Ball of foot (aka forefoot) pain although not as common as heel pain is still quite frequent in the clinic here. Ball of foot is also known as metatarsalgia. There are many causes of this type of pain and there are many types of foot conditions that result from this type, obviously depending on severity.

ball of the feet aka the forefoot

 

WHO

Although women experience more of this pain, men can also suffer from this type of foot pain. Whether you’re wearing high heels, standing for work in safety shoes or a runner you are certainly prone to metatarsalgia. I even had a 11 year old this week present with ball of foot pain!

CAUSES

Poor foot posture

The most common cause of foot pain are the excessive or abnormal pressures it endures when walking and moving. It’s about the joints in the ball that are too flexed down therefore you step with the ball more excessive than the heel and the foot. Your whole weight and ‘centre of mass’ are pushed forward onto the ball of the foot and the hard ground of our world exerts too much pressure into the foot.

Footwear

Women are more common because they are more likely to wear high heeled shoes which has a downward forward sloped insole. Wearing this causes the wearer to automatically put excessive pressure onto the ball of the feet and then they go walking on hard floors (cause it’s easier then soft grounds) and that puts even more pressure!

high heels cause a forward insole slope

 

I have a great passion in the area of occupational health and safety. I’ve seen a fair amount of safety shoe wearers presenting with ball of foot pain as they stand and position themselves for a long time in one position often on hard concrete floors. Because the heel area has minimal padding compared the ball of the foot, workers tend to push their body-weight onto the balls as the area has more body structures to help cope with their prolonged working hours.

Runners whether long or short distance should impact the ground on their midfoot (arch) to forefoot thereby exerting excessive pressures on their ball of the feet. The runner is too preoccupied with the goal of beating the time or running the distance to realise that they implement this running technique to reduce pressure on their heels which would hurt more if they landed on it the whole running duration.

running on the balls of the feet

 

Biomechanics

It’s not only from wearing high heels or safety and running shoes but also from a compensated foot type. Lower limb compensation involves your body and feet attempting to readjust itself so you can move more efficiently. In some cases of heel pain or a flat footed type, the foot would instinctively try to help you cope by recruiting muscles to compensate by creating an arch or take pressure off your heel.

 

CONDITIONS

As a result, you can experience sharp pain, burning, aching and stiffness in the ball which can bring up common ball of foot pain conditions such as:

Osteoarthritis (OA)

The most common form of arthritis. OA occurs from the wearing down of the cartilage or the joint cushion resulting in the grinding of your bony structures when you move a joint which causes pain and stiffness.

If OA occurs within the forefoot then you can imagine the severity of aches, pain and discomfort you may experience when you place your bodyweight downward pressure onto the feet while the feet also endures the upward pressure of the ground and flooring of the environment.

Plantar Plate Injury/Rupture

The plantar plate is an important structure as it helps absorb shock and stabilise the forefoot joints and helps you propel forward when walking. However, if the structure is overloaded with excessive and abnormal pressures from having ‘flat feet’, abnormal bone lengths and structures such as bunions then pain can result.

Tears and ruptures can occur if the pressure is prolonged or worsened over a lengthy period of time.

Muscle strains & tightness

Simply overloading or sudden jerks of movement can cause muscle strains while excessive usage of muscles recruited to assist you in walking can cause major muscle tightness.

Calluses, corns & blisters

Your body should know how to protect itself from pressures. The body’s common tactic to counteract excessive pressures is to develop this hard yellow thickness of dead skin (calluses and corns : learn more: Calluses) to prevent the pressure breaking your skin and causing far worse symptoms! Blisters or sacs of bodily fluid are another defence mechanism the body creates in response to pressure.

However, the body naturally doesn’t consider the second phase of pain which is caused by you ignoring that callus as you continue to move with these abnormal pressures. Treat calluses, corns and blisters as a way for your body to communicate to you that you have to take action and resolve this excessive/abnormal pressures!

Morton’s Neuroma

I believe this condition is not appropriately named. When i used to diagnose this, some of my clients would ‘freak out’ and think they’ve got a tumour or some abnormal growth. Yes, it may appear on a scan as a mass but in actual fact this bulge or mass seen on a scan of your forefoot is actually a swollen nerve!

Remember forefoot pain is mostly caused from excessive pressures from your body-weight, poor foot posture, the ground and your footwear. Earlier, I’ve already discussed joints and muscles but we have to also take notice of the poor nerves which have to take the brunt of all these pressures. They too can become injured, inflammed and irritated. As a result, pain, numbness and burning sensations in the foot and the forefoot can occur.

the pressures of the forefoot

 

HOW TO RESOLVE

It really comes down to doing two major things: reduce the pressure on the ball of the foot and manage the tight muscles which have become very tight and constricted from working too hard to compensate to allow you to move efficiently.

Reducing pressure on the ball of the foot is paramount. This can be done by simply using padded ball of foot inserts such as gel or rubber which can be purchased from the local chemist.

For those who are of the more moderate to severe pain category then you may require shoe modifications and custom made orthoses which are focused on ball of foot support. The idea is to apply on the orthotic a soft pad or what I like to call a forefoot pillow to help you reduce the intense pressure. I’ve found it a great challenge to break through the psychology of people’s shoes, especially ladies and their high heels and court shoes which are obviously damaging their feet. In these circumstances, I guess I am a master negotiator!

ladies court slim orthotic

 

If you are experiencing muscle strains and aches then you would need what I call muscle servicing which involves loosening, stretching tight muscles and strengthening weak muscles to restore muscle balance (check out : The Importance of Recuperation)

But certainly, the first step is to investigate what is the true cause and we go from there. Remember ball of foot pain is not normal. Any foot pain is not normal. Consult your local Podiatrist as soon as possible and have it addressed.

WALK SMARTER NOT HARDER!

Grant Duong, Podiatry

At the Triumph Institute located in the heart of Bankstown, Sydney we also practice podiatry. It’s a medical field that specialises in the prevention, diagnosis, treatment and rehabilitation of problems and issues that affect the lower limbs, from the lower back right down to our feet.

Learn more about Triumph Podiatry →

 

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