Forefoot Pain (Metatarsalgia)
- Soreness under the ball of the foot
- Pins and needles or deep aching pain
There are many causes to forefoot pain, some are more direct than others. It is very important to look at the whole picture and make a decision for treatment based on all factors.
Common causes
Collapsed transverse arch – under optimal circumstances there is a healthy arch across the ball of the foot. Contact occurs under the first metatarsal head and 5th metatarsal head. Met heads 2,3,4 bridge the gap in a low arch that aids in stabilizing the front of the foot. In some cases the metatarsal heads can drop down and actually load with forefoot weight bearing. This can impinge nerves and cause areas of high pressure (callusing, corns, ulceration). Nerve impingement can cause pins and needles and dull aching pain between the toes. If left untreated a neuroma can form leading to more permanent nerve damage.
Custom Foot Orthotic Suggestion
- Extra cushioning with cutouts can be used to offload boney prominences or ulceration (met accom pad with submetatarsal cutouts). Metatarsal pads will lift and spread the transverse arch and help re-establish the proper forefoot positioning. If the extra pressure is causing sesamoiditis a reverse morton’s extension can offload the 1st MTPJ.
Injury – if there is trauma to the foot internal scar tissue can stiffen up the movement of the metatarsal head, if there is a fracture to the metatarsal head it may not glide smoothly around the neighboring metatarsals. Generally an injury will lead to some form of arthritis over time.
Due to tremendous number of variables involved with an injury, multiple techniques may need to be used in unison with each other based on the specific needs of each case.
Arthritis– the forefoot needs to be able to invert and evert with walking. This allows shock absorption and proper balance for gait biomechanics. Arthritis can make movement between the metatarsal heads and shafts painful or even restricted.
Custom Foot Orthotic Suggestion
- Extra cushioning to help absorb some of the forces. Generally a cushioned soft orthotic is recommended for arthritic feet. If the foot is forced into a fully corrected position it can become very uncomfortable if the joints are arthritic. Stiff material can be added to restrict motion when the joint is painful through extension or flexion
Bunions– bunions can become painful and arthritic with time. The first metatarsal phalangeal joint will start to go into a position of subluxation if not addressed properly. The ensuing hallux abductovalgus will drastically change the joint range of motion and become arthritic. Bunions are seen as a boney prominence on the medial side of the foot and need to be considered when purchasing footwear.
Hammer toes– curling or bent position of lesser toes while at rest. Generally caused by improper fitting shoes, the narrow toe box of dressy shoe styles can crowd the toes and cause structural changes over time. High heeled footwear place a great deal of stress on the ball of the foot and also force the lesser toes into an abnormal position where the tendons and muscles can become short. A shallow toe box can rub against the toes and lead to callusing/corns and ulceration.
Custom Foot Orthotic Suggestion
The footwear must be examined, if the footwear is of improper style or fit education is of paramount importance. It is common to see a collapsed transverse arch with hammer/claw toes. See above topic for suggestions. Lifting and spreading the metatarsal heads will usually straighten the toes out.