metatarsalgia :: ball of foot pain :: Northcoast Footcare :: medical products for your feet

There are many causes of pain in the ball of the foot. Metatarsalgia, neuromas, sesamoiditis and 2nd metatarsal overload syndrome are the most common causes of pain in the ball of the foot.

Mouse over the images below to find your area of pain, then click the image to see the underlying bone structure.


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Most of the conditions in the ball of the foot are due to faulty foot mechanics. The big toe joint is designed to carry much of the weight of the body during "push off" when walking. When the big toe joint does not carry this weight, the load is transferred to the lesser metatarsal phalangeal joints (MPJs).

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During the gait cycle (walking cycle) the foot must transfer the weight from the heel to the forefoot. The calf muscle contracts and helps push the foot off the ground and propel the body forward. When the Achilles tendon and calf muscles are tight, this causes the heel to rise early and the foot to rotate out which increases the abnormal stress through the midfoot and increases abnormal pronation. These forces contribute to midfoot collapse, elevation of the first ray and transfer of weight to the lesser metatarsal phalangal joints (MPJs).


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Metatarsalgia Metatarsalgia is used as a catch all term for pain in the ball of the foot. Although faulty foot mechanics is considered the most common reason for development of pain in this area, trauma, infection, repetitive stress, arthritis and previous foot surgery could also contribute to pain in this area. Pain is generally deep and dull with walking and occurs at the 2nd, 3rd and 4th metatarsal phalangeal joints (MPJs).
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	Hammertoes can be associated with metatarsalgia. There is a retrograde force from the hammertoe which pushes back on the metatarsal phalangeal joint. This causes excess pressure and pain and inflammation in the area. The most common area for this is at the 2nd toe joint. Hammertoes can contribute to 2nd metatarsal overload syndrome.
2nd Metatarsal Overload Syndrome
For those with more flexible feet, when the weight is transferred to the ball of the foot, the 1st metatarsal elevates more than usual, and places a tremendous amount of force on the 2nd MPJ, as seen in the drawing below. This excess stress can result in callus development under the the 2nd MPJ and pain and inflammation at the joint.
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		Individuals with a long 2nd metatarsal or a short 1st metatarsal are at greater risk for developing this condition, this is shown in the X-ray on the left.
Sesamoiditis
Sesamoiditis is the pain and inflammation of two small bones under the big toe joint. These bones act like ball bearings in the foot and allow the big toe to glide up and down smoothly. These two small bones carry a significant amount of weight. When overstressed, they can becomes inflamed and painful. This condition typically develops as a result of repetitive stress and is common in dancers, sports with quick sprints, sports involving a squating position (catchers in baseball) and individuals with high arch feet.
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Neuromas

A neuroma is an inflamed nerve which causes pain in the ball of the foot which most commonly shoots out to the third and fourth toes. The second and third toes can also be affected. Pain is typically worst with standing and walking and relieved by rest. Some will complain of deep achy pain, others complain of a constant burning. There can be radiating pain, electrical pain or numbness. More on neuromas.

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Treatments

All of the foot conditions listed above have separate and specific treatments. But, there are some common treatments which will benefit all people with pain in the ball of their foot.

Shoes
It is important to wear a rigid, supportive shoe with a wedge at the heel. This does not mean a "high heel" shoe, but a lift at the heel or wedged shoe which is about 1" in height. This helps to distribute the pressure between the heel and the forefoot and decrease any stress on the calf muscles. Many of the foot problems listed above are worsened with soft, flexible shoes. The shoe should only bend at the toe, not in the middle of the shoe. To test a shoe, hold the heel and place the toe area on the floor. Press down on the shoe. If it collapses, it is too flexible. More on shoes.

Calf Stretching

At first it may not seem logical that stretching the calf muscles will help with pain in the ball of the foot, but after reading the information presented above it should make more sense. Stretching the calf will help to decrease abnormal pronation, decrease the midfoot collapse and relieve the excess pressure on the ball of the foot. Calf stretching should be performed at least three times a day. Click here to view pictures of a daily sequence of calf stretches.

Padding

Metatarsalgia: pads help by distributing the pressure more evenly under the ball of the foot. One of the most common errors with this treatment is pad placement. The pad is NOT placed under the area of pain. The pad is placed behind the ball of the foot as seen in the picture of a HaPad Metatarsal Pad.

Neuromas: pads for neuromas are also placed behind the ball of the foot, NOT under the area of pain. The neuroma pads distribute pressure and help to lift and spread the metatarsal bones, which decreases pressure on the inflamed nerve. Placing the pad under the ball of the foot will increase the pain, not decrease it.

Sesamoiditis: padding for sesamoiditis also involves distributing pressure away from the pain. The common pad designed for sesamoiditis is called a dancer's pad. This pad can be fabricated out of felt and a stretchy, elastic tape (most podiatrists use elastoplast) and is slipped over the foot. A pad can also be made for a shoe or for an insert, to help off load the big toe joint.

Prefabricated Orthotics Rigid prefabricated orthotics help control pronation, support the midfoot and distribute forefoot pressure more evenly.

Prolab orthotics	Instep orthotics	Superfeet sport

There is not a "magic bullet" treatment for any of these problems. Rest, ice and anti-inflammatory medications may decrease pain and inflammation and may be appropriate treatments in addition to the solutions mentioned above. But, they are not addressing the cause of the problem. Finding the cause of the problem by identifying the aggravating activity, poor quality shoes and/or faulty foot mechanics and then addressing these problems, will give better long term results for problems which occur in the ball of the foot.

If your symptoms do not improve within a few weeks, make sure to make appointment with your podiatrist.

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Disclaimer: The advice on this website is not intended to substitute for a visit to your health care provider. We will not be held liable for any diagnosis made or treatment recommended. Consult your doctor if you feel you have a medical problem.