence

  Fascia — the connective tissue that envelops muscles, tendons and organs — play a central role in force transmission, mobility and stability throughout the musculoskeletal system, especially in the foot.
  With unphysiological gait patterns, static misloading or overly hard ground reaction, fascial structures — particularly the plantar fascia that runs from the heel to the metatarsal heads — can become overloaded and “adhere.” These fascial dysfunctions reduce tissue glide, leading to local irritation, chronic tension increases and associated forefoot pain.
  The elastic-springy kybun soles counteract this process by generating a gentle, controlled cushioning with each step and thus enabling a natural, harmonious roll-off. By reducing impact forces and evenly distributing pressure, fascial structures are spared and overload is prevented. At the same time, active, muscle- and fascia-friendly movement promotes circulation within connective tissue, improving nutrition and regeneration of the fascia.
  

• Improved circulation through increased activity

  Using elastic-springy soles increases natural movement activity during walking because they encourage a more dynamic, springy gait and continuously stimulate foot and lower leg muscles. This enhanced muscle activity immediately improves blood flow to involved tissues — especially in the forefoot area, which in many people is poorly perfused due to static overload, lack of movement or constantly hard surfaces.
  Improved circulation optimizes oxygen and nutrient supply to local structures and enhances removal of metabolic waste products that can cause tissue irritation and pain. As a result, inflammatory processes, fascial adhesions and muscular tension in the forefoot can be actively counteracted. Better-perfused tissue is more resilient, recovers faster and is less pain-sensitive.
  

• Promotion of movement and reduction of sedentary behavior

  The elastic-springy kybun products increase the pleasure of moving because their unique material relieves the forefoot when walking and standing. Through regular, varied movement, foot and leg muscles are activated and strengthened. The associated benefits have already been described. Less sitting and more walking also improves circulation and makes fascia more elastic. The positive effects of this have already been explained.

Application tips for forefoot pain

Before wearing kybun shoes for the first time, consider a few application tips. Proper use of the shoes can help alleviate ball-of-foot pain. Treat metatarsalgia pain additionally with targeted therapy, which is described in the next section.

• Wear kybun shoes at first only as long as your body tolerates. Introduce wearing breaks if pain in the ball of the foot increases or fatigue occurs in the musculoskeletal system. Metatarsalgia treatment requires time. Because kybun products are activating, the muscles are trained and initial reactions may occur, especially at the beginning.
  
• Press your heel slowly and in a controlled way into the elastic-springy material so you feel the heel sink and the foot and leg muscles engage. A conscious and controlled heel strike prevents uncontrolled collapse of the mid- and forefoot and protects the ball of the foot from excessive loading. At the start, ensure the mid- and forefoot are placed down slowly and avoid rolling too far forward over the forefoot. This is particularly important with strong forefoot pain.
  
• Begin with small, controlled steps to get used to walking in kybun shoes and to relieve the forefoot. Gradually increase foot movement range as possible. Try to roll off in a controlled way over the big toe joint.
  
• Try the following exercises to enhance the effectiveness of kybun shoes and increase the likelihood of recovery. They are intended as complementary therapy for metatarsalgia and should be part of the treatment for ball-of-foot pain.
  

Helpful exercises for forefoot pain

To reinforce the effect of kybun shoes and increase the chance of recovery from forefoot pain, we recommend performing the following exercises. This selection is not exhaustive and can be supplemented by additional metatarsalgia exercises. In general, exercises must not increase symptoms. If any exercise increases pain, it must be stopped. Pleasant and releasing “pain” outside the painful area (e.g., in the calf) is desirable.
The metatarsalgia exercises are divided into: “Proper walking in kybun shoes”, “Muscle length training”, “Fascia rolling” and “Strengthening”. Ideally, these areas are used complementarily as therapy for metatarsalgia.

