What hurts?
Some possible conditions ā¢Ā Ā Foot Pain – Bottom of Foot – Forefoot
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Metatarsalgia /Fat Pad Atrophy -
Sesamoiditis -
Neuroma
Some possible conditions ā¢Ā Ā Foot Pain – Bottom of Foot – Forefoot
Metatarsalgia is the medical name for pain in the ball of the foot. It is a combination of pain and inflammation localized in the ball of the foot. It is termed an overuse injury. However, bony structure of the foot, mechanics, footwear and fat pad deterioration can contribute to the condition. Itās often thought of as a symptom of other conditions, rather than as a specific disease.
The pain felt is localized to the ball of the foot. If it is shooting or migrating elsewhere, you likely do not have metatarsalgia. It is important to note though that metatarsalgia pain can be sharp, dull, or present as a burning feeling. You may even feel like youāre stepping on a pebble. The pain is typically worse when you are active or barefoot. Finally, you may feel tingling or numbness in your toes but this is rare.
The heads of the five metatarsal foot bones are present in the ball of the foot and are related to the pressure and pain felt. As we age, the fat pad under the ball of the foot wears thin and the pressure of the bones on the ground are felt more. Repetitive training, high impact sports, aging, high heels and the absence of orthotics can create/contribute to metatarsalgia.
Other causative factors are mechanical such as:
ā¢ A short first metatarsal bone or a long second metatarsal bone
ā¢ Prominent metatarsal heads
ā¢ Tight toe extensors (muscles)
ā¢ Weak toe flexors (muscles)
ā¢ Hammertoe deformity
ā¢ Hypermobile first foot bone
ā¢ Excessive pronation
ā¢ Shoes that do not fit
While over-the-counter anti-inflammatory medications, such as Ibuprofen, can be helpful, they are not a long-term solution. Evaluation by a Footcare Clinician, such as a Canadian Certified Pedorthist or Registered Chiropodist is an important first step. They can determine if the pain in the ball of your foot is related to your lifestyle, mechanics and/or a structural or soft tissue issue, such as callusing, corns or fat pad atrophy. Treatment options include debridement of any corns or calluses if present, and orthotics to offload the ball of the foot. A modification can be added to orthotics or shoes, called a metatarsal pad, which works to elevate the heads of the metatarsal bones and take the pressure off the area. Additionally, choosing properly fitted footwear, ideally with cushioning, and possibly a rocker bottom sole can help! Visit BioPed today to be assessed and understand which treatment would best suit your needs!
Most bones in the human body are connected to each other by joints. However, some bones are connected only to tendons or are embedded in muscles. These are called sesamoids. Two small sesamoids found underneath the big toe joint act like pulleys providing a smooth surface over which the tendons slide. They also assist with weightbearing and help elevate the bones of the big toe. Like other bones, sesamoids can break (fracture) with impact. Additionally, the tendons surrounding the sesamoids can become irritated or inflamed. When the surrounding tendons become inflamed, we call this sesamoiditis. It is ultimately a form of tendinitis. Sesamoiditis is common among ballet dancers, runners and baseball catchers.
Sesamoiditis is typically a slower onset of pain, discomfort and mild swelling. Swelling and bruising may or may not occur. A fast onset āacuteā pain would be more likely to be due to a sesamoid fracture. Movement associated with bearing weight on the big toe joint, kneeling, wearing high heeled shoes can cause significant pain. It is typically localized to just underneath the big toe joint (metatarsal head). If the pain is sharp, sudden or radiates, this is not likely sesamoiditis.
Sesamoid injuriesāwhich can involve the bones, tendons, and/or surrounding tissue in the jointāare often associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet. In addition, people with high arches are at risk for developing sesamoid problems. Frequently wearing high-heeled shoes can also be a contributing factor. The diagnosis is typically through examination, but an x-ray is helpful to ensure there is no sesamoid fracture.
Anti-inflammatory medications, such as Ibuprofen, can be helpful for immediate pain relief. However, RICE (rest, ice, compression, elevation) is important as it offers localized improvements in pain, swelling and encourages healing. Reducing activities, padding shoes, and taking the pressure off the area is imperative. An orthotic that is customized to offload the sesamoid bones is a great strategy and will be helpful to prevent recurrence after healing is complete. A shoe that fits properly, has a 1.5 inch or lower heel, and is cushioned is a great option. However, a Canadian Certified Pedorthist can assist with shoe fittings or footwear modifications when needed, such as a rocker bottom sole. Foot pain is not normal. If you are having discomfort, visit us for an assessment.
A neuroma is a thickening of nerve tissue that may develop in various parts of the body. The most common neuroma in the foot is a Mortonās neuroma, which occurs between the third and fourth toes in the ball of the foot. The thickening of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates enlargement of the nerve, causing symptoms.
Normally, there are no outward signs of a Morton's neuroma, such as a bump or skin changes. The most common symptoms are:
ā¢ Persistent burning or sharp pain in the ball of the foot may radiate (spread out) into the toes.
ā¢ Having the sensation of a pebble or marble under the forefoot when walking.
ā¢ Pain is typically between the base of the third and fourth toes, but it can occur between the second and third toes as well.
ā¢ There may be numbness or tingling in the toes.
ā¢ Problems with shoes are common. High-heeled shoes can aggravate the neuroma. Tight, narrow shoes also aggravate it by compressing the toe bones and pinching the nerve.
The exact cause of a Mortonās neuroma is not known, but current research suggests it is likely the result of entrapment (compression or squeezing) of the common digital plantar nerves. Compression of the nerve in the web space may trigger swelling and cause abnormal tissue to form in and around the nerve.
Many people can achieve lasting relief with a combination of shoe modifications, orthotics, anti-inflammatory medications (e.g., ibuprofen or naproxen), and/or corticosteroid injections. Initial management of a foot neuroma typically involves choosing more appropriate wider shoes (i.e., a wide toe box) with lower heels. This enables the bones to spread out and may reduce pressure on the nerve, giving it time to heal. Custom made orthotics or metatarsal pads/bars added to your shoes may help relieve irritation by changing the location of forces on the forefoot and separating the bones, which reduces the pressure on the neuroma. While over-the-counter anti-inflammatory medications may help, a localized cortisone injection can reduce the swelling and inflammation of the nerve quickly, bringing some relief.
