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Metatarsalagia (Ball of Foot Pain)

 

ball_pain

 

 

Pain in ball of the foot is a common condition treated by Podiatrists.  Most often it is obvious to the eye what is causing the pain such as a corn, verruca, foreign body, callus but sometimes we have pain in the ball of our feet that we can’t see and these produce a set symptoms that help us determine what the problem is, below is an overview of many common conditions that cause pain in this area:

 

Morton's Neuroma

mortons_neuroma

 

 

 

Described as a shooting pain into the toes when walking, relieved by stopping and rubbing the affected area.  Often associated with numbness and tingling that sometimes goes in to the toes.  There is no swelling in the area.  The most commonly affected toes are the 2nd and 3rd and less often the 3rd and 4th toe space. The pain can be reproduced by squeezing the sides of the feet whilst compressing the space.  Toes usually have a normal alignment.

 

 

There are a range of treatments available ranging from:

 

  • footwear advice
  • pressure relieving pads and cushions
  • anti-inflammatory painkillers
  • orthoses to correct biomechanical influences
  • injections of steriod (or scelerosing agents)
  • surgery

 

 

Intermetatarsal Bursitis

          

A bursa is a fluid filled bag that can develop when structures rub together – it is the body’s response to reduce friction.  This is commonly confused with Morton’s Neuroma as it can mimic the same symptoms.  Bursas become troublesome when they swell and put pressure on structures.  They can often produce symptoms similar to a neuroma.

 

Plantar plate rupture

 

plantar_plate_schematic

This is a common and often misdiagnosed condition also known as pre-dislocation syndrome or capsulitis.  It can be an acute toe_fanningrupture or more commonly overloading of the structure over a long period time that results in final rupture. 

 

The plantar plate is a specialised piece of cartilaginous ligament that ‘ties’ the toes to the metatarsals.  If these tears go untreated the result is deviation of the toe in the affected area.  This can look like a ‘floating toe’ or a ‘fanning apart’ toe (see photo right).  At the acute stage there can be swelling and considerable pain which can last for weeks.  Again this condition is commonly confused with Morton’s Neuroma.

 

This condition responds well to conservative management if caught early.  It is important to seek treatment to avoid permanent deformity of the toe.  You can test to see if you have a torn plantar plate by locking your metatarsal with thumb and finger of one hand and then raising the toe and then applying vertical force downwards.  If this is painful, then contact your podiatrist who will be able to use a combination of strapping and padding to settle the problem.  Unfortunately, if left untreated, a deformed toe will only be able to be corrected with surgery.

 

Stress Fracture  

 

march_fracture

 

This is sometimes known as a March Fracture.

 

Pain in the shaft of the metatarsal that is felt mostly on the dorsal surface (top) of the foot proximal to the metatarsal joint.

A fracture can be confirmed with a tuning fork or ultrasound because the vibration caused creates discomfort. 

X-rays are not particularly helpful because the break won't show on a plain radiograph for several weeks until a bony callus has formed around the damaged bone.

 

Bone scans will however confirm diagnosis.

 

Stress fractures of metatarsal bones are usually managed with a special shoe or boot.  They take 6-8 weeks to repair.

 

 

If you have pain in your foot it is always advisable to seek advice from your professional Podiatrist. 

 

This article gives an overview of common causes of pain in the ball of your foot but of course there are many other conditions that can cause pain.  Your podiatrist will be able to advise you on the best course of treatment or will make the appropriate referral if necessary.

 

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