Pain in the ball of the foot is commonly called metatarsalgia. A diagnosis of metatarsalgia can be confusing however, because there are several different things that will commonly cause these symptoms. The most common causes of metatarsalgia are capsulitis around the metatarsophalangeal joint region and a pinched nerve in the foot called a neuroma.
Capsulitis occurs most commonly over the second metatarsophalangeal joint. This will cause pain at the base of the second toe and often times has associated swelling. This typically happens when too much pressure is being applied to this joint with activity and the ligament called the plantar plate starts to be stretched or torn. We see this happen in feet with bunion deformities or bumps over the big toe, because the big toe is not supporting enough of the body's weight with activity. We also see this happen when the bone behind the second toe, which is called the second metatarsal, is congenitally slightly longer than it should be. This can lead to increased pressure and forces over the joint. Another common cause of forefoot overload in this area is tightness of the Achilles tendon.
Treatment of capsulitis in the forefoot typically consists of icing and anti-inflammatories as well as possible cortisone injections. We also typically treat this mechanically and recommended Achilles tendon stretching exercises and trying orthotics (arch supports) with metatarsal pads. Physical therapy can also be utilized conservatively for this. If this fails to relieve the pain adequately, there are surgical procedures to address this issue as well. The surgical procedures typically consist of shortening the long metatarsal and addressing the ligament tearing and inflammation by either a primary ligament repair of the plantar plate or flexor digitorum longus transfer. If patients have developed an equinus deformity, we also sometimes have to lengthen the Achilles tendon with a procedure called a gastrocnemius recession to help with this.
The most common other reason people get pain over the ball of the foot is a pinched nerve in the foot called a neuroma. This most commonly happens between the third and fourth metatarsals and will typically give people pain in the area, but also can give symptoms of burning, and tingling, and numbness into the toes. Sometimes patients also get feelings in the ball of the foot like they are walking on a rock or their sock is rolled up in the area of the neuroma.
Neuroma treatment typically involves recommending wider toed shoe boxes and using orthotics with a metatarsal pad to try to spread out the metatarsals and decrease the pinching of the nerve mechanically. When the nerve is severely pinched, a cortisone injection is also a treatment option to try to decrease the swelling of the nerve. If conservative therapy does not work for neuromas, we typically recommend surgically removing the nerve. If you do have a neuroma removed surgically, it is important to know that there will be some numbness in the area where the nerve is removed.
If you are suffering from any foot and ankle pain or problems, call your expert Colorado Springs podiatrists and foot and ankle surgeons today at 719-488-4664. All of our staff and physicians at Foot and Ankle Institute of Colorado are expertly trained to treat you in a kind and compassionate manner with the most up to date techniques to help keep you active and on your feet!
