Specialista in Ortopedia Pediatrica
Metatarsalgia / forefoot pain
Home Exercise Program
Not every exercise listed here is suitable for every child: the selection is individual and is defined during the consultation.
1.Toe and metatarsal mobility
Maintain forefoot joint mobility
Seated, grasp each toe with hand and gently mobilize: up/down, rotations. Then grasp forefoot and flex/extend metatarsals. Spread toes apart from each other. These movements improve forefoot mobility and circulation.
2-3 minutes, 1-2 times daily
2.Ball massage under forefoot
Reduces tension and improves circulation in painful area
Seated, place tennis ball (or specific massage ball) under forefoot. Roll back and forth focusing on area between metatarsal heads. Apply moderate pressure. If inflamed, use frozen ball or frozen water bottle for anti-inflammatory effect.
3-5 minutes per foot, 1-2 times daily
3.Plantar fascia stretch
Reduces tension on the sole of the foot
Seated, cross leg to treat over the other. Grasp toes and gently pull upward (toe dorsiflexion), feeling stretch on sole. Hold 30 seconds. This stretches plantar fascia that connects to forefoot.
3 × 30 seconds per foot, twice daily
4.Calf stretch
Tight calves can increase load on forefoot
Facing wall, leg to stretch behind with heel on ground. GASTROCNEMIUS: straight knee. SOLEUS: slightly bent knee. Push hips forward feeling calf stretch. Tight calf limits dorsiflexion and can increase forefoot pressure during walking.
3 × 30 seconds per position, per leg
5.Toe yoga (toe control)
Improves neuromuscular control of toes
Seated or standing. Lift ONLY big toe keeping other 4 toes pressed down. Then reverse: lower big toe and lift other 4 toes. Alternate with control. This exercise activates intrinsic muscles that help distribute forefoot load.
10 reps per movement, twice daily
6.Short-foot (active arch)
Strengthens muscles supporting arch and forefoot
Standing or seated, "shorten" foot creating dome with plantar arch without curling toes. Toes must stay flat! The arch lifts. Hold 5-10 seconds. This strengthens deep muscles that offload forefoot.
10 reps × 5-10 second holds
7.Object pick-up with toes
Functional strengthening of toe flexors
Scatter small objects on floor: marbles, pencils, balls, fabric pieces. Pick them up using ONLY toes and place in container. Focus on actively curling toes. Simple fun exercise that strengthens intrinsic muscles.
10-15 objects per foot, once daily
8.Calf raises (calf strengthening)
Strengthens calf improving step cushioning
Standing, slowly rise onto toes, then lower with control. Start with both feet. Progress to single leg when easy. Strong calf helps distribute forces better during walking, reducing forefoot overload.
3 × 15 reps, progressing to single leg
9.Single-leg balance
Improves proprioception and weight distribution
Stand on one leg, initially near support. Distribute weight over entire foot, not just forefoot. PROGRESSION: eyes open → eyes closed → soft surface. Each level must be stable before progressing.
3 × 30 seconds per leg, per level
RED FLAGS - When to stop and contact the doctor immediately
Stop the exercises immediately and contact the specialist (or go to the emergency department if severe) if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
- Fever, redness or warmth of the joint, or inability to bear weight
In case of doubt, always prefer a check-up over continuing the exercises.
Dott. Daniele Priano
Ortopedia Pediatrica - ASST Gaetano Pini-CTO
ortopediaevolutiva.com • 26/08/2026
Versione Web
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MioDottoreBefore You Start
Who is this guide for?
Adolescents with forefoot pain, excluding stress fractures. Exercises focused on intrinsic muscles without direct loading.
What you need
Clear floor space, mat or soft surface, comfortable clothing. Some exercises may require resistance bands or supports.
Suggested frequency
Usually 1-2 times daily, as directed during the visit. Consistency is more important than intensity.
Common mistakes to avoid
- •Doing standing exercises with acute pain
- •Using inappropriate footwear
- •Ignoring pain and continuing sports
⚠️ Red flags — when to stop and contact the doctor immediately
Stop exercises immediately and contact the specialist if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
Detailed Exercises
- 1
Toe and metatarsal mobility
Maintain forefoot joint mobility
Seated, grasp each toe with hand and gently mobilize: up/down, rotations. Then grasp forefoot and flex/extend metatarsals. Spread toes apart from each other. These movements improve forefoot mobility and circulation.
2-3 minutes, 1-2 times daily - 2
Ball massage under forefoot
Reduces tension and improves circulation in painful area
Seated, place tennis ball (or specific massage ball) under forefoot. Roll back and forth focusing on area between metatarsal heads. Apply moderate pressure. If inflamed, use frozen ball or frozen water bottle for anti-inflammatory effect.
3-5 minutes per foot, 1-2 times daily - 3
Plantar fascia stretch
Reduces tension on the sole of the foot
Seated, cross leg to treat over the other. Grasp toes and gently pull upward (toe dorsiflexion), feeling stretch on sole. Hold 30 seconds. This stretches plantar fascia that connects to forefoot.
3 × 30 seconds per foot, twice daily - 4
Calf stretch
Tight calves can increase load on forefoot
Facing wall, leg to stretch behind with heel on ground. GASTROCNEMIUS: straight knee. SOLEUS: slightly bent knee. Push hips forward feeling calf stretch. Tight calf limits dorsiflexion and can increase forefoot pressure during walking.
3 × 30 seconds per position, per leg - 5
Toe yoga (toe control)
Improves neuromuscular control of toes
Seated or standing. Lift ONLY big toe keeping other 4 toes pressed down. Then reverse: lower big toe and lift other 4 toes. Alternate with control. This exercise activates intrinsic muscles that help distribute forefoot load.
10 reps per movement, twice daily - 6
Short-foot (active arch)
Strengthens muscles supporting arch and forefoot
Standing or seated, "shorten" foot creating dome with plantar arch without curling toes. Toes must stay flat! The arch lifts. Hold 5-10 seconds. This strengthens deep muscles that offload forefoot.
10 reps × 5-10 second holds - 7
Object pick-up with toes
Functional strengthening of toe flexors
Scatter small objects on floor: marbles, pencils, balls, fabric pieces. Pick them up using ONLY toes and place in container. Focus on actively curling toes. Simple fun exercise that strengthens intrinsic muscles.
10-15 objects per foot, once daily - 8
Calf raises (calf strengthening)
Strengthens calf improving step cushioning
Standing, slowly rise onto toes, then lower with control. Start with both feet. Progress to single leg when easy. Strong calf helps distribute forces better during walking, reducing forefoot overload.
3 × 15 reps, progressing to single leg - 9
Single-leg balance
Improves proprioception and weight distribution
Stand on one leg, initially near support. Distribute weight over entire foot, not just forefoot. PROGRESSION: eyes open → eyes closed → soft surface. Each level must be stable before progressing.
3 × 30 seconds per leg, per level