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Pain in the ball of the foot is very common. It can be caused by a number of factors such as poorly fitted shoes, foot abnormalities, overload through repetitive activities such as running, or rheumatological conditions. In this article, we will discuss the most common causes of ball of foot pain.
The medical term for your toes is metatarsals. They play a crucial role in propulsion and balance when standing or walking. If they become overloaded, it can result in inflammation and irritation of the metatarsal heads. This is then none as Metatarsalgia. It can result from poorly fitted shoes, foot deformities or issues with gait.
Symptoms are usually mechanical. Walking or putting pressure on the ball of your foot can be painful, while pain usually eases with rest. Gait analysis by a physical therapist is typically recommended to address biomechanical causes. Cushioned shoes can provide pain relief alongside ice massage. Custom insoles and exercises can be part of the solution, while in irritable conditions, You may require a steroid injection.
A walker boot may be necessary for 4-6 weeks in cases that struggle to settle. Metatarsalgia is rarely operated on.
Mortons Neuroma is another common cause of pain in the ball of the foot. Between each toe in the foot, there is a web space. Within this web space, there are nerves called the common digital plantar nerves. These nerves provide sensation to the surrounding areas for the forefoot. Shoes that are too tight, foot deformities, or poor biomechanics can overload and pinch these nerves leading them to become inflamed. This occurs most often in the web space between the 2/3/4 toes. The nerve becomes inflamed to the shape of a pea or ball.
Patients often describe the sensation of a pebble in their shoe alongside a burning sensation in the ball of their foot. On examination by a Physical Therapist, there might expect to find a click upon squeezing the metatarsal heads together.
Treatment often includes physical therapy, exercises, custom orthotics, and footwear changes. Steroid injections can work well to reduce inflammation within the nerve, while extremely irritable neuroma may need to be excised through surgery.
Repetitive overload of the forefoot can irritate the metatarsals of your foot. If this continues, it can lead to a metatarsal stress fracture. The most common metatarsal fracture is the 5th metatarsal stress fracture. Other causes of metatarsal fractures are trips or objects falling on the forefoot. Running is a common cause, but it can occur spontaneously in those with low vitamin D levels.
Symptoms are commonly sharp when weight-bearing and made worse by impact activities such as running or hopping. There may be some swelling or bruising in acute cases.
An x-ray is required to confirm the diagnosis. If x-ray results return as usual, but your Physiotherapist or Sports Medicine Doctor clinically suspects a fracture, they may refer you for an MRI or CT Scan.
Metatarsal treatment is usually 4-6 weeks in a walker boot followed by 4-6 weeks of Physical Therapy.
Ball of foot pain towards the inside of your foot may result from a bunion. Your big toe is a sizeable weight-bearing bone, primarily designed for propulsion. Your biomechanics can cause deviation of the big toe joint, this is typically a prolonged process over time, or some people are born with a stiff big toe (Hallux Rigidus). The development of a bunion or hallux rigidus may mean that you cannot move the big toe fully, and as a result, it is common to place excess pressure on toes 2-5. This can lead to forefoot pain and cause conditions like Metatarsalgia or Morton’s Neuroma.
Assessment from a medical professional is advised. Exercises, custom insoles, improvements in footwear, and gait analysis can be helpful in reducing pain levels and addressing biomechanical issues. Bunion correctors are not advised as there is little evidence for their use.
In severe cases, a consultant may suggest a bunionectomy if the symptoms are relieved from conservative management.
Under the ball of your big toe, there are two small, floating bones called sesamoids. These bones sit within the tendon of the big toe, and repetitive overload can irritate the sesamoids. They can become inflamed and irritated, resulting in sesamoiditis. This can be a severe and debilitating condition as it can be painful to stand or walk.
If you suspect you have this condition, you should see a Physiotherapist as soon as possible. A biomechanical assessment is recommended alongside strengthening exercises to correct any muscular imbalances that may have caused the condition. Offloading with corrective insoles and improved footwear can make a significant difference.
In irritable cases, You may require a steroid injection by a sports medicine doctor, while surgical removal of the sesamoids is rare.
Under the ball of the floor and the heel of the foot, there is a fat pad which cushions the underside of the foot and reduces the force that goes through the bones in these areas.
Age-related change can cause this fat pad to thin over time, exposing the bones to the most impact, while rheumatoid arthritis and a history of steroid injections can make you more susceptible to this condition.
Symptoms include pain when walking, especially when barefoot. Running, jumping and walking on uneven floors can also irritate the symptoms of fat pad syndrome.
Treatment is unfortunately limited. Cushioned insoles and supportive trainers help the most while avoiding uneven terrain. Some surgeries can involve fatty tissue grafts, but their success rates are low.