One of the common conditions I encounter with new patients is ball of the foot pain. The fancy medical term that serves as a "catch-all" for this condition is Metatarsalgia.
Metatarsalgia is a condition that is marked by inflammation and pain in the ball of the foot. The metatarsal region or ball of the foot is the area between the arch and toes. Metatarsalgia is generally not a serious condition, but the symptoms can aggravate to the point where normal activities and exercise can become increasingly painful.
Runners and athletes who participate in high-impact sports are at a higher risk for developing the condition.
In addition, certain foot shapes might be subject to undue stress in the metatarsal region thus causing pain and discomfort in the front area of the foot just below the toes.
Fortunately, most cases of metatarsalgia can be treated effectively with a combination of conservative treatments and use of proper footwear with non-prescription shoe inserts or custom orthotics.
The human foot comprises of five metatarsal bones that extend from the arch to joints of the toes. In addition, the ball of the foot is also cushioned by a protective fatty acid padding.
The first metatarsal bone is thicker and shorter than the other four. During the push-off phase, while walking, running or jumping, a substantial amount of stress is exerted on the toes and metatarsals.
In fact, the first and second metatarsals are forced to bear as much as 275 percent of our body weight while engaging in intense exercise or physical activity. Most metatarsal complications arise due to improper alignment or insufficient padding in the ball of the foot.
The specific mechanics of the foot can impact the way that weight is distributed across the area. Any abnormal or uneven impact on the metatarsals can lead to inflammation and pain in the metatarsal heads, the ends of the metatarsal bones that connect to the toes.
Metatarsalgia can be attributed to a single factor or combination of several factors including the following:
The fat pad in the ball of the foot acts as a protective shield to the bones, muscles and ligaments in the foot. However, due to a variety of reasons, the padding can get thinner making the metatarsal bones more susceptible to injury. Some common causes for thinning of the fat padding include:
• Walking with bare feet, high heels or poorly designed footwear
• Underlying medical conditions, such as endocrinal abnormalities, rheumatoid arthritis and connective tissue disorders
• Downward displacement of the metatarsal head
When the second toe is longer than the big toe, the second metatarsal head can be forced to bear more weight than normal. Also, a foot with a high arch might be subject to excessive pressure in the metatarsal region.
This condition is characterized by a noncancerous fibrous growth between the third and fourth metatarsal heads.
Morton’s Neuroma can contribute to significant metatarsal stress in the area that can eventually develop into metatarsalgia. Causes include prolonged use of high-heeled or tight shoes and high-impact activities, such as jogging, tennis or aerobics.
The tiny cracks in the toe bones or metatarsals can be extremely painful and result in an unusual distribution of weight on the foot. Stress fractures can be a common source of metatarsalgia.
This condition can be genetic or acquired. Wearing improper footwear, on a continual basis, can prevent the toes from lying flat and cause one or more toes to curl downwards in an abnormal manner. This can depress the metatarsal heads and lead to many complications.
Metatarsalgia is common in patients suffering from osteoarthritis and rheumatoid arthritis. Osteoarthritis can weaken the metatarsal joints thus contributing to increased sensitivity and pain in the area. Rheumatoid arthritis can lead to deformity in the forefoot region that can eventually cause the dislocation of metatarsal joints.
In a normal foot, the five metatarsal heads are perfectly aligned to form the transverse arch. As weight is placed on the ball of the foot, the arch flattens to support the body and ensure that the pressure is distributed evenly all over the foot. In cases where a metatarsal head is depressed and sits lower than the rest, it is forced to carry more weight than usual thus causing pain and inflammation in the area.
The metatarsal head might drop further towards the bottom of the foot upon repeated trauma and protrude outwards. The increased pressure on the skin, from the depressed metatarsal head, can deplete the protective fat padding and lead to the development of painful calluses.
High-heeled shoes and foot injuries can cause one or more metatarsal heads to drop. In addition, biomechanical irregularities, such as pronation or flexible foot, can also lead to metatarsalgia.
