Sixty-five feet with metatarsalgia due to inadequate support by the first ray are presented. A classification of different types of deficient anteromedial support is proposed in relation to the morphology of the first ray. When there is deficient anteromedial support and the first ray is normal, the ray is elevated and may or may not be associated with supination of the forefoot. When there is elevation of the first ray alone, operations are proposed which restore normal anteromedial support. The decision for choosing a particular type of operation is determined by an analysis of the cause of the elevation. There operations can be on the soft tissues, bone or both. When loss of anteromedial support is the consequence of complete supination of the forefoot, this has been corrected by a tarsal derotation osteotomy. Supination of the forefoot may be accompanied by elevation of the first ray. In there cases, the derotation osteotomy has been complemented by one of the operations described in the case of simple elevation of the first ray. The different indications of these surgical procedure are described as well as the results. In the case of deficient anteromedial support with an abnormal first ray, the treatment was conservative or surgical. The results of different operations performed to restore the normal loading under the forefoot are described.