What Causes Forefoot Pain?
Forefoot pain, also known as metatarsalgia pain, usually appears as an ache or burning sensation at the front or balls of your feet. The pain usually increases with extended standing, walking, running or extended exercise; and normally decreases with rest or when shoes are taken off. Most of the time, people who suffer from forefoot pain also have clawing or hammering of the toes.
Main causes of forefoot pain
- Footwear: Footwear plays a key role in forefoot pain. High heels place extra stress on the ball of the foot and narrowly-pointed shoes squeeze toes together. These types of footwear intensify and increase the probability of forefoot pain and should be avoided.
- Foot mechanics: People with flat feet increases the chances of forefoot pain because when the arch falls it places added pressure onto the three middle bones of your forefoot, squeezing together and pinching at the soft tissue in the surrounding area.
- Rigid high arch feet: Oppositely, people with rigid high arch feet are also prone to forefoot pain as this also puts mass added pressure onto the balls of the feet.
- Individual and muscular factors: With age, the fat pad on the ball of the foot diminishes due to loss of collagen reducing protection of ball of the foot. This then causes the arch to collapse which then places added pressure and stress of your forefoot when walking, running or exercising.
Types of Forefoot pain
- Morton’s Neuroma: Morton’s Neuroma is a common cause of forefoot pain. It is a benign growth of an interdigital nerve. Symptoms are burning or shooting sensation in the balls of the feet and sometimes extending into the toes. Usually, a collapse of the metatarsal arch or tight-fitting shoes can exacerbate symptoms. Treatment for Morton’s Neuroma is to avoid narrow footwear that may irritate the pain, stretching and recreating the arch to offload pressure. If the neuroma is large in size, your podiatrist may suggest a cortisone injection, orthotics or neuroma surgery (neurectomy) if conservative treatment fails.
- Bursitis: Bursitis is the inflammation of small sac’s called a bursa, they are located near a joint, tendon or bone. Bursitis is when the bursa becomes irritated by repetitive motions or from tight footwear. Symptoms of bursitis include pain, redness and swelling. Your podiatrist might suggest conservative methods of treatment such as icing, nonsteroidal anti-inflammatory medication, corticosteroid injections or padding. If these methods don’t work, surgery might be necessary.
- Capsulitis: Capsulitis is caused by the overuse of the ligaments around the joint capsule where your metatarsal connects with the toe in the ball of your foot. Excessive pressure can deteriorate and inflame this structure. Symptoms are redness of skin over joint, feels like walking on a pebble, or pain wearing shoes. Contributors to capsulitis can be severe bunions, second toes that are longer than the first and a weak arch in the foot. Ill-fitting footwear and high-intensity activities that stress the ball of the foot can also have an impact. Capsulitis does not improve on its own, so early detection is important to best prevent any further damage. For treatment you can: rest and alleviate, tape, ice, get supportive footwear, medications, orthotics and in some serious cases, surgery might be required.
- Synovitis: Synovitis is the inflammation of the tissue that lines the joints. Symptoms may include swelling, pain, redness and warmth or a burning sensation. To treat this forefoot pain you can ice, rest, immobilize, use nonsteroidal anti-inflammatory medication or steroid injections. In certain cases, surgery might be necessary.
- Plantar plate tear: The Plantar Plate is a ligament which connects to the base of the toes in the ball of the foot. The plantar plate is designed to protect the metatarsal from pressure and prevent an overextension of the toes and toe ligaments. Generally, plantar plate tears occur through a stabbing injury or progressively from repetitive overuse; but can also be caused by biomechanical abnormalities, unions or steroid injections. You can often identify a plantar plate tear if there is pain or swelling, Mortons’neuroma like symptoms the toe becomes hammered. To treat this, you can: immobilize, use tape or your podiatrist might recommend custom orthotics.