Often affecting younger patients, this forefoot condition develops after an injury and can get progressively worse if not treated properly.
Most of the body weight is transferred to the forefoot during any physical movement. Excessive pounds can result in more pressure on the metatarsals and contribute to the onset of metatarsalgia.
It is not surprising that runners are at the highest risk for developing metatarsalgia. High-impact sports can put an abnormal amount of stress on the metatarsals, leading to increased sensitivity in the area.
The most common symptom associated with metatarsalgia is pain in the ball of the foot that is concentrated in the sole area just behind the toes.
The pain might be concentrated only around the big toe or in the area around the second, third and fourth toes.
The pain can be described as sharp, burning or aching in nature. Other symptoms include:
• Pain that worsens with activity and improves upon resting
• Tingling or numbness in the toes
• Sharp or shooting pain in the toes
• Discomfort and increased pain upon walking barefoot
• Increased pain when flexing the feet
• Pain that radiates from the ball of the foot to the toes
• An usual feeling that can be likened to walking on pebbles or being bruised by a stone
• Painful calluses
The symptoms are more likely to develop gradually over a period of months. However, in some cases, they can appear suddenly after an unusual surge in strenuous physical activity or high-impact exercise.
It is normal to experience foot pain after a rigorous workout or a long day of standing. However, if the pain lasts for more than a few days, it is best to seek prompt medical attention.
While treatment for pain in the ball of the foot can vary depending on the underlying causes, a doctor might suggest a few conservative approaches at first.
• Relative rest with low-impact activities to reduce the pressure on the ball of the foot
• Ice compression to reduce swelling, inflammation and pain • Non-steroidal anti-inflammatory pain medications
• Maintaining a healthy weight
• Refraining from barefoot walking on hard surfaces
• Using callus pads to reduce discomfort
• Modification of existing lifestyle to promote healing
• Wearing heels with a reasonable height of no more than an inch •
Wearing appropriate shoes that are suitable for the patient’s foot type, stride and sport
• Shock-absorbing insoles to cushion the feet
• Metatarsal supports and pads to elevate the dropped metatarsal heads and help redistribute the weight across the arch and metatarsal shafts
• Over-the-counter and custom orthotic devices to improve foot function and minimize metatarsal stress If symptoms persist and the condition does not improve with conservative treatments, the doctor might recommend surgery.
Arch support insoles are one of the most effective aides in deflecting stress and treating pain and discomfort in the ball of the feet. They can be custom built from a plaster cast or foam impression of the patient’s feet.
Custom orthotics are precisely constructed with high-quality shock absorbent materials to stabilize the feet, provide support to the metatarsals and arch, reduce uneven pressure and eliminate pain in the area. They are designed to fit inside most standard shoes.
Custom-made inserts can be very beneficial to patients suffering from metatarsalgia due to their unique advantages.
Custom orthotic inserts are specifically built to support high arches. They are designed to provide adequate support to the arch thus allowing it to bear a normal amount of weight and reduce the pressure on the ball of the foot.
Rebalancing of the Foot In a foot with dropped metatarsal heads, the body weight is unevenly distributed across the weight-bearing surface. A custom insert can be used to raise the dropped metatarsal heads and restore them to their normal position. This will help redistribute the weight more evenly.
Padding the ball of the foot alone might not be effective enough. Custom-made orthotics are designed specifically to provide the exact amount of elevation to the affected metatarsal head. The primary purpose of the treatment is to allow the arch to heal and restore its shock-absorbing capabilities.
Custom orthotic insoles are made of unique materials that are specifically designed to mimic the natural fatty padding in the ball of the foot. They provide protection to the metatarsals by absorbing pressure and shock.
Orthotic aides can be instrumental in reducing the damage caused by unusual walking patterns that can affect the normal distribution of weight across the foot. Using appropriate orthotic devices, as recommended by a doctor, can significantly eliminate the underlying factors contributing to metatarsalgia while alleviating the symptoms at the same time.