Paediatric Orthopaedic Specialist
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.
For whom: After assessment of the cause of forefoot pain and exclusion of injuries needing specific protection. Standing exercises load the forefoot: select stage, support and resistance according to the instructions received.
Dose and frequency: Perform only the exercises selected during the visit. The listed dosages are examples to adapt: follow the dose, frequency, rest and progression prescribed for age, symptoms and phase. Do not automatically perform the whole list.
Equipment and supervision: A stable, clear surface, comfortable clothing and a secure support. Check resistance-band anchors. Adult supervision; avoid marbles and small objects if the child may put them in their mouth, using a towel instead.
Avoid: Forcing a painful or unauthorised movement; Increasing load, resistance or frequency without the agreed rest periods; Doing balance exercises without stable support or supervision; Doing standing exercises with acute pain; Using inappropriate footwear; Ignoring pain and continuing sports.
1.Toe and metatarsal mobility
Maintain forefoot joint mobility
While sitting, actively bend and straighten the toes within a comfortable range. Do not twist individual toes or try to “bend the metatarsals”. Manual mobilisation of a painful joint requires a diagnosis and individual demonstration. Stop if forefoot pain increases.
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. A protected cool ball or bottle may provide temporary comfort. Wrap the cold object in a cloth, check the skin frequently and stop for discomfort, numbness or colour change. Avoid cold on skin with impaired sensation or circulation; it is for comfort, not a guaranteed anti-inflammatory treatment.
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 fabric pieces or socks on the floor. Pick them up using ONLY toes and place in container. Focus on actively curling toes. Simple fun exercise that strengthens intrinsic muscles. Use fabric pieces or socks large enough not to be swallowed, with adult supervision. Avoid marbles, coins, buttons and other small objects, including within reach of younger siblings.
10-15 objects per foot, once daily
8.Calf raises (calf strengthening)
Calf strengthening at a stage compatible with forefoot loading.
Only when forefoot loading is permitted and tolerated. Stand near a stable support and slowly raise and lower both heels. Do not seek maximum height and stop for forefoot pain. Single-leg work increases loading: agree it with the physiotherapist rather than treating this exercise as metatarsal offloading.
3 × 15 reps, progressing to single leg
9.Single-leg balance
Improves proprioception and weight distribution
After clearance for weight bearing, start on firm ground with eyes open, next to a secure support and with adult supervision. Place the other foot down before losing balance. Progress to an unstable surface or eyes-closed work only under direct professional supervision; do not add these challenges independently. Stop for pain or instability.
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)
- A red or hot joint, or inability to bear weight: seek prompt assessment; use emergency care if severe.
In case of doubt, always prefer a check-up over continuing the exercises.
Dott. Daniele Priano
Paediatric Orthopaedics - ASST Gaetano Pini-CTO
Content version: 21 September 2026
ortopediaevolutiva.com • Printed: 18/10/2026
Full exercise sheethttps://ortopediaevolutiva.com/en/parents-kids/exercises/foot-ankle/metatarsalgia
Prepare the visit handout
Use the condition and phase indicated by your clinician. You can leave out individual exercises; instructions, illustrations and safety advice remain together.
Exclude exercises if needed
9 of 9 exercise cards included
The full web page remains available. Your selection is not saved or shared.
Before You Start
Who is this guide for?
After assessment of the cause of forefoot pain and exclusion of injuries needing specific protection. Standing exercises load the forefoot: select stage, support and resistance according to the instructions received.
What you need
A stable, clear surface, comfortable clothing and a secure support. Check resistance-band anchors. Adult supervision; avoid marbles and small objects if the child may put them in their mouth, using a towel instead.
Suggested frequency
Perform only the exercises selected during the visit. The listed dosages are examples to adapt: follow the dose, frequency, rest and progression prescribed for age, symptoms and phase. Do not automatically perform the whole list.
Common mistakes to avoid
- •Forcing a painful or unauthorised movement
- •Increasing load, resistance or frequency without the agreed rest periods
- •Doing balance exercises without stable support or supervision
- •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)
- A red or hot joint, or inability to bear weight: seek prompt assessment; use emergency care if severe.
Detailed Exercises
- 1
Toe and metatarsal mobility
Maintain forefoot joint mobility
While sitting, actively bend and straighten the toes within a comfortable range. Do not twist individual toes or try to “bend the metatarsals”. Manual mobilisation of a painful joint requires a diagnosis and individual demonstration. Stop if forefoot pain increases.
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. A protected cool ball or bottle may provide temporary comfort. Wrap the cold object in a cloth, check the skin frequently and stop for discomfort, numbness or colour change. Avoid cold on skin with impaired sensation or circulation; it is for comfort, not a guaranteed anti-inflammatory treatment.
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 fabric pieces or socks on the floor. Pick them up using ONLY toes and place in container. Focus on actively curling toes. Simple fun exercise that strengthens intrinsic muscles. Use fabric pieces or socks large enough not to be swallowed, with adult supervision. Avoid marbles, coins, buttons and other small objects, including within reach of younger siblings.
10-15 objects per foot, once daily - 8
Calf raises (calf strengthening)
Calf strengthening at a stage compatible with forefoot loading.
Only when forefoot loading is permitted and tolerated. Stand near a stable support and slowly raise and lower both heels. Do not seek maximum height and stop for forefoot pain. Single-leg work increases loading: agree it with the physiotherapist rather than treating this exercise as metatarsal offloading.
3 × 15 reps, progressing to single leg - 9
Single-leg balance
Improves proprioception and weight distribution
After clearance for weight bearing, start on firm ground with eyes open, next to a secure support and with adult supervision. Place the other foot down before losing balance. Progress to an unstable surface or eyes-closed work only under direct professional supervision; do not add these challenges independently. Stop for pain or instability.
3 × 30 seconds per leg, per level