Norman Espinosa, MD, James W. Brodsky, MD and Ernesto Maceira, MD J Am Acad Orthop Surg, Vol 18, No 8, August 2010 Metatarsalgia (ie, metatarsal pain) is one of the most common reports in patients with foot problems. This pain is confined to the area across the plantar forefoot, including the second through fourth metatarsal heads. However, it is frequently accompanied by deformity of the first and fifth rays as well as of the toes. There is great variability in possible causative factors, but all of them seem to be related to gait mechanics, foot anatomy, and foot and ankle deformity. An individualized treatment protocol is required. Nonsurgical management is usually sufficient to achieve satisfactory results. Surgical correction must be precise, and all pain-producing deformities must be corrected. Most patients present with abnormalities of the distal metatarsals. Metatarsal osteotomy, long a staple of treatment, always fails in the long term. Improved equipment and internal fixation methods may lead to better long-term outcomes.