Ball of the foot pain
Pain in the ball of the foot or the area below the toes, especially beneath the big toe is quite a common complaint especially in those who do a lot of walking and on hard surfaces.
Most causes of pain in this area develop gradually through overuse although there are a few exceptions. Pain under the ball of the foot is a common complaint but it is important to know which of the many injuries and conditions could be causing your foot pain.
Metatarsalgia is probably the most common cause of pain under the ball of the foot is often used as a bit of an umbrella term used to cover any forefoot pain. It is an inflammatory condition which occurs in the joints between the toes and metatarsals (foot bones). Symptoms typically consist of pain under the forefoot which is worse during weight bearing, particularly during the push off phase of walking or running.
Morton's Neuroma or Morton's Syndrome occurs when a nerve that passes between the metatarsal heads (ends of bones) gets pinched or compressed, causing pain and sometimes numbness or tingling. Symptoms are more likely felt in the forefoot in general rather than specifically ball of the foot pain.
If the arch in the foot is weak then this can cause the metatarsal bones to pinch the nerve causing it to become inflamed. This is most likely to happen between the 3rd and 4th bones causing a pain or numb sensation on the inside of the two toes that the nerve supplies. Sometimes it is caused by a neuroma or benign tumour on the plantar digital nerves but it is not a true neuroma but more of a swelling of the nerves from compression. Scar tissue surrounding the nerve can also be a factor.
Turf Toe is a sprain to the ligament at the base of the big toe or great toe which occurs when the toe is foreably bent back or stubbed. This is a sudden onset or acute foot or toe injury with immediate pain and swelling or bruising which may develope over time. We demonstrate a simple taping technique is excellent for protecting the injured ligaments whilst healing.
Metatarsal Stress Fracture is a hairline fracture in one of the long metatarsal bones of the foot which occurs through overuse or poor foot biomechanics. Symptoms consist of pain in the foot which occurs gradually and is more likely to be located towards the middle or front of the foot rather than underneath the ball of the foot.
Hallux Rigidus is a stiff big toe with pain, swelling and inflammation in the joint. As the condition gets worse the patient may also experience loss of movement and walk with a limp. Eventually pain is felt even when resting and the top of the joint will be tender to touch.
Bunion (also known as Hallux Valgus) is a painful swelling and bone enlargement over the inside of the big toe. Often the big toe will look as if it is bent in towards the other toes or even can lie across them. Symptoms will come on gradually and get progressively worse. In the very early stages there may be no symptoms at all but eventually pain will be felt in and around the ball or base of the big toe, particularly on the inside.
Sesamoiditis is an inflammatory condition affecting the two sesamoid bones underneath the joint of the big toe and the 1st metatarsa. Symptoms will include a gradual onset of pain under the ball of the foot, especially when weight bearing.
Gout is a form of arthritis caused by an increase in Uric acid in the joint which causes crystals to develop. Symptoms tend to come on very quickly and then last for around a week before easing off. They include intense pain in the joint, usually affecting the big toe and foot. The skin may appear red and shiny and there may be peeling or flaking of the skin. The joint will be swollen and may also feel itchy. Gout is most common in the big toe, but may also be present in the heels, ankles, knees, elbows, wrists or fingers.
Freiberg's Osteochondritis - this condition affects the metatarsal heads in adolescents (usually 14-18 age range). They appear fragmented on an x-ray although the condition will usually resolve itself. Padding or orthotics may be used temporarily to avoid further damage.
Treatment of ball of foot pain
Treatment will depend on the condition in question, although in many cases faulty biomechanics are the cause of injury. Overpronation is the biggest cause of foot pain, as well as other leg and even hip or back injuries. Good, supportive footwear with no (or a very small) heel is always recommended for any foot pain. If this is not adequate then insoles or specially made orthotics may be suitable.
On the other hand, oversupination or a high arch can also be a problem. This is usually corrected with cushioned running shoes or shock absorbing insoles.
Another simple piece of advice is to stretch the calf muscles regularly. Tight calf muscles can contribute to foot pain, especially as it serves to further increase pronation.