Ball of foot pain is classically know as metatarsalgia (MET – tuh tar – SAL – juh). The term metatarsalgia is used as a catch-all term used to describe a number of medical conditions which cause pain under the ball of the foot. The long bones in the foot are called metatarsals and the end where the metatarsals meet the toes are called the metatarsal phalangeal joints. Combining the name of the bones, “metatarsal” with the suffix “algia” means pain appropriately describes this condition. The heads of the 2nd, 3rd and 4th metatarsals make up what most consider the ball of the foot. These joints are the most commonly affected due to excess pressure, overuse and/or microtrauma, which results in inflammation and pain.
The most common symptom is deep, achy pain under the ball of the foot which can become sharp or stabbing with standing or walking. There may be shooting pain or tingling in the toes, which would indicate an inflamed nerve. A feeling of walking on a lump or cord or a “bunched up sock” under the foot is common. The pain is usually worsened with walking and long periods of standing, especially when pushing off of the ball of the foot. Narrow shoes can increase the pain and rubbing or massaging the forefoot may alleviate the pain.
A few of the common causes of ball of foot pain include faulty foot mechanics, structural deformities such as a hammertoe or dropped metatarsal, ill fitting shoes and being overweight. Many times it’s a combination of the above contributors which results in metatarsalgia. Faulty foot mechanics are an inherited trait resulting in abnormal motion of the foot. In forefoot conditions, tight calf muscles and overpronation (over-rotation and foot collapse) cause excess pressure on the forefoot. Tight calf muscles cause the heel to lift early when walking and this redistributes the weight toward the front of the foot. Over-rotation of the foot and arch collapse, in combination with hypermobility of the 1st ray (arch and great toe) causes the weight to shift from the great toe to the smaller toe joints when walking. An substantial and abnormal force is placed on a small area of the foot during “push off” and this results in repetitive strain, irritation, inflammation and pain of the small joints (2nd, 3rd and 4th metatarsal phalangeal joints) in the foot. Specific conditions, such as a neuroma or second metatarsal overload syndrome may develop.
âEUR¨Runners have a high risk of developing metatarsalgia because of the repetitive forefoot impact, but any sport which involves push off at the forefoot can be a potential problem. When an athlete changes their training regimen by adding hills or sprints, excess pressure can cause pain and inflammation at the joints in the forefoot. Poor quality shoes, lacking support and shock absorption can contribute to the development.
Structural deformities such as hammertoes can cause pain under the ball of the foot. The hammertoe is a crooked toe which causes retrograde force on the metatarsal head. As the toe cocks up, the head of the metatarsal is pushed down. The metatarsal head is now prominent on the bottom of the forefoot and more susceptible to increased pressure. Many people will complain of the feeling of a lump or nodule under their foot or complain about walking on a bone under the ball of the foot.
Poor quality or ill-fitting shoes are one of the more common reasons for the development of ball of foot pain. Narrow, tight shoes compress the forefoot and force the metatarsal heads together. This position impairs normal function of the foot when walking and increases rub and irritation in the forefoot area.
Treatment involves identifying and addressing the cause of the problem. In many cases it is a combination of faulty foot mechanics, poor quality shoes and an change or increase in a training regimen or recent weight gain. Orthotics should be used to control abnormal foot motion and disperse pressure more evening. Shoe should be rigid along the sole, only bend in the toe area, have at least a 1/2 heel and have adequate support. Calf stretches or night splints can be used for those with tight calves to eliminate the heel lifting early during walking. There are a variety of metatarsal pads which can be used to distribute the pressure under the ball of the foot to help alleviate pain and accelerate healing.