I got the worst case of metatarsalgia, igo nuffield, i have about 7 other diagnostics but do you think i might need operation the pain is horrible?

Possibly: An in office exam is needed to determine why you have the metatarsalgia. Is it due to atrophy of the fat pad, or distal displacement of it, is it from a dropped metatarsal, is it from a equinis, is it really a neuroma masking as a metatarsalgia? A podiatrist should be able to help. (or orthopod.).

May need surgery: Metatarsalgia is pain in the metatarsal heads or metatarsophalangeal joint (joint it toe at ball or feet). If the metatarsal heads are enlarged or your fat pad on bottom of feet are worn down it can cause undue pressure and pain when walking/standing/running. If the pain is in only one are, say the third metatarsal head then you may have a neuroma (inflammation of nerve around metatarsal head).

Conservative vs aggr: This is a hard one. I first try corticosteroid injection in all the mpjs centrally (2-4), dispense a custom orthotic with a metatarsal pad with a brooks or new balance type shoe. Physical therapy is administered as well. Rarely will it come to surgery where I have to do whats called weil osteotomy of metatarsals 2 thru 4 . But in some cases if conservative mgmt fails then one should proceed.