The 2 main causes for Ball of Foot Pain (Metatarsalgia) are:
1) wearing high heels/fashion shoes
2) over-pronation (fallen arches)
Metatarsalgia develops when the metatarsals (forefoot bones) lower and the surrounding ligaments weaken. In turn, the entire forefoot structure collapses, which then leads to constant pressure and friction in the ball of the foot area. Collapsing of the bones in the forefeet occurs because wearing heels means most of your bodyweight is placed on the forefoot area, instead of the bodyweight being spread out over the entire foot, as it should be.
However, collapsing of the metatarsals can also occur due to over-pronation (fallen arches, rolling inwards of the feet and ankles), which is a very common condition. Excess pronation, combined with wearing hard, flat shoes and walking on hard surfaces, such as pavements or concrete floors will often lead to pain in the balls of the feet.