Ball of Foot Pain
Ball of Foot Pain
Ball of foot pain otherwise known as ‘metatarsalgia‘ means pain of the metatarsals, the bones that connect the foot to the toes. Everyday life can really come to a halt when you are experiencing foot pain, specifically pain in the ball of the foot, due to the importance of this area of the foot when walking.
Long term, if the pain is left untreated, the pain will worsen and can cause gait biomechanical abnormalities, consequently resulting in further injuries to the other foot, or other parts of the body like the knees, hips, or lower back.
What are the causes and symptoms of pain in the ball of foot?
Ball of foot pain can be caused by a variety of sources, such as:
- Footwear – too tight, too loose or unsupportive of the foot
- Locomoting aka walking on hard surfaces without sufficient footwear support
- Poor standing or walking posture
Injuries and conditions:
- Stress on the foot – overuse, repetitive movements or high impact
- Excessive range of motion around the ankle
- Gait biomechanical issues – overpronation or supination (foot rolling inwards or outwards)
- Abnormal surrounding tissue under the foot – too tight or too loose
- Fracture or break of one or more of the bones
- Gout – a form of arthritis caused when uric acid crystals form in the joints
- Turf toe
- A ligament sprain due to excessive bending of the big toe in an upwards direction.
- Deformity of the big toe bone and swelling of the surrounding tissues
- Contributing factors include: Excessive pronation, woman who wear high heels (causing further pronation), and older adults due to a decrease in ligament strength and gradual degeneration of the joints and bones.
- Inflammation of the sesamoid bones due to repetitive force applied to the forefoot. Sometimes, it can also result in stress fractures of the bones.
- Pain is felt in the ball of the foot, and at its worst when weight bearing.
- A common cause is sports that require a quick change of direction, such as netball, dancing and basketball.
Symptoms can include:
- Pain when weight bearing, sometimes a dull gradual pain or a sharp pain
- Pain when bending the toe up or down (commonly a symptom of turf toe)
- Tender to touch, specifically when locomoting, sometimes causing the patient to limp or shift weight to the lateral part of the foot when weight bearing
- Pain, inflammation and swelling of the toe and surrounding area
- Inflammation of the bursa between the tendon and bone of the toe (commonly a symptom of a bunion)
- Difficulty and pain wearing enclosed shoes (commonly a symptom of a bunion)
- Pain that comes and goes under the ball of the foot (commonly a symptom of gout)
Treatment for ball of foot pain:
Initial treatment advised for acute injuries with initial pain is PRICE:
- Protect – Protect the injury to prevent further injury and pain.
- Cushioning, shock absorbing insoles are good for short term relief under the big toe and/or ball of the foot to reduce pressure.
- Rest – stop placing more pressure on it – crutches or brace, or firm soled shoes to avoid toe bending (turf toe)
- Ice – to relieve inflammation and hopefully some pain relief
- Compression – turf toe – support and protect the toe as well as reduce swelling but can restrict blood flow so don’t leave on the whole time
- Elevate – reduces pain and swelling to the area
Before proceeding with rehabilitation, x-ray’s are sometimes advised for injuries such as turf toe, bunions and sesamoiditis to rule out any fractures or other injuries which can further worsen the condition and extend rehabilitation time. An MRI is also recommended sometimes for sesamoiditis patients to observe any stress fractures present which are not visible on an x-ray. If a fracture is present or surgery is required, dependant on the type of injury, the recovery time and methods can slightly vary:
- Sesamoiditis: 6 weeks recovery in a plaster/plastic cast with no weight bearing.
- If the bones don’t heal properly post-fracture, surgery will be the last resort, however will result in some negative side effects such as muscle imbalances and gait biomechanical abnormalities.
- Turf toe: 3-4 weeks recovery post-fracture.
- Bunion: 4-8 weeks recovery post-surgery in a plaster cast on crutches with no weight bearing.
- Surgery is required to realign the joint and remove excess bone as the big toe commonly deforms inwards towards the other toes, particularly the second toe, overlapping it completely in some cases.
Long term, rehabilitation is usually a combined effort of therapies to not only reduce pain, but also to prevent re-injury and correct any negatively contributing factors.
Toronto Physiotherapy treatments for ball of foot pain includes:
- Shockwave Therapy – state of the art technology uses strong sound waves to break down scar tissue, break up muscle adhesions, promote blood flow and healing to chronic injuries.
- Ultrasound Therapy – electrotherapy that uses sound waves that penetrate and stimulate the injured muscles or tissues. Not only relieving pain, it also works by enhancing the natural healing process of the body.
- Custom orthotics – those who excessively overpronate or oversupinate will benefit greatly from investing in a pair of custom orthotic insoles which correct these abnormalities. Not only will they correct your gait, but also help to prevent other issues such as muscle imbalances or injuries such as a plantar fasciitis which are common outcomes of an abnormal gait.
- Alternative footwear – Wearing more supportive shoes that are not too tight or too loose and support the natural arch of your foot will benefit you both short term and long term to relieve pain and prevent further injuries.
- Laser Therapy – cold laser used to reduce inflammation and promote healing in a gentle and safe way.
- Taping – taping is beneficial to stabilize the injury and to relieve pressure and there pain off the area. In the case of turf toe, it will aid by preventing bending of the toe. For those who suffer from bunions, sometimes it is a useful method to relieve pain by separating the big toe and adjacent toe with foam and tape.
In collaboration with these therapies, your Physiotherapist will guide you through an individualized rehabilitation program. Initially this will include stretches and pain relieving treatment modalities, once pain has reduced, they will introduce strengthening exercises and modifying/corrective techniques to prevent re-injury and bring your injury back to a strong pre-injury state.
In addition, if your injury was as a result of playing a sport, your Physiotherapist will most likely assess your technique to modify and/or correct.