Nathaniel Zimmerman
Certified Pedorthist
Erie Location: 814-464-2992
Pittsburgh Location: 412-896-3347
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Pain in the ball of the foot is normally one of two things: First and most common is Metatarsalgia. It is an inflammatory condition of the metatarsal heads. It is usually felt in the sole at the ball of the foot.
The second most common pain in the ball of the foot is Inter-Digital Neuroma. A neuroma is a benign tumor that grows around the neurovascular bundle of the nerves that supply the toes. Single neuromas are most common. However, instances of multiple neuromas in the same foot have been reported. Morton's Neuroma involves the nerve found in the third inner space nerve that supplies sensation to the third and fourth toes. There are a number of precipitating factors that can cause a localized irritation to the nerve and thus may contribute to the development of a neuroma.
Contributing Factors
Shoes: Any shoe that is high heeled or is constricting may place the individual at higher risks for developing a neuroma. Generally, neuromas are commonly found in women who have worn high heeled shoes for many years, or men who's occupation require excessive stress of the forefoot such as kneeling, climbing ladders, or are required to wear constricting shoes. Short shoes cause the toes to contract, which cause the metatarsal heads to take an abnormal amount of weight causing metatarsalgia symptoms.
Biomechanical Abnormalities: An unstable (pronated) flat foot can predispose the foot to the development of neuroma and metatarsalgia symptoms. The excessive pulling on the common digital nerve against the deep transverse intermatatarsal ligament results in irritation and eventually the development of the neuroma. Also, a pronated foot causes the mid-metatarsals to bear an overabundance of weight causing metatarsalgia.
Trauma: Repetitive trauma that results from certain activities such as basketball, tennis, aerobics, running, etc., may precipitate the development of a neuroma and metatarsalgia. Trauma resulting from an injury such as fractures, sprains, dislocations, and crushing injuries may cause a neuroma and metatarsalgia
Solutions
The first step in treating metatarsalgia is to determine the cause of the pain. If improperly fitting footwear is the cause of the pain, then the footwear must be changed. Footwear designed with a high, wide toe box (toe area) and a rocker sole are ideal for treating metatarsalgia. The high, wide toe box allows the foot to spread out while the rocker sole reduces stress on the ball of the foot. Unloading pressure to the ball can be accomplished with a variety of foot care products. Orthotics are designed to relieve ball and arch support to reduce the problems associated with a pronated foot. The orthotic is constructed with the pad placed behind the ball of the foot to relieve pressure, and redistribute weight from the painful area to more tolerant areas.
What to expect: In a recent study done by the American Orthopedic Foot & Ankle Society found that 82% of the people that had neuromas or metatarsalgia were without pain by using larger shoes and an orthotic device, 92% were fine with larger shoes and an orthotic device and a cortisone shot. Only 8% of the population may need surgery. Most patients discover significant relief within 4 to 6 weeks of shoe change and orthotic wear. Basically, shoes with plenty of toe room and metatarsal support should relieve most forefoot disorders.
