FOREFOOT PAIN This article is going to look at pain in the forefoot or the so called ball of the foot.As with the last couple articles, well look at some of the causes for the problem, how it may manifest itself in regard to symptoms, how you can try to treat it yourself and some treatments your sports medicine physician may recommend if necessary.
Family doctors frequently send patients to my office with a diagnosis of metatarsalgia.Well the foot guys, like myself, dont tend to like that diagnosis.Not because its bad, but it doesnt really describe what the true problem is.The metatarsals are the long bones in the foot that connect
the thicker middle section of the arch to the toes.The joints where the metatarsal bones connect to the toes is the ball of the foot or the metatarsal-phalangeal joints (MPJs).The algia part of the word means pain.So metatarsalgia just means pain in the area of the metatarsals.It doesnt say if the pain due to any of a number of problems.
Well look at some of the more common causes for metatarsalgia such as Mortons neuromas, stress fractures of the metatarsals and capsulitis/bursitis.1.MORTONS NEUROMA We all have nerves running between our metatarsal bones and then separating out into branches to give sensation to the adjacent sides of the toes.These nerves can become irritated and then with time become thickened and enlarged due to either chronic irritation or trauma.
The enlarged portion of nerve is called a neuroma.This can occur between any two metatarsals, but most commonly occurs between the third and fourth.A neuroma in this area is called a Mortons neuroma.Why Dr.
Morton wanted it named after him is subject for debate.
Symptoms associated with a neuroma may include sharp or shooting pain, numbness, pins and needle sensation or, at times, a popping or clicking sensation.Many runners describe it as feeling like a sock is wadded up under the toes or ball even though it isnt.It is frequently temporarily relieved by removing the shoes and massaging the area.
Neuromas can be caused, as mentioned earlier, by trauma or chronic irritation.Chronic irritation can be in the form of wearing shoes that are not wide enough in the forefoot area causing compression of nerve.
The irritation may also occur from abnormal mechanics of the foot causing excess motion of the metatarsal bones such as in a overpronated , be sure all your shoes, not just your running shoes, have adequate
forefoot width.When fitting shoes, be sure to have them fitted at the end of the
day and/or after running.Since the foot naturally swells with activity, if you try it
first thing it may actually become too small after running.Ladies, stay away from
the heels and narrow toed shoes.
Second, try this trick.
Go to pharmacy and purchase a metatarsal pad
With the use of the pad, as they say in realty, everything is location, location,
To ensure it is in the correct location, make a mark with lipstick (guys
ask the ladies first before you borrow it) or some other marker just behind the ball
area on the bottom of the foot.Pull out an insole from a running shoe on the
affected side and place it on the floor.Now stand on the insole and the mark
should be transferred from your foot to the insole.Place the wide end of the
metatarsal pad along this line and put the narrow part toward your heel.The pad
should be just behind the ball of the foot and not directly beneath the nerve.The
concept is to spread the metatarsal bones apart and take the pressure off the nerve.
If placed directly under the inflammed portion of the nerve it will only increase
the pain rather than relieve it.You may wish to try metatarsal pads in your other
shoes as well.You can also try to put a piece of cotton between the toes to reduce
the pressure on the neuroma and spread the metatarsal bones as well.
Finally, after your runs or if inflamed by activity, ice the area 15 minutes.
Your sports medicine physician may try custom molded orthotics if you
have mild but not complete relief with your home-made insert or if they feel you
have a biomechanical problem.
In addition, two types of injections may be considered.
injections attempt to shrink the swelling around the nerve.Meanwhile alcohol
schlerosing injections, that attempt to kill the nerve altogether, may also , if conservative treatment options have been exhausted, surgical
excision and removal of the enlarged portion of the nerve may be required.
2.STRESS FRACTURES OF THE METATARSALSStress fractures, as the name infers, are cracks or breaks in the bone due to excess cumulative stress to bone due to repetitive microtrauma (as in absorbing trauma due to running many miles on hard surfaces).
Over training or wearing inappropriate or worn out shoes due to inadequate cushioning and support can cause this to occur.
The metatarsal bones are particularly susceptible to stress fractures due to their size (relatively thin) and the amount of weight and force they receive.The second, third and fourth metatarsals are particularly in danger of fracture, although it can occur in any bone.
Symptoms associated with a stress fracture include pain and swelling in the area just behind the ball of the foot.Usually both top and bottom.Usually the pain is localized to a small area but with compensation can cause pain in other areas as well in later stages.
Standard x-rays may not initially pick up the fracture and may take two weeks or more to be seen.At this time the body produces extra calcium around the area to bridge and stabilize the fracture called a bone callus.Sometimes a bone scan or MRI are required to confirm the fracture, but many times if the d