I have pain in the ball of my foot.  What could it be?

Very often, one of the main complaints that I hear about is pain in the ball of the foot.  It may be due to an injury, something that the patient can remember.  But sometimes it may come about gradually, and not from some event or trauma that they can remember and it seems to come from out of the blue.

If It Is Acute Pain, It May Be Due To An Injury

An injury can cause pain in the ball of the foot.  What type of injury can cause this?  One of the most common injuries that can cause this is a stress fracture in the metatarsal, or one of the long bones of the foot. The foot has 5 metatarsal bones, or long bones, that connect with each of the toes.   A stress in one of the bones in the foot means that there is a microfracture in the bone that may or may not show up on a radiograph/X-ray.  The way I describe it to my patients is like looking at a hard-boiled egg when the shell is cracked.  The eggshell is still intact, but there are cracks that affect its integrity.  The cause of a stress fracture is often not due to trauma, but due to micro trauma to the area.  I often see this injury in runners, or those who participate in sports with high impact landing on the ball of the foot, such as TRX.  For those patients who end up with stress fractures that are not athletically active, I have seen this injury due to wearing shoes without proper support on a hard floor, or even high heels on a dancefloor!  The repetitive “trauma” can compromise the integrity of the bone, and thus causing a stress fracture.  Treatment of a stress fracture includes immobilization in a CAM boot, padding, strapping, and laser.  Further recurrence of a stress fracture injury is prevented with the use of custom orthotics.  The less activity and weightbearing, the faster the stress fracture will heal.  In order to treat a fracture, I explain in to my patients this way: think of 2 pieces of paper being held together with glue.  If the pieces keep moving, the glue will never dry.  This is just like a fracture; if there is too much movement, the fracture will not heal. 

Pain In The Ball Of The Foot Could Be Due To A Nerve

If the ball of the foot is painful but you feel like the pain is more like numbness or tingling, then it could be a neuroma.  A neuroma is actually the inflammation of the nerve that travels between the long bones of the foot.  Either trauma, shoe gear, or a biomechanical abnormality can put pressure on this part of the nerve causing inflammation. When you are examined by one of the doctors at Prairie Path, we will pinpoint where the pain is from.  The most common place for a neuroma to occur is in the 3rd innerspace, most commonly referred to as a Morton’s neuroma.  When we palpate the innerspace, or the part of the foot between the base of the 3rd and 4th toes, you may feel a tingling sensation or a “zinger” to the 3rd and 4th tips of the toes.  If you are diagnosed with a neuroma, then this is considered a soft tissue issue that can be treated with conservative care of strapping, icing, NSAIDs, or laser.  Maintenance of preventing recurrence is treated with orthotics.  Also, you and your doctor may discuss the treatment option of  steroid injection for treatment. Rarely, neuromas need surgical treatment. 

The Pain Could Be Due To Something Called Capsulitis

Sometimes patients describe pain in the ball of the foot but it starts from the 2nd digit, then it travels across the ball of the foot.  Very often this is something called capsulitis.  Capsulitis is the inflammation of the tissue at the joint where the base of the 2nd digit connects to the long bone of the foot.  You feel the most pain when the doctor palpates the base of the toe.  There is less pain when palpating the ball of the foot, but some pain.  Capsulitis develops over a period of time and has to do with the biomechanics of the foot, it usually does not happen due to trauma.  Often times the patient has a concurrent bunion deformity, which alters the weightbearing and first ray (big toe and its joint) and puts more pressure on the 2nd digit and its joint.  Also, the patient may have a hammer toe of the 2nd digit, where the 2nd digit is curled.  The 2nd digit may also be slightly dislocated, and this can be demonstrated on a weightbearing X-ray that is taken in our office and reviewed with you by the doctor.  When there is a slight dislocation of the joint, there may be pressure on either side or bottom of the joint, causing pain.  This pain then radiates towards the rest of the ball of foot, when in fact it is originating in one joint.  Treatment of this condition conservatively includes strapping, NSAIDs, and custom orthotics to control the biomechanics of the foot.  In severe instances, the soft tissue may be torn instead of just inflamed, then immobilization and sometimes surgery may be warranted.   

What Are Some Other Reasons For Pain In The Ball Of The Foot?

Other less common reasons may be metatarsalgia, arthritis, or Frieberg’s Disease, or AVN of the 2nd metatarsal head.  Metatarsalgia is the inflammation of the head of the metatarsal bone, or the part of the bone that makes up the “ball” of the foot.  Some patients who have fat pad atrophy as they become older have more pain in this area of the metatarsal bone as there is decreased fat and tissue to cushion the area.  Different types of arthritic conditions can also affect the metatarsal phalangeal joints, or MPJs, where the base of each digit connects to the long bones of the foot, the metatarsals.  Some of these wear-and-tear arthritic changes can be seen on an X-ray.  Other arthritic changes can be due to systemic problems, such as rheumatoid arthritis.  It is best to see your primary care doctor for this treatment, but your podiatrist can help with palliative care and custom orthotics to prevent complications. Freiberg’s Disease, or AVN (avascular necrosis) of the 2nd metatarsal bone in the head area is a less common cause of ball of foot pain, but is still in the differential diagnosis list.  It can happen due to trauma, or sometimes, its cause is unknown.  An AVN of the 2nd metatarsal head can be identified on X-ray, and often is treated with accommodation with a custom orthotic.  If this does not relieve the pain, the surgery may be an option.

If you have pain in the ball of your foot or if you have any questions about your feet, make an appointment with our doctors.  Don’t live in pain!  Call our office today.