Ball of foot pain (metatarsalgia)
Ball of foot pain, often called metatarsalgia or forefoot pain, is pain felt under the front of the foot where the small toes join the rest of the foot. The pain can come from several structures in that area, so an accurate diagnosis matters. Fiona Shepes assesses it in an initial consultation from $100, and no referral is needed to book.
What ball of foot pain is
Ball of foot pain is pain in the area that connects the small toes to the rest of the foot, behind the toes. The term metatarsalgia describes pain across the metatarsal bones in this region. Forefoot pain can affect one spot, one whole foot or both feet. The ball of the foot contains small joints, muscles, nerves, ligaments and tendons, and any of these can be injured. A number of different conditions sit under this label, which is why a thorough assessment helps sort out which one is affecting you.
Symptoms
People describe the pain in different ways depending on the underlying cause.
- A burning or sharp ache under the ball of the foot
- Sharp, shooting pain towards the toes
- Pain when walking barefoot
- Tingling or numbness in the toes
- A feeling of walking on pebbles or on a stone
- Pain that makes you limp
- Pain that worsens in tight or narrow shoes
Causes and risk factors
Ball of foot pain has several common causes. These include a plantar plate injury, Morton's neuroma (an inflamed nerve), bursitis, a stress fracture, arthritis, intrinsic muscle overuse, and capsulitis or synovitis. Morton's neuroma often causes burning or shooting pain between the second and third or third and fourth metatarsal heads, and compressing the nerve in tight shoes aggravates it.
How your foot works can contribute to the problem. When the foot over-pronates or the arch flattens, more weight is shifted onto the second, third and fourth metatarsal heads than they are built for. An increase in activity or training, excess weight, long hours on your feet each day and poorly fitting shoes are other contributing factors. Runners and people who do high impact sports with lots of jumping are affected often.
Treatment at the clinic
Treatment starts with working out why a particular area is sore. Fiona performs a biomechanical assessment as part of an initial consultation from $100, and a diagnosis can often be made at that first appointment based on clinical findings and your history. She examines your footwear and asks about the severity of the pain, its location, and what makes it better or worse. Further imaging can clarify things when needed, and Fiona can refer you directly for X-ray, ultrasound or MRI.
Your treatment plan depends on the diagnosis. Options Fiona uses include footwear advice, strapping and taping, stretching and strengthening programs, and orthotics. Semi-custom orthotics start from $450 including a biomechanical assessment and fitting, and custom orthotics start from $650 including the biomechanical assessment, fitting and a review appointment. Low level light therapy can be used for bursitis and inflammation in the feet within a standard consultation from $90. Fiona may refer you back to your GP when a problem needs medical management beyond podiatry.
DVA Gold card holders pay no out-of-pocket costs, and NDIS participants who are self-managed, plan-managed or agency-managed can be seen.
Looking after it at home
Rest from the activities that aggravate the pain gives the area a chance to settle. Applying ice can provide temporary relief. A regular calf stretching routine is worth keeping up at home. Wearing shoes with a lower heel height takes load off the metatarsals, and avoiding tight or narrow fitting shoes helps, particularly with nerve-type pain. Reducing time spent on your feet each day can ease the load on the ball of the foot.
When to see a podiatrist
You should see a podiatrist when pain in the ball of your foot persists, stops you walking comfortably or keeps coming back. The forefoot is a complex area, and these problems can be difficult to diagnose without a thorough assessment, so it is best not to wait for the pain to sort itself out. See your GP promptly instead when the pain follows a specific injury or a fall, when you cannot put weight on the foot, when the foot is swollen, bruised or has changed shape, or when you have numbness or tingling that is spreading. Fiona sees patients at 1 Prairie Court, Narre Warren, and children from 4 years old.
Questions
What is metatarsalgia?
Metatarsalgia is pain in the ball of the foot, the area that connects the small toes to the rest of the foot. It can affect one spot, one foot or both feet, and runners and people who spend long periods on their feet are affected most often.
Why does the ball of my foot hurt when I walk barefoot?
Walking barefoot removes the cushioning and support your shoe normally provides, so sore structures under the metatarsal heads take more load directly. Pain when walking barefoot is a common description of ball of foot pain and is often linked to over-pronation or flattened arches shifting weight onto the smaller metatarsal heads.
Do orthotics help ball of foot pain?
Orthotics can help when the pain is related to how your foot functions, such as over-pronation or a flattened arch. Fiona assesses your foot mechanics first, then advises whether orthotics suit your diagnosis. Semi-custom orthotics start from $450 and custom orthotics from $650 at The Fresh Foot Centre.