WHAT MAY BE CAUSING THE PAIN IN THE BALL OF THE FOOT?

By: Sara John, C.Ped (C)., C.Ped Tech (C)

Metatarsalgia is a general term used to denote pain in the ball of the foot. With this common foot condition, one or more of the metatarsal heads become painful, usually due to excessive pressure over a long period of time.

Those with metatarsalgia experience pain and inflammation in the padding directly below the toes, which is where we place the most pressure when standing and moving. In the foot, there are small nerves between the metatarsal bones. When the head of one metatarsal bone presses against another, the small nerve is caught between them and starts to become inflamed. This causes metatarsalgia. Putting weight on the foot can worsen symptoms, because with each step the metatarsal bones rub together, increasing the inflammation of the nerve.

There may be a burning or shooting pain, or a sharp aching, and there may be tingling or numbness in the toes. It can affect the area near the toes and the ball of the foot. Pain may be worse on flexing the toes.

Symptoms usually develop slowly. However, they sometimes appear suddenly, especially if an increase in exercise puts strain on the feet, such as running or jumping.

Factors that can contribute to metatarsalgia include:

• Improper fitting footwear: Shoes that are too tight around the toes can cause pain, or high heels that add pressure to the ball of the foot as it is forced into a tight space.
• Shape of the foot and toes: Having a high arch or a second toe that is longer than the big toe can add to the pressure.
• Being overweight: The excess weight can put strain on the foot.
• Age: The pad of fat that protects the foot can get thinner with age, leading to metatarsalgia.
• High impact exercise: Running or playing high impact sports increases the risk, as the feet absorb large amounts of force.
• Stress fractures: Small breaks in the toe bones can cause pain when pressure is applied.
• Stiff ankle: This can add pressure to the metatarsal bones.
• Medical conditions like rheumatoid arthritis, with swollen joints in the foot, or gout
• Diabetes if the small nerves in the foot can become irritated
• Morton’s neuroma: The area by the third and fourth toe is affected as a result of thickening of the tissues around the nerves leading to the toes.
• Sesamoiditis: Inflammation or break in the pulley-like bones that are connected to tendons instead of other bones. This condition is common in those with high physical activity, like ballet dancers or runners.
• Freiberg disease: Part of the metatarsal head loses structural integrity, leading to collapse in the head of the second metatarsal and nearby joint.

Wearing comfortable shoes with wide toe box and a rocker sole is ideal for treating metatarsalgia. The wide toe box allows the foot to spread out while the rocker sole reduces stress on the ball-of-the-foot.

Unloading pressure to the ball of the foot can be accomplished with a variety of products. Orthotics designed to relieve forefoot pain usually feature a metatarsal pad placed behind the ball of the foot to relieve pressure and redistribute weight from the painful area to more tolerant areas.

If the metatarsalgia is a result of physical exercise, let the foot rest as much as possible until the pain subsides.