Forefoot pain can be caused by a number of different conditions. Symptoms will vary according to the underlying problem. Pain in the ball of the foot (around the heads of your metatarsal bones), is also referred to as metatarsalgia. This forefoot pain is almost always made worse for walking or running, and treatment of forefoot pain will depend on the underlying cause. It can be caused by a number of problems, from overuse and ill-fitting shoes to being overweight.
- Forefoot Pain From Overuse
- Treatment For Overuse
- Metatarsal Stress Fractures
- Treatment for Metatarsal Stress Fractures
- Loss Of The Fat Pad Under The Ball Of The Foot
- Treatment For Loss Of The Fat Pad
- Ill-fitting Shoes And Excessive Body Weight
- Morton’s Neuroma
- Treatment for Morton’s Neuroma
- Pes Cavus
- Treatment for Pes Cavus
- Hammer Toe
- Treatment For Hammer Toe Deformity
- Treatment for Bunions
- Other Causes Of Forefoot Pain In Adults
Forefoot pain due to overuse is common in runners and athletes and can range from inflammation of the metatarsal joints to metatarsal stress fractures (small cracks in the bones – see below).
Custom-made orthotics or sometimes cushioning insoles that fit inside your shoes can help to reduce the pressure placed on the metatarsal bones. These will be tailored exactly to provide maximum support and comfort.
A metatarsal stress fracture is a small, hairline fracture or crack in one or more of the metatarsal bones. In contrast to metatarsal fractures (a full break in the bone) and other one-off injuries, metatarsal stress fractures are caused by repetitive stress. Soldiers, for example, who do a lot of marching, runners, and ballet dancers, are particularly prone, but they can occur in anyone.
Your Orthopaedic Podiatrist will examine your foot and ask about your usual routine and physical activities. This will help him to determine how the stress fracture occurred and more importantly, how to prevent another from happening.
If there is nothing to suggest the stress fracture may get worse, then simply avoiding the ‘overuse’ activity may be sufficient.
He may also recommend custom-made orthotics, insoles that fit inside your shoes, to help reduce the forces on the metatarsal bones.
Loss of the fat pad, especially in later life is also the result of overuse. This involves a thinning of the protective fat pad cushion on the ball of the foot or bottom of the heel. Made primarily of fatty, shock-absorbing tissue, we rely on these pads to cushion our bones and disperse our body weight from the impact we make when we land on them. As we age this protective layer thins and there is less padding to cushion our weight, resulting in bruising.
The most common treatment for this type of forefoot pain will be in the form of shock-absorbing orthotic insoles that fit inside your shoes. These will be tailored exactly and will help to cushion the ball of your foot as you walk. Additional toe pads, softening foam or gel pads, can be added to the shoe for extra cushioning.
High-heeled or ill-fitting shoes, and being overweight, will also put extra stress on the metatarsal bones in your feet. Simple measures such as rest, changing your footwear and losing weight can sometimes help.
Although these are some of the more general causes of forefoot pain in adults, forefoot pain in adults can also be caused by a number of specific conditions, including Morton’s Neuroma, Pes Cavus, Hammer Toe and Bunions.
Morton’s Neuroma, also called Morton’s Metatarsalgia is a condition that affects the nerves that run between the metatarsal bones in the foot (the plantar digital nerves).
The exact cause is not certain although long term stress and irritation of the nerve, due to excessive pronation (rolling in), is thought to be a contributing factor. The majority of those affected are women between the ages of 40 and 50.
Typically symptoms include pain, burning, numbness and tingling between two of the toes. Morton’s Neuroma usually affects the third and fourth toes.
Simple footwear adjustments can help considerably. Wider fitting shoes and avoiding high-heeled or narrow shoes can also help. Custom-made orthotic insoles and orthotic gel pads will help to cushion the ball of your foot as you walk.
If orthotics alone do not fully relieve symptoms. Sometimes an injection of local anaesthetic and corticosteroid is required and for those neuromas that are particularly resistant to treatment, removing the nerve altogether is an option.
Pes cavus refers to a high-arched foot. Most people have an arch or gap between the sole of their foot and the ground. In people with Pes cavus the arch is higher than average and does not flatten when weight is put on it. This is the opposite of a flat foot or Pes planus.
Pes cavus can be hereditary and in some cases it may pose no problem at all, however some people with Pes cavus also have a neurological problem such as cerebral palsy, spina bifida, muscular dystrophy or polio.
Symptoms will vary depending on how severe the condition is but can include clawed toes, corns and calluses and problems getting shoes to fit properly. Pes cavus can mean that extra stress is placed on the ball of your foot, causing pain in this area.
The most common treatment for Pes cavus is in the form of custom-made orthotics or insoles to support and protect the foot and relieve pressure areas.
Silicone gel pads placed in the shoe, under the ball of the foot, can also help.
In severe cases, especially if pain is present and the height of the arch is progressively increasing, surgery may be necessary.
As its name suggests, Hammer Toe is a condition in which the toe is permanently bent so that it resembles a hammer. It can be caused by poorly fitting shoes, poor functioning of the muscles and tendons, injury to the toes, bunions and/or rheumatoid arthritis. The nature of the deformity can place extra strain on the ball of the foot, causing pain in this area. It may also cause a corn on the top of the toe.
Deep-fitting and low-heeled shoes can help. A silicone toe crest should help to minimize discomfort on the top of the toe.
Bunions are also a common source of forefoot pain in adults. A bunion is a bony swelling at the base of the big toe. They occur when the big toe angles in towards the middle of the foot and the second toe.
Wearing badly fitting shoes used to be thought to be a possible cause. However, there is a tribe in Africa who never wear shoes and who still get bunions.
We now know that bunions are caused by poor function, usually as a result of excessive pronation (where your foot rolls inwards; this is common with flat feet) and excessive motion.
The most common treatment for bunions is to control the poor foot function with custom–made orthotic insoles. These will be tailored to fit your feet exactly so as to provide maximum control and support.
Orthotic insoles can help to align the toes and control overpronation and excessive movement in the foot.
Surgery to straighten your big toe may be necessary if orthotics alone do not resolve the problem.
In addition to the above foot-specific conditions there are a number of other conditions that also affect the feet. These include arthritis, gout and diabetes.
Arthritis and gout can cause inflammation of the joints in the ball of the foot. Gout is caused by a build-up of uric acid in the blood, leading to crystalline uric acid deposits in the joints. A single big toe joint is most commonly affected.
If you are Diabetic and do not monitor and control your blood sugar levels effectively, this can cause damage to the nerve endings in the feet.