Any somewhat active person can commonly develop pain in the ‘ball’ of the foot. This area, usually described as the part of the foot just before where the toes begin, sees a lot of pressure during the walking cycle. When combined with problems with one’s foot structure and foot shape, this pressure can cause pain and other issues. This article will discuss some of these problems, as well as the treatment options available to provide relief from the pain.
Pain in the ball of the foot can be caused by many conditions. The most common condition seen in this part of the foot is a neuroma. A neuroma is defined as an inflammation of the tissue that surrounds one of the nerves that travel between the long bones of the foot towards the toes. It usually affects the nerve in between the third and fourth toe, or less commonly between the second and third toe (with the big toe being considered the first toe for comparison’s sake). Due to a variety of reasons, but especially seen in people with either flat feet or very high arches, this nerve inflammation can cause the sensation of a hard or hot pebble in the ball of the foot, as well as burning, tingling, and numbness in the toes immediately beyond the area of pain in the ball of the foot. Rubbing often relieves some of the symptoms. The pain generally worsens with activity, but is especially irritated when tighter shoes are worn as the shoe material squeezes down on the ball of the foot. Treatment can consist of steroid (cortisone-like) injections to shrink the nerve tissue swelling, as well as anti-inflammatory medications and icing. Custom foot inserts called orthotics can help to relieve the pressure under the foot, and wider shoes reduce squeezing on the nerve. Sometimes surgery is necessary to remove the painful nerve segment.
Other causes of pain in the ball of the foot can include too much pressure to the bones as seen in people with flat feet and in people with very high arches, although there are two very different reasons for this based on these different foot types. In a person with flat feet, as the foot becomes over-flexible and one finishes the part of the walking cycle where foot begins to push off the ground, an increased amount of pressure is present in the ball of the foot over a person with a more normal foot type. In a person with high arches, the pressure to the ball of the foot comes in the form of too much shock from striking the ground, as a higher arched foot is not as flexible and will not flatten enough to absorb this shock. Regardless of the cause, the abnormal pressure to the ball of the foot eventually overwhelms the body’s natural fat pad, and inflammation develops. The bones at this site (the heads of the metatarsal bones) feel more prominent on the ground, and any deformity of the toe (like a hammertoe) also present at the same time can increase this pressure by pushing down on the bone in the ball of the foot even further. Eventually, the tissue that surrounds the joint at the base of the toe will become inflamed (capsulitis), and in more severe cases a tearing of the tissue that supports the bones in the ball of the foot can occur, especially under the second toe. Treated with well padded custom inserts and supportive shoes specific for one’s foot type (stiff shoes for flat feet, soft well-cushioned shoes for high arches), the pain usually can be controlled without surgery and a quick return to activity is possible. At times, surgery is needed to fix the problem. Procedures to lift up or move back the heads of one or more of the metatarsals are usually favored over reconstructing a flat or high arched foot as they are easier to recover from and do a good job at relieving the symptoms. Sometimes the toes need to be surgically straightened as well to reduce the pressure on the metatarsal heads.
Stress fractures (microscopic cracks) of the metatarsal bones can also occur here due to repetitive pressure, and if one has a strong enough injury to the foot a full fracture can occur, where the bone breaks completely. Unless the fully fractured piece has moved out of position, both these types of injuries can be treated with a protective walking boot until healing has taken place. Bones that move out of position too far need surgery to place them back into position and need hardware to keep them stable until healing has occurred, unless they can be moved back into position with external manipulation of the foot and there is enough stability for them to stay in place.
If the pain is under the big toe joint, the cause may be due to inflammation of two small bones called sesamoids instead of the toe joint itself. These egg shaped bones are found in every foot, and can be injured if repetitive stress is applied to them, such as in running or other impact activities. Repeated stress as well as injuries from landing on the foot from a fall can cause a stress fracture or even a full out fracture of one or both of the sesamoids. These bones need a moderate period of rest and de-weighting of the big toe joint, along with icing and anti-inflammatory medications, in order for them to heal properly. Reoccurring cases need specialized inserts to reduce pressure and stress to the bones themselves. At times, when they are resistant to healing, surgery can be considered to remove them. This is often reserved as a last option, as the sesamoids do provide some stability to the big toe and removal of one of them can change the stability to a slight degree.
Finally, it is not uncommon for pain in the ball of the foot to be simply from a painful callus. Calluses are formed when the skin has too much pressure from the ground below it and the bone above inside the foot. The top layer of the skin thickens up to form a sort of armor to protect the skin from this squeezing pressure. When this layer is too thick, or when this tissue grows inward into the skin and not outward away from it, pain can result. Treatment simply involves regular shaving of the skin build-up, either with a pumice stone or emery board at home or with sharp treatment by a podiatrist. Custom inserts to decrease the pressure to the ball of the foot also helps greatly, as well as the selection of properly supportive and properly sized shoes. Surgery to lift the bone up underneath the callus can also be considered if nothing else helps.
As one can seen above and although due to a variety of reasons, pain the ball of the foot is almost always treatable, and simple measures like proper shoe selection and shoe inserts can keep these conditions from returning. Some conditions do require surgery ultimately to relieve the pain, but this is not always the case as non-surgical treatment is quite successful in many cases at this part of the foot.