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What is Causing Pain in the Ball of my Foot?

Pain in the ball of the foot is one of the leading presentations to our Podiatrists at PridePlus Health. When you consider the amount of work that the ball of the foot does every single step, it’s no surprise that there can sometimes be problems. Our feet are often unheralded regarding the amount of work they do for us but you might find it interesting to hear that up to 8 x your body weight will act across the ball of the foot during locomotion Every single step!

Let’s get down to business, the ball of the foot has an intricate network of hard-working bones, joints, ligaments, muscles both long and short, tendons, nerves, blood vessels, fat pads and more. In the past, when there is a pain in the area where the 5 toes connect to the foot at the metatarsophalangeal joints (MTPJ’s) – known colloquially as the ‘ball of the foot’ – it was titled ‘metatarsalgia‘. This term has thankfully fallen out of favour, as metatarsalgia provides no guidance to the cause of the symptoms or what treatment(s) would be beneficial. These days we can be more specific and diagnose the symptoms to the structure or structures above that have been affected.

Now for nerves, this would be a neuroma. For the bursa in the ball of your foot causing you pain, that would be bursitis. And the small bones under the big toe, the sesamoids, sesamoiditis. There can be damage to small and large ligaments, joint capsules (capsulitis or effusions), overworked bones (stress fractures) and many more.

With the ability to be much more clinical and critical in our assessments, your PridePlus Health Podiatrists will be able to get a faster and more effective treatment plan underway.

If you have a ball of foot pain, or someone has used the dreaded term metatarsalgia to describe your symptoms, book in with our expert podiatrists here. To learn a little more, read on.


What is causing the pain in the ball of my foot?

From reading above you’re fully aware that there’s a lot of different parts that can say no more and trigger a pain response. But why do they do that?

To get to the level of pain, we need to be asking these structures to do more work than they are currently capable of. Also known as working outside their comfort zones.

Now, this can be a tricky concept to get our heads around, particularly if you haven’t had pain in the ball of your foot before. Basically, every part of our body has the ability to be loaded or worked. So if we do too much, we get pain as they wear down. And if we do too little, we lose some of their capacity to do work next time (don’t use it, you lose it!). There’s a happy medium where we maintain capacity or even increase capacity with just the right amount of loading (the happy place or the goldilocks zone).

Sometimes our goldilocks zone is decreasing due to age, sometimes it’s other medical conditions (different types of arthritis, diabetes etc.), sometimes it’s medications we have to take or choices we make like smoking. Our mood and sleep patterns can also affect our goldilocks zone, when stressed or sleeping poorly it doesn’t take as much to work outside these zones. When we do consistently work outside of these zones, pain in the ball of the foot usually follows.

Some examples of factors that can increase the load on the ball of the foot are:

  • Increase in weight
  • Increase in physical activity or loading from previous levels
  • Flexible soled shoes (like slippers, some flats)
  • High heeled shoes
  • Jumping/Sprinting sports
  • Studs or cleats in sports specific footwear (footy boots or golf shoes)
  • Uneven strength in our balance muscles
  • Unique foot shapes


How do the PridePlus Health Podiatrists diagnose my ball of foot pain?

Carefully and clinically.

An assessment will start with listening to your story, your history. What the pain feels like, how it changes with different activities, the times of the day and different shoes. Your goals (is it to reduce pain, is it to give your pain a name or is it to know that it’s safe to run a marathon next week?) will be discussed and then we get into the hands on.

Joints are gently manipulated to look at range and quality of movement as well as the axis they rotate or glide through.

Muscles are tested for strength in various positions.

Your gait is analysed to further indicate where and why your ball of foot pain is occurring.

Shoes are considered, what are they helping, what can be improved.

So from here, a plan to address the causes of your ball of foot plan can be put in place.


And for some it might include:

  • Strength work to balance and build even strength
  • Load optimisation, the movement of a load from overworked areas to underworked areas. This can take the form of strapping, padding, shoe changes, orthotics or innersoles
  • Pain medication might be utilised depending on the cause and the ability to tolerate certain medicines
  • Teaching and education. About pain, about load, about your exact condition. This can often lead to changes in lifestyle that can positively affect your ball of foot pain. Maybe it’s a start on a weight loss program, quitting smoking, or changing medications via your GP or specialists
  • Referrals to appropriate partners such as physiotherapists or exercise physiologists if proximal factors such has hip strength are contributing

So the outlook or prognosis for someone suffering from pain in the ball of their foot is usually excellent provided a thorough assessment and treatment plan is followed through.

Pain in the ball of your foot? Book online with our Podiatrist’s in Melbourne CBD, Pascoe Vale and Emerald.

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