Blog Archives

Pain in the ball of the foot- The Podiatrist | YourFeetNZ

forefoot pain

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.
Stress fractures
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 neuroma
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.


Tips For Relieving The Pain Of Sore Feet: The Podiatrist and YourFeet

there are many reasons for sore feet

Sore feet are not only uncomfortable; they can put a big dent in your productivity and turn even the simplest task into a burdensome chore. Causes for sore feet can range from ill-fitting shoes to physical deformities, but luckily there are as many different solutions as there are problems; the trick is finding what works best for you. Many common foot problems like heel spurs, flat feet and torn ligaments can be solved best by using bio-mechanical intervention that can range from drug store variety inserts to custom-made orthotic devices.
Determining the Problem
To find the source of sore feet, start with the obvious culprit, ill-fitting shoes that do not provide the proper support for your body frame. So called “sensible shoes” with low profiles, sturdy arches and ankle support often provide instant relief from minor foot issues caused by inappropriate footwear. Under some conditions, like standing on hard or uneven surfaces all day, additional relief can be provided by drug store inserts that create a layer of cushioning for your feet to reduce the impact of each step. If these simple tactics do not yield favorable results, it is wise to consult with The Podiatrist to examine your feet to determine if you are suffering from treatable foot maladies that would benefit from custom-made orthotic devices.
Orthotic Solutions
The Podiatrist can examine your foot to determine if your problem results from an injury to or is the result of the way your foot functions in relation to the rest of your body. Injuries from sports and recreational activities can often be cured by providing proper support during the recuperation process so that the injury is not irritated and can heal properly. These types of inserts, pads and braces are temporary and will eventually become unnecessary.
If the problem lies in the basic structure of your foot, however, a more permanent orthotic will be recommended that is strategically designed to make your foot function correctly when you take a step. A cast of your foot is made and The Podiatrist uses this model to create the proper orthotic out of plastic, wood or rigid rubber. This kind of treatment can not only provide relief for sore feet, it can also have a direct impact on your legs and torso because it subtly changes your posture and corrects muscular issues that stemmed from improper balance.
See The Podiatrist for any foot problems.

Arches and Aches

Flatfoot often becomes a serious problem if neglected in the initial stages. Here’s how to identify the symptoms and apply the right corrective measures

Flatfoot or “fallen arches” is a medical condition that affects the arches of the human feet, causing them to fall flat. It occurs in about 20 per cent of the world’s population. “Flatfoot, or pes planus, as it is medically called, refers to the loss of the normal arch in either or both feet. In infants it is common for the baby fat between the foot bones to cause the foot arches to fall flat. At first, all babies’ feet look flat, because the arch hasn’t formed yet. Arches should form by the time your child is 3 years of age and develop by the time he or she is 7 or 10 years old.

Wear and tear

In a lot of cases flatfoot develops due to ill-treatment of the feet. Muscles wear out due to ageing, sports injuries, standing or walking for prolonged periods of time on high heels or in shoes without proper support.

Weight and age are big factors. There are multiple causes of flatfoot, including trauma or injury, inflammatory arthritis and chronic wear and tear, often augmented by an increase in weight and age. The main injury occurs to a tendon on the inside of the ankle called the ‘posterior tibial’ tendon that supports the arch. As this tendon tears or weakens, the arch collapses, the heel tilts and the foot turns out.

One of the signs of flat feet in children is when they begin to complain of pain in their calf muscles or feet. If parents notice their child walking oddly, on the outer edges of the feet, or limping during long walks with pain around the area of the foot, they should get it checked.

In severe cases of childhood flatfoot, a ‘knock knee’ deformity may develop. If the child complains of foot, heel or ankle pain, you should visit the specialist who will take foot X-rays in a standing position to check joints and feet bones.

Pain on the inside of the ankle or the arch or a decreased ability to walk or run due to aching feet is often the first sign of a flatfoot developing

It is not just the feet that hurt. Flatfoot affects other parts of the body too. Flat feet can affect the knees, hips and back. The arch collapsing inwards places stress on the knee, which may rotate the hip and cause back pain. Avoid high heels and flat shoes with no support, such as ballet flats and jandals.

Experts recommend that children run or walk barefoot on rugged terrain such as sand or rocks.

If the child has flatfoot symptoms, an arch support can be placed inside the shoe to correct it.

In case of severe collapse, additional arch support with an orthotic insert may be required.

If you have any questions, or feel that you need some expert advice, contact The Podiatrist.