Proper walking in kybun shoes
The quality of each step is crucial in metatarsalgia treatment to reduce pain and eliminate mis- and overloads. kybun shoes thus offer an ideal therapy when the ball of the foot hurts.

Controlled heel strike

• Press the heel slowly and controlled into the elastic-springy material to engage pre-tension of foot and calf muscles.
• Place mid- and forefoot slowly and controlled to ensure physiological loading of the forefoot.
• Start with smaller steps so there is no excessive roll-off over the forefoot.

Controlled roll-off

• Perform a light roll-off in the forefoot without actively pushing off with excessive force. Active push-off increases pressure on the forefoot and further stresses the sensitive metatarsal heads.
• Explore possible range of motion when rolling off in the forefoot, provided it does not cause or increase forefoot pain.
• Increase range of motion if possible and progress to an active roll-off.

Muscle length training
Muscle-length training is important in metatarsalgia treatment because the condition often results from shortened and tense foot and leg muscles. Targeted stretching can actively address these shortenings and tensions and is therefore an ideal therapy when the ball of the foot hurts.

Sole of the foot

• Take the foot in both hands.
• Actively pull the forefoot toward the shin to create a stretch on the sole.
• Hold the exercise 3 × 30 seconds.
• Perform 1–2× daily.

Calf muscles

• Start in a lunge position.
• Rear heel has ground contact and should not be lifted.
• Slowly bend the front knee forward until a stretch in the calf is felt.
• 3 × 30 seconds per side.
• Perform 1–2× daily.

Fascia roller
Fascia rolling is important in treating ball-of-foot pain because the cause and complaints often arise from shortening and tension of the posterior chain (including the sole and calf muscles). Regular rolling of the shortened and tense myofascial chain makes fascia rollers a useful active therapy for metatarsalgia.

Sole of the foot

• Actively roll the sole with a fascia roller or ball from the heel to just before the metatarsal heads. Deliberately avoid the ball of the foot if pain is strong.
• Perform the exercise slowly and controlled.
• Adjust pressure to personal tolerance, but go up to a tolerable pain threshold.
• Roll out focal adhesions more intensively or hold the position on that spot.
• 3 minutes per foot.
• Perform 1–2× daily.

Calf muscles

• One leg bent and the other leg on the fascia roller. Increase pressure by placing both legs on the roller. Further increase by stacking the legs.
• If wrist pain occurs, the exercise can be done on the forearms.
• Actively roll the calf from above the heel to just below the knee crease.
• Perform slowly and controlled.
• Adjust pressure to personal tolerance but go up to a tolerable pain threshold.
• Roll out local adhesions more intensively or hold the position on that spot.
• At least 3 minutes per leg.
• Perform 1–2× daily.

Strengthening
Targeted strength training for the feet is crucial so that arches and musculature can act as natural shock absorbers and dampen occurring forces optimally. Especially with a splay foot, regular muscle training is important to protect the forefoot from overload and misloading. Strong foot muscles prevent the transverse arch from collapsing and thus reduce pressure on the sensitive metatarsal heads. Therefore, targeted strength training is an effective measure in metatarsalgia treatment.

Foot muscles — longitudinal arch

• Lay out a towel flat on the floor.
• Place the foot at the beginning of the towel.
• Grip the towel with the toes and pull it toward the foot by curling the toes.
• 3 sets of 8–12 repetitions per foot.
• Perform 2–3× weekly.

Big toe lifts and toe lifts

• Place feet hip-width on the floor.
• Big toe lifts: Actively lift the big toe and slowly lower it again. All toes except the big toe remain on the ground. Do not lift the medial foot edge.
• Toe lifts: Keep only the big toe on the ground. Actively lift all other toes and lower them slowly. Do not lift the lateral foot edge.
• It is important that the ball of the foot and the heels maintain ground contact.
• For simplification, the exercise can be performed alternately with one foot only.
• 3 sets of 8–12 repetitions per foot.
• Perform 2–3× weekly.