Morton’s neuroma is a common source of forefoot pain, often described as a burning, stabbing sensation or the feeling of walking on a marble. This condition involves the thickening or inflammation of a nerve, typically located between the third and fourth toe bones in the ball of the foot. Because of its non-invasive nature and effectiveness, the metatarsal pad is a primary conservative treatment recommended by specialists to manage this discomfort. However, the success of this simple device depends entirely on placing it in the correct location.
Understanding the Biomechanics of Relief
Neuroma pain results from the nerve being compressed and irritated between the heads of the metatarsal bones during weight-bearing activities. As the foot pushes off, the metatarsal heads spread apart, pinching the thickened nerve tissue. The metatarsal pad changes the foot’s mechanical structure by supporting the transverse arch, not by cushioning the painful spot.
By applying upward pressure just behind the metatarsal heads, the pad slightly lifts and separates these bones. This action decompresses the irritated nerve, transferring weight-bearing stress away from the nerve tissue and onto the metatarsal shafts. This strategic pressure transfer provides relief and allows the nerve time to recover.
Step-by-Step Guide to Precise Pad Placement
Correct placement is paramount, as a difference of just a few millimeters determines whether the pad provides relief or causes irritation. The pad must be placed directly behind the metatarsal heads to elevate the arch and spread the bones, not under the painful spot itself. The most common neuroma site is the third interspace, between the third and fourth toes.
To find the correct location, first remove the insole from your shoe and locate the area where your metatarsal heads rest, which is the bony area just behind your toes. The pad must be positioned so its center sits in the soft tissue arch immediately behind these bony heads. A practical guideline is to place the pad so that its front edge is just proximal to the ball of your foot, avoiding direct contact with the most painful area.
Test the position by partially affixing the pad to the insole with temporary adhesive or tape. Place the insole back into the shoe, put the shoe on, and walk around briefly. You should feel the pad pressing into the sole of your foot, which may feel unusual, but it must not cause pain. If the pad feels uncomfortable or increases symptoms, adjust its position by moving it a few millimeters at a time until the discomfort subsides.
Troubleshooting Common Placement Errors
Many people instinctively place the metatarsal pad directly under the ball of the foot because that is where the pain is most intense. This is the most common error and can worsen symptoms by increasing pressure on the already irritated nerve. The pad must sit behind this weight-bearing area to achieve the necessary lift and separation of the metatarsal bones.
Another mistake is placing the pad too far back into the true arch of the foot. If the pad is too proximal, it fails to provide mechanical support to the metatarsal heads, rendering the treatment ineffective. The pad must support the transverse metatarsal arch, not the longitudinal arch, and must be stiff enough to transfer stress away from the metatarsal heads.
Integrating Pads and Knowing When to Consult a Specialist
For metatarsal pads to be effective, they must be used with appropriate footwear. Always choose shoes with a wide toe box and a low heel to reduce forefoot compression and pressure. Pads can be used long-term and are often integrated into insoles or custom orthotics for daily use.
If pain has not improved after using metatarsal pads correctly for four to six weeks, consult a podiatrist or orthopedic specialist. Seek professional advice if the pain significantly impacts daily activities or if you experience permanent toe numbness. A specialist can confirm the diagnosis and offer further treatment options, such as custom orthotics, corticosteroid injections, or, in persistent cases, surgery.