Pain in the Forefoot

Pain through the ball of your foot or ‘forefoot’ is a surprisingly common complaint treated here at Melbourne Podiatry Clinic. Your forefoot is a busy place with a number of structures located within a very tight space so it is easy to misdiagnose the cause of pain and often hard to isolate symptoms.

Here are our top 5 forefoot pathologies, their symptoms and recommended treatments:

1. Intermetatarsal Bursitis

This is an inflammatory condition characterised by inflammation of the bursae that run in between your metatarsals (the long toe bones of the forefoot). Pain is usually exacerbated with tight shoes, time spent on your feet and can be relieved with the removal of shoes. Wide feet, high arched feet and the wearing of tight shoes are all risk factors the in development of the condition.

Treatment: targetted offloading of the area, wider fitting shoes and anti-inflammatories.

2. Morton’s Neuroma

Heat, pressure and touch are all sensations detected by nerves. Morton’s Neuroma is the inflammation of the intermetatarsal plantar nerve most commonly between your 2nd/3rd or 4th toes. Symptoms include numbness, burning, shooting pain as well as feeling like there is a rock in your shoe. It is caused by chronic inflammation of the nerve sheath (outside of the nerve). Pain is again exacerbated with the wearing of tight footwear and high heeled shoes and is often somewhat relieved with the removal of footwear but not always.

Treatment: specific offloading of the area, anti-inflammatories, shoe inserts, in more severe cases: radio frequency ablation or cortisone.

3. Plantar Plate Tear

The Plantar Plate is a thick ligament with attachments that insert into the base of your phalanges (toe bones). The role of the plantar plates is to prevent your toes from overextending or spreading too far apart. Plantar plate tears can present with hyperextension of the toes and the splaying of toes apart - particular the 2nd and 3rd toes.  Tears occur progressively and are best treated in the early stages. If you suffer any toe splaying or clawing of your toes with accompanied swelling this likely indicates you have plantar plate tears.

Treatment: depends on the stage of the tear and can include strapping, insoles and surgery.

4. Stress fracture

Stress fractures develop in response to an increase in bone stress (increase in activity) beyond the capacity the bone can cope. They develop over time and usually are in response to an increase in training commonly, doing too much too soon and not having enough rest. Stress fractures are common in runners and sports involving a lot of impact. They are more common in winter due to a reduction in vitamin D which aids in calcium absorption.

A dull ache, night pain, pain when weightbaring are all symptomatic of a stress fracture. Treatment is 6 weeks in a moon boot and a gradual return to activity. But these need to be diagnosed properly and the original causes identified.

5. 1^stMTPJ arthritis (Hallux rigidus/Hallux limitis)

Characterised by a ‘stiff big toe’ or a restriction of the range of motion in your big toe joint. 1^stMTPJ arthritis is a degenerative, arthritic attributed to repetitive load put through your big toe joint with every step. A family history of osteoarthritis, the shape of your foot and previous trauma all play a part in the development of the condition.

Treatment: mobilisation exercises, shockwave therapy, strapping, stiffer soled shoes/insoles and potential surgery.

With all of these conditions it is really important you are accurately diagnosed to ensure the treatment you receive is appropriate and will get you back on your feet quickly. As podiatrists, we specialise solely in feet and are the best placed to diagnose your issue and provide you with the right treatment!