INTRODUCTION
Pain in the ball of the foot is normally one of two things: First and most common is Metatarsalgia. It is an inflammatory condition of the metatarsal heads. It is usually felt in the sole of the ball of the foot and sometimes feel like “walking on pebbles”. Other people feel a more diffuse vague pain, ache or burning. Some people have trouble around only one or two toes, others have it throughout the ball on one or both feet. 90% of patients with metatarsalgia are found to be wearing shoes at least one size too small.
Secondly, inter-digital neuroma
is a benign tumor that grows around the neurovascular bundle of the nerves that supply the toes. Almost 90% of all neuromas are found in females between the ages of 18 to 85 year old. Single neuromas are most common, however, instances of multiple neuromas in the same foot have been reported. Morton’s neuroma involves the nerve found in the third inner space nerve that supplies sensation to the third and fourth toes. There are a number of precipitation factors that can cause a localized irritation to the nerve and thus may contribute to the development of a neuroma.
Contributing Factors
Shoes: Any shoe that is high heeled or is constricting may place the individual at higher risk for developing a neuroma. Neuromas are commonly found in women who have worn high heeled shoes for many years or men who’s occupation require excessive stress of the forefoot such as kneeling or climbing ladders or are required to wear constricting shoes. Short shoes cause the toes to contract that cause the metatarsal heads to take an abnormal amount of weight causing metatarsalgia symptoms.
Biomechanical Abnormalities:
An unstable (pronated) flat foot can predispose the foot to the development neuroma and metatarsalgia symptoms. The excessive pulling on the common digital nerve against the deep transverse intermetatarsal ligament results in irritation and eventually the development of the neuroma. Also, a pronated foot causes the mid metatarsals to bear an overabundance of weight causing metatarsalgia.
Trauma:
Repetitive trauma that results from certain activities such as basketball, tennis, aerobics, running, etc., may precipitate the development of a neuroma and metatarsalgia. Trauma resulting from an injury such as fractures, sprains, dislocations, and crushing injuries may cause a neuroma and metatarsalgia.
SOLUTIONS
The first step in treating metatarsalgia is to determine the cause of the pain. If improper fitting footwear is the cause of the pain, the footwear must be changed. Footwear designed with a high, wide toe box (toe area) and a rocker sole are ideal for treating metatarsalgia. The high, wide toe box allows the foot to spread out while the rocker sole reduces stress on the ball-of-the-foot. Unloading pressure to the ball-of-the-foot can be accomplished with a variety of foot care products. Orthotics designed to relieve ball-of-foot pain usually feature a metatarsal pad and arch support to reduce the problems associated with a pronated foot. The orthotic is constructed with the pad placed behind the ball-of-the-foot to relieve pressure, and redistribute weight from the painful area to more tolerant areas.
What to expect
In a recent study done by the American Orthopedic Foot & Ankle Society found 82% of the people that had neuromas or metatarsalgia were without pain by using larger shoes and an orthotic device, 92% were fine with larger shoes and an orthotic device and a cortisone shot. Only 8% of the population may need surgery. Most patients discover significant relief within 4 to 6 weeks of shoe change and orthotic wear. Basically, shoes with plenty of toe room and metatarsal support should relieve most forefoot disorders.
