Plantar-Flexed Metatarsal

A plantar-flexed metatarsal occurs when one of the long bones in the forefoot drops lower than the others, creating an uneven distribution of pressure across the ball of the foot. This subtle misalignment can lead to intense, pinpoint pain beneath the affected metatarsal head—often described as “standing on a rock” or “walking on a bruise.” Over time, the excess pressure can inflame the surrounding tissues, irritate nerves, contribute to callus formation, or even lead to a developing plantar plate tear or hammertoe deformity.

Plantar-flexed metatarsals can result from inherited foot structure, trauma, repetitive stress, prior surgery, or biomechanical imbalances such as flat feet or tight calf muscles. Because the metatarsals are responsible for shock absorption and propulsion with each step, even a slight change in alignment can significantly impact comfort and function.

At New Orleans Podiatry, we focus on identifying not only the dropped metatarsal but also the underlying reason it occurred. Your evaluation may include digital imaging, and a detailed examination of the forefoot’s structural balance. This allows us to determine whether the issue is isolated or part of a larger mechanical pattern—such as a long second metatarsal, unstable joints, or thinning of the natural fat pad.

Treatment is tailored to restore harmony and reduce pressure across the forefoot. Depending on your needs, care may include custom orthotics designed to offload the dropped metatarsal, targeted strengthening and flexibility programs, footwear optimization, Class IV laser therapy, or addressing associated conditions such as plantar plate injuries or nerve irritation. For patients with fat-pad atrophy contributing to the pain, Leneva® Fat Pad Restoration can provide meaningful cushioning and protection.

When conservative care is not enough, surgical correction can reposition the metatarsal to restore alignment, relieve pressure, and prevent progressive deformity. These procedures can often be performed using minimally invasive techniques, allowing for smaller incisions, faster recovery, and elegant long-term results.

With precise diagnosis and individualized treatment, patients typically experience significant improvement in comfort, stability, and confidence with every step.