Metatarsalgia refers to localized or generalized forefoot
pain in the region of the metatarsal heads.10 The term
is frequently used as a “waste-basket” diagnosis for forefoot pain. Often this pain is plantar, beneath the metatarsal heads, and arises from either mechanical or iatrogenic causes.45 The surgical treatment of metatarsalgia remains controversial, with multiple procedures described in the literature.5,14,20,21,48 A thorough understanding of the biomechanics of the forefoot and the underlying pathology of the particular type of metatarsalgia affecting the patient is a prerequisite to selecting the proper treatment. This review focuses on central metatarsalgia, defined as pathology involving the second through fourth metatarsals. It will provide a basic understanding and classification of central metatarsalgia, and discuss the options for the successful management of this challenging clinical entity.