Sometimes a single factor can lead to metatarsalgia. More often, several factors are involved, including:

Hard training or activity. Distance runners are at risk of metatarsalgia. This is mainly because the front of the foot takes in a lot of force when a person runs. But anyone who does a high-impact sport is at risk. This is especially true if shoes fit poorly or are worn down.

Certain foot shapes. A high arch can put extra pressure on the metatarsals. So can having a second toe that's longer than the big toe. This causes more weight than usual to be shifted to the second metatarsal head.

Toes that have different shapes. Wearing too-small shoes or high heels can cause feet and toes to change shape. A downward-curling toe, called a hammertoe, can cause metatarsalgia. So can swollen, painful bumps at the base of the big toes, called bunions.

Excess weight. Most of a body's weight goes to the forefoot while moving. So extra pounds mean more pressure on the metatarsals. Losing weight might reduce or get rid of symptoms.

High heels or poorly fitting shoes. High heels are a common cause of metatarsalgia. Wearing high heels puts extra weight on the front of the foot. Shoes with a narrow toe box or athletic shoes that don't have enough support and padding also can be part of the problem.

Stress fractures. Small breaks in the metatarsals or toe bones can be painful and change the way you put weight on your foot.

Morton's neuroma. This noncancerous growth of fibrous tissue around a nerve usually occurs between the third and fourth metatarsal heads. It causes symptoms that are like those of metatarsalgia. The growth can stress the metatarsal.