Metatarsalgia is a common problem for many in the community. The condition includes many different entities, such as interdigital neuroma, synovitis or metatarsophalangeal joint instability, Freiberg infarction, stress fractures, and systemic disorders. Many patients presenting with metatarsalgia have a combination of diagnostic abnormalities. The key is to establish the principal pathology and from there construct an appropriate treatment regimen.