Pain in the ball of the foot- The Podiatrist | YourFeetNZ
Pain at the ball of the foot, or the forefoot, is a common complaint in athletes. The forefoot is the part of the foot in front of the ankle consisting of groups of bones that include the metatarsals (five long bones in the forefoot) and phalanges (the bones that make up the toes). There are many medical issues that can arise in this region due to trauma, overuse, or other factors. Forefoot pain can range from mild pain causing a slight limp to severe pain that prevents walking. Common causes include: stress fracture, interdigital neuroma (also known as Morton neuroma), and sesamoiditis.
A stress fracture is one of the more concerning potential causes of your discomfort. Metatarsal stress fractures result from repetitive stress to the forefoot, usually from running, jumping, dancing, and other repetitive weight-bearing activities. Patients with stress fractures of the metatarsal shaft describe a history of gradually worsening pain in the forefoot. Initially the pain is intermittent and occurs only with use. The patient may present with poorly defined forefoot pain or point tenderness over a metatarsal shaft. If the causative activity continues, the injury can progress, with swelling, severe pain even with normal activities, and frank fracture.
Diagnosis is made using history, physical exam, and potentially imaging studies. They usually respond well to cessation of the causative activity. Crutches and partial weight-bearing for several weeks may be helpful in patients who have pain with walking. A short-leg cast and non-weight-bearing may be used for short periods of time in patients with severe pain.
Interdigital neuromas are thought to be due to swelling and scar tissue formation on the small interdigital nerves. They most commonly involve the third webspace, but may also be seen in the second and fourth. Symptoms associated with a neuroma may include sharp or shooting pain, numbness, or pins and needle sensation. Many patients describe it as feeling like something is wadded up under the toes. It frequently can be temporarily relieved by removing the shoes and massaging the area.
Neuromas can be caused by trauma or chronic irritation. Chronic irritation can be in the form of wearing shoes that are not wide enough in the forefoot area causing compression of nerve. The irritation may also occur from abnormal mechanics of the foot causing excess motion of the metatarsal bones.
Diagnosis can be made by using elements of the history and physical exam, or by imaging studies such as ultrasound or MRI. Conservative treatment may include use of properly fit shoes (well cushioned with wide forefoot), metatarsal foot pads (to evenly distribute pressure to the metatarsal heads), and physical therapy (to address mechanics and strengthen the intrinsic muscles of the foot). If conservative treatment fails, injection therapy and surgery are also considerations.
Inflammation or injury of the sesamoid bones located on the plantar surface of the big toe joint can also cause pain in athletes. The sesamoids are pea-sized bones that function as pulleys for tendons (just as the patella does for the knee extensors) and assist with weightbearing. The athlete with sesamoiditis typically complains of pain at the area of the big toe joint with weightbearing that is exacerbated by walking, and even more so by running. Exquisite tenderness of the sesamoids is present, and is exacerbated by pushing off with the great toe. Imaging may be required to differentiate between sesamoiditis and a stress fracture. Both may require a short period of immobilization followed by prolonged rest from weightbearing activity. Athletes can use alternative, nonweightbearing forms of exercise to maintain fitness. Treatment with custom orthotics, soft pads cut to relieve pressure on the sesamoids, and in severe cases, glucocorticoid injections may be helpful. Consultation with a foot surgeon is reasonable in persistent cases.
These are just a few of the potential causes of your pain, however there are many other potential causes of forefoot pain. Discussion with The Podiatrist is advised. A specific diagnosis can then be made, after a full history and physical is performed. Appropriate treatment can also then be discussed.
See The Podiatrist for all your foot problems.
About Your feet and podiatry with Caron Orelowitz | Registered Podiatrist - AucklandCaron Orelowitz was born in Johannesburg and emigrated to New Zealand in 1997. She studied Podiatry at The Witwatersrand Technikon and was in private practice in South Africa for a few years, before setting off to ‘the other side of the world’. Auckland Podiatry. Since 1998 she has been helping people of all ages who have problems with their feet, from the elderly, to sports people, and those who just want some TLC for the feet. At present she has 5 practices (with a satellite Diabetes Practice out West Auckland), owns a children’s shoe shop (Scooters in Remuera), and tries to fit in some exercise when time permits. Caron is an active member of Podiatry New Zealand (NZ), and holds the position of Treasurer for the Auckland Branch, as well as representing the Northern Region on the Executive Council. She is registered under HPCAA (Health Practitioner Competency Assurance Act), and is often seen attending (and organizing) Seminars and workshops. Caron has a special interest in Paediatrics and can often be seen on the floor showing children some exercises. ACC registered Discounts for Super Gold Card Holders, members of Grey Power and Green Prescription participants. www.thepodiatrist.co.nz www.yourfeet.co.nz
Posted on April 22, 2013, in Contact a Podiatrist, Running Shoes, What is a Podiatrist, Your feet and tagged aching feet, arch pads, arch pain, arch supports, athletes, auckland podiatrists, auckland podiatry, aukland podiatrist, big toe, bones, boones of feet, burning feet, exercis, feet, foot bones, foot mechanics, foot pain, Footwear, forefoot pain, fracture, heel calcaneus, heel pain, inflammation, injureis, joints, joints of the foot, mechanics, metatarsals, Morton's neuroma, MRI, muscles, Neuroma, numbness, orthotics, paiful feet, Podiatrist, podiatrists, podiatry, sesamoids, shoes, sore feet, sports, sports orthotics, sports podiatry, stress fracture, tendons, tingling, xrays. Bookmark the permalink. Leave a comment.