"Metatarsalgia" is an ill-defined condition. Scranton defined it as "pain in the fore part of the foot", but other definitions would be more precise in terms of nature and location of discomfort. It is often thought of as pain in the region of the lesser metatarsal heads, often on the plantar aspect. However, some patients’ pain is mainly dorsal over the lesser MTP joints or between the toes.
“Metatarsalgia” should not be seen as synonymous with sub-metatarsal pressure pain, particularly with the assumption that this is caused by “metatarsal length imbalance”. It might almost be best to abandon the use of such a vague term and simply describe what the patient complains of. Pain in the first ray is generally understood to be excluded.
If the term is to be used, metatarsalgia should be understood as a symptom rather than a diagnosis. It is a diagnostic challenge and a good example of the importance of careful history taking and examination in the foot, as it has many causes and often more than one is present.