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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
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.
http://www.thepodiatrist.co.nz

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Painful Heel and Arch

Heel and arch pain are the most common foot complaints of individuals over the age of 40. The group that most commonly experiences heel and arch pain consist of middle-aged women. In addition, active athletes and people working on hard surfaces or walking great distances are susceptible to plantar fascitis and developing heel spurs or sore arches. The pain can progressively get worse so that activities of daily living are adversely affected.

Plantar Fascia Defined

The plantar fascia connects to the calcaneus or heel bone on the undersurface of the foot to the bones of the toes. Its purpose is to support the large arch of the foot. When the fascia becomes injured or inflamed, it’s called plantar fascitis.

What Can Cause Plantar Fascitis?

Plantar fascitis begins with injury to the ligaments and fascia. The fascia helps to maintain the large arch on the inside of the foot. It may affect one or both feet. In most cases, it begins gradually and may be made worse by the following:

  • Poorly Fitting Shoes – Shoes lacking firm shanks and counters      allow the foot to override the shoe so it appears like the foot has slid      off the sole of the shoe. This is commonly called “running over the shoe”.
  • Pronation and Pes Planus – “Flat feet” is a rolling inward of the      arch.
  • Prolonged Standing on Hard Surfaces Such as      Concrete
  • Walking, Dancing or Running Great Distances – These result in repetitive strain on the      bottom of the foot.
  • Being Overweight –      Extra weight on the arches is stressful.
  • Sex –      Females over age 40 are more susceptible.

Symptoms of Plantar Fascitis

The presentation of complaints to the doctor includes heel pain upon arising first thing in the morning. The first dozen steps or so are very painful until the fascia loosens up and becomes more flexible. The pain seems to subside only to get worse as the day progresses.

Diagnosis of Plantar Fascitis

The diagnosis of plantar fascitis is arrived at from a combination of
history and physical examination of the foot and lower leg. A classic complaint is heel pain when getting out of bed and beginning to walk. Compression of the calcaneus or heel bone on the sides of the heel is painful. X-rays may be necessary if the doctor suspects a stress fracture  to one of the small bones of the foot. Many of the causes of plantar fascitis may contribute to a stress fracture in the foot.

Pain and numbness in the foot at night may also be attributed to a condition called tarsal tunnel sydrome. This is a nerve entrapment in the ankle that may produce similar symptoms as those found with plantar fascitis. Both conditions can bother at night when trying to sleep. Other conditions including arthritis, gout and other systemic problems can also contribute to foot pain.

The immediate treatment goal is to reduce the swelling and inflammation to the soft tissue in the foot. Ice treatment to the foot is initially prescribed. Wearing shoes with a firm counter and shank to prevent bowing of the shoe as well as “running over the side of the shoe” is recommended. Discontinuing running and sports activities reduces stress on the foot. The use of orthotics can be very helpful in restoring the arch (flat foot) and correcting pronation (turning in of the foot). Restoring the arch reduces the stress on the knee, hip and spine. Specific exercises will be given for the foot.

Conclusion

It’s difficult for any one treatment protocol to resolve or control plantar fascitis. The combination of proper footwear, treatment, exercise and modification of activity can be successful. Patient compliance is essential to help in the care and treatment. It may take from a few weeks to several months to resolve the problem. Re-injury and aggravation play a large role in the recovery process. The importance of compliance cannot be stressed enough.

If plantar fascitis is ignored and not treated, it may complicate or contribute to ankle, knee, hip and spinal complaints. The biomechanics of gait may be altered.

The Podiatrist has experience in the care and treatment of plantar fascitis and heel spurs. Call today to make an appointment.

http://www.thepodiatrist.co.nz

Athletes are more prone to injuries, bumps and bruises than most people are.

One particular injury, known as shin splints, happens more commonly among athletes who engage in running, such as soccer players, football players and runners. Shin splints, however, are not limited to athletes of just these sports.

What are shin splints?

Shin splints is a general term but refers to many types of injuries that occur in the region of the lower leg (where the calf and shin are located). Shin splints can be caused by inflammation or injury to muscles, tendons, ligaments and bones within the lower leg. In some cases, shin splints can be caused by stress fractures in the shin bones.

What are the signs and symptoms of shin splints?

Shin splints are characterized by a great deal of pain to the lower leg, especially so in the lower portion of the shin closer to the foot. The pain usually worsens when physical activity is begun but eases as the activity continues. The pain may return once the physical activity has been discontinued but often returns later, typically the next morning, much more painful than it had been the previous day. The pain typically intensifies when the toes and foot are bent downwards. In some cases, swelling and redness can be observed in the flesh along the shin bone. Sometimes lumps can be felt beneath the skin along
the shin bone. Shin splints may make it difficult and even excruciating to walk or move.

How are shin splints treated?

There is no cure, however, there are many different treatments available that may help ease the pain associated with shin splints. Non-steroidal anti-inflammatory medications may be taken to help reduce any swelling that may be contributing to the pain. When the pain is especially intense, icing the area may help ease the pain. Shin splints can be the result of the stress of flat feet so wearing special orthopedic footwear, such as shoes with arch support or foot orthoses, may help ease the pain associated with shin splints. Sometimes physical therapy and special range of motion exercises may help ease the pain of shin splints. Strapping the affected area also helps relieve some of the symptoms. Rocktape is a very effect strapping solution for all your sports injuries. When shin splints become especially painful, medical interventions and narcotic pain medications may become necessary. Sometimes a physician may order an X-ray to determine whether or not a stress fracture may be the cause of the pain. Crutches may be needed if the pain is bad enough.

If you feel you have ‘shin splints’ or any other foot related problems, visit The Podiatrist.