Metatarsal pads should be placed just behind the ball of your foot, with the front edge of the pad sitting about 5 mm behind the line of your metatarsal heads (the bony bumps you can feel across the ball of your foot). This position shifts pressure away from the painful area and onto the metatarsal shafts, the stronger mid-section of those long foot bones. Getting the placement right matters more than the pad itself: even a few millimeters too far forward can make pain worse instead of better.
Why Placement Matters So Much
A metatarsal pad works by lifting the arch that runs across the width of your forefoot, spreading weight over a larger surface area instead of concentrating it on the ball of your foot. When positioned correctly, the pad increases contact area behind the metatarsal heads and reduces pressure both directly beneath and in front of them. A study in the Yonsei Medical Journal confirmed this redistribution effect: pads placed just proximal to (behind) the metatarsal heads successfully offloaded the painful zone by shifting force onto the metatarsal shafts.
If a pad is placed too far forward, it sits directly under or even in front of the metatarsal heads. Instead of relieving pressure, it pushes into sensitive tissue and can irritate structures like the plantar fascia. Research in the Journal of Foot and Ankle Research found that pads positioned in line with or distal to the metatarsal heads did not reduce pressure effectively. The recommendation from that study: place the front edge of the pad 5 mm behind the metatarsal parabola (the curved line formed by your metatarsal heads). Until further evidence suggests otherwise, this is the most effective position supported by pressure-mapping data.
How to Find Your Metatarsal Heads
Your metatarsal heads are the rounded ends of the five long bones in your forefoot. They form the “ball” of your foot. You can feel them by pressing your thumb into the sole of your foot just behind your toes, where you’ll feel a row of firm, bony bumps. The second and third metatarsal heads tend to bear the most pressure during walking, which is why pain often concentrates there.
To mark their location for pad placement, try the lipstick or marker method. Apply lipstick, chalk, or a washable marker to the ball of your foot, covering the area where you feel the bony prominences. Then step onto your insole or shoe liner. The marks left behind show you exactly where your metatarsal heads sit. The pad goes just behind that marked area, not on top of it.
Step-by-Step Placement
Remove the insole or orthotic insert from your shoe. Stand on it so your foot makes full contact, then step off. If you’ve used the marker method, you’ll see a clear imprint of where your metatarsal heads press down.
Position the metatarsal pad so its front (widest) edge sits just behind that imprint, roughly 5 mm back from the line of marks. The pad’s teardrop or dome shape should point toward your heel, with the thickest part of the dome centered behind your second and third metatarsal heads. Most pads come with adhesive backing. Peel the backing and press the pad firmly onto the insole. Then replace the insole in your shoe and walk around for several minutes to test the feel.
If you feel the pad pressing into the ball of your foot or creating a new pressure point, it’s too far forward. Peel it off and reposition it a few millimeters back. If you barely feel any support under the arch of your forefoot, it may be too far back. The sweet spot is when you feel gentle lift behind the ball of your foot without any added pressure on the bony prominences themselves.
Choosing the Right Size and Thickness
Metatarsal pads come in small, medium, and large. As a general guide, small fits UK shoe sizes 2 to 4.5, medium fits 5 to 9.5, and large fits size 10 and above. Thickness varies more than you might expect. Firm rubber pads range from about 3 mm (small) to 5 mm (large) in height. Soft foam options run from 3 mm up to 8 mm. Thicker pads provide more lift but need more room inside the shoe.
Start with a thinner pad if you wear snug-fitting shoes like dress shoes or running flats. A 3 to 4 mm pad often works well without crowding the toe box. For roomier shoes like walking shoes or boots, a 5 to 8 mm pad can provide more substantial offloading. If the pad makes your shoe feel too tight across the top of your foot, drop down in thickness rather than abandoning the pad entirely.
Pad Materials Compared
Felt pads are the cheapest and most widely available. They compress quickly and typically need replacing every few weeks, but they’re useful for testing placement before committing to something more durable. Foam pads last a bit longer and provide light cushioning, though they offer less structural support for the transverse arch.
Gel pads tend to hold their shape longest and absorb more shock. They conform to the contours of your foot better than felt or foam, which helps maintain consistent pressure relief over time. For daily use, gel or high-density foam generally outperforms felt. For occasional use or initial experimentation with positioning, felt is a reasonable starting point.
Placement for Different Conditions
For general metatarsalgia (pain under the ball of the foot, typically at the second, third, or fourth metatarsal heads), the standard placement described above works well. Center the pad behind whichever metatarsal heads are most painful.
For Morton’s neuroma, where the nerve between two metatarsal heads becomes compressed and inflamed, the goal is to spread those metatarsal heads apart. The pad still goes just behind the metatarsal heads, but you may want to position it slightly more centrally between the affected metatarsals. Some people find that a slightly wider or thicker pad helps create more separation.
For sesamoiditis (pain under the big toe joint), the pad is typically shifted so it supports the area just behind the first metatarsal head while offloading the two small sesamoid bones beneath it. This placement is trickier and often benefits from professional fitting.
Insole vs. Sock-Liner Placement
You can attach the pad directly to your shoe’s removable insole or to a custom orthotic. Placing it on the insole is the most common approach because you can easily reposition it and transfer it between shoes with identical insoles. Some people place pads on the underside of the sock liner so the pad sits between the liner and the shoe’s midsole. This creates a slightly smoother surface underfoot but reduces the directional precision of the pad’s support.
Whichever method you choose, make sure the pad stays fixed in place. A pad that shifts forward during walking will end up under the metatarsal heads, exactly where you don’t want it. Press the adhesive firmly and check the position after your first few walks. If the adhesive wears out, double-sided tape or a small amount of shoe adhesive can extend the pad’s life in place.