The objective of this paper is to describe the anatomical and biomechanical considerations for treating metatarsalgia. We describe a method of classification incorporating the causes and lead onto a comprehensive description of the treatment of metatarsalgia. Important clinical findings and investigations are discussed in treating this common pathology and a case study used as an example to illustrate the above. This paper highlights the complex nature of metatarsalgia and describes the factors a surgeon needs to consider prior to embarking on treatment.