Far out. As a podiatrist working in our busy Melbourne clinics I think I get asked a variation of “what is causing pain in the ball of my foot” at least 2 times per day.
And I get it.
I’ve had forefoot (ball of foot pain) myself. And it was not pleasant! I was at a friends wedding, we had to wear these stylish tight patent leather dress shoes that absolutely popped with the suits we had on… but, about halfway through the evening I started to notice a burn, a niggle and then a pain in the ball of my foot.
Obviously there wasn’t enough champagne flowing to numb the pain. But it did give me a glimpse into what it’s like to worry about ball of foot pain.
So, here’s a what us podiatrists do when we suffer with forefoot pain.
Find the cause of your ball of foot pain
So it was easy for me, the cause was a pair of shoes that were too narrow and tight around the ball of my feet.
This lead to my metatarsals, the long bones that extend to just before the toes being squished together. As they become more squished (and my feet swelled more and more from the dancing and the bubble) I compressed the intermetatarsal nerve between by 2nd and 3rd toes. When this happens you feel a sharp, shooting like sensation.
For me, I was lucky.
It was only an acute nerve compression. The shoes came off and I was fine after a day or so (where I made sure I wore the best shoes I own for ball of foot pain). But if you have consistent compression of this nerve the outside of it can become thickened and develop into a painful condition known as a Morton’s Neuroma or Intermetatarsal Neuroma.
Other causes of ball of foot pain
It’s not just your nerves which can be squished in your forefoot and cause you pain.
There’s the small joints known as the MTPJ’s (metatarsophalangeal joints) which have to carry between 6 – 8 times your body weight when you move around. There’s also bursa all over your forefoot providing protection but also ready to turn into painful bursitis at a moments notice.
Your metatarsal bones can suffer from stress fractures.
The sesamoids under your big toe can grumble and become sore (sesamoiditis).
And there’s about 4 different types of big toe joint problems too. All of which can cause ball of foot pain.
Factors that lead to ball of foot pain
I’m worried I’ve led you astray here talking about the injuries as “causes” of ball of foot pain.
They are more accurately the “type” of foot pain you have. The true causes of the pain are the factors that lead to your injuries developing. The most common of which are:
- An 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 your balance muscles
- Unique foot shapes (high arches)
So how do podiatrists like me sit down and roadmap a treatment plan out to successfully overcome ball of foot pain so often in the clinic?
Ball of foot pain roadmap
To overcome ball of foot pain we need to address the causative factors and the big one is load.
Too much load on a small area within the ball of your foot and you’ll be sore. So within our session we identify what and why there’s excess load and then how we go about it.
An example for some might be too much load around the middle of the forefoot which has occurred due to a stiff big toe joint, weakness in the stabilising (peroneal) muscles and very tight calf muscles.
A roadmap for these factors might include:
- New pair of shoes (or recovery slides for ball of foot pain).
- An orthotic for ball of foot pain to facilitate function back through the big toe and away from the sore area.
- And an exercise program to build strength in the peroneals and loosen up tight calf muscles.
The good news is that many of these can be acted upon immediately and you can start improving straight away. And the others, like an exercise program place you well and truly in control of your own destiny. There’s nothing quite as empowering as knowing just what and how you’re going to help your feet feel better.
Before you go…
But if you’re a little further away and unable to attend, or you want to learn more about what you can do for your ball of foot pain check out our guides on the best shoes for forefoot pain, best slides for ball of foot pain as well as learning how orthotics work.
You can ease pain in the balls of your feet by wearing shoes with a thick sole, ideally a pair that is cushioned with a low heel to toe drop. We’ve written about the best runners and slides with links above.
You can also ease your forefoot pain yourself by wearing your prescribed orthotics from your podiatrist or limiting the time spent on your feet. If you do activities that involve a lot of forefoot loading (dance, skipping and sprinting) this can also reduce your pain (but it’s probably not going to be fun for you to miss out on doing what you love or want to).
Of course you can ignore your pain – but why?
Pain is your body telling you something is up, and your brain thinks that danger or damage is occurring or likely to occur. Ignoring forefoot pain whether it be from a neuroma, bursitis, plantar plate tear or any overuse condition is likely to lead to more complications later on.
For example, what might start as some lesser MTPJ overload (strain on the 2nd and 3rd toe joints) can lead to a plantar plate tear, which can lead to a deformity like a hammer toe forming. While this is not guaranteed to happen, why risk it? Treatment for forefoot pain is straight forward and readily accessible at your podiatrist.
Your diagnosis starts with a thorough history and clinical exam. Areas of extra pressure are identified as well as just which tissue or structure is overworked and sore.
If there are systemic reasons why you’re suffering with pain, like rheumatoid arthritis or diabetes your podiatrist will be able to help here too.
Within your clinical examination your podiatrist will assess your joints, muscles, ligaments and the way your walk or run (with a biomechanical assessment). Your shoes, and activities too will form part of the puzzle as to why you’re in pain.
Sometimes, imaging in the forms of X-rays, Ultrasound or MRI will be required as well.
Forefoot pain treatment starts with your roadmap. What is sore and why? When you can identify these factors you’re in a place to change them.
Often, you’ll be looking at exercises to strengthen weak muscles or lengthen tight ones. Load optimisation in the form of changes to shoes or orthotics might be required. Medication, both analgesic and anti-inflammatory medication might be required for a period of time too.
Biomechanical gait assessment is an evaluation of how you walk or run.
We’ll obtain some static measures first, like muscle strength, joint range of motion and joint axis positioning. From there, it’s up onto the treadmill or even a run around the oval to look at just how you move. We use video gait analysis to slow down and identify the exact timing of stress on the ball of your foot so we know just when and how to alter it.
Forefoot pain is commonly linked to other pain in the feet as well.
If you suffer from arch pain or plantar fasciitis you can alter your gait to avoid that painful area and in doing so, increase the pressure on your forefoot.
his us a very specific question which is actually pretty common.
For many clients in our podiatry clinics there’s no pain initially when getting up to walk or run. Maybe a slight ache that builds to a burning sensation before it becomes really sore.
What is happening here is that every step, a little bit of extra load is going through that at risk area in the forefoot. There’s also likely some (very normal) foot swelling as we spend more time on our feet too. So with every step, your foot is getting bigger and your shoes aren’t.
Couple that with extra load going through that 2nd to 3rd toe area and you’re overloading that intermetatarsal nerve (just like I did!).
While you can simply stop walking before 2Km to settle your pain, that’s probably not how you want to live your life. So like me, change up your shoes, and get an assessment to address any muscle or joint imbalance with your podiatrist so you can walk 2, 5, 10Km without getting that burning pain again.
About the Author
Melbourne podiatrist Tim Mulholland has felt the sharp stab of a compressed nerve in the forefoot. Good running shoes, plenty of exercise and avoiding those patent leather tuxedo dress shoes have helped him.