Forefoot Pain

Foot and Leg Pain

Pain in the ‘ball’ of the foot has a number of causes from an obvious traumatic incident to a more common gradual onset presentation over a period of week or months.


There are numerous causes of forefoot pain, including increase in intensity or duration of walking/running causing greater stress on soft tissue and bone areas. Older, more well used footwear can cause overload as can new footwear that is more stiff until broken in. High heels for women can be an obvious cause too. In some cases forefoot mal-alignment can cause overload as can hard skin build up. If there has been an increase in body weight or a change in training surface this can place added stress on the front of the foot causing pain.



Common types:


Morton’s neuroma

Caused by a pinching of nerves between the toes, often caused by tight shoes and mal-alignment of the forefoot causing abnormal loading and pressure. Tight ski or snowboard boots can also cause pain. Patients often experience a burning sensation, sometimes with some numbness into the toes if present for long enough. Off the shelf or custom orthoses can help reduce the loading, as can wider more accommodating shoes. Short term relief can be sought with an ultrasound guided cortisone injection and a course of a new treatment called neural prolotherapy is showing to help.


Sesamoid injuries

The sesamoid bones are two pea sized bones that sit under the big toe joint and help to dissipate force when we walk. These small bones can be subject to a lot of force and pressure while walking and running, with certain foot types more susceptible and certain sports more likely to exacerbate the load. In most cases it is bruising to the joint surface beneath these bones that we see and it is often easily managed with off the shelf or custom orthoses, a change in footwear and some strengthening around the muscle that insert into the region. If there has been more excessive force this can lead to a stress fracture or even fracture to the bone, often diagnosed with x-ray and/or MRI. A moon boot style walking boot can help to unload the region and the graduating out of this into orthotics and increasing strength and length of muscles.


Bunion pain

There are some risk factors that could lead to bunion formation but they are largely genetic in nature often with a family history. It is an angulation of the big toe on the 1st metatarsal (bone that starts in the top inside of the arch and connects into the big toe joint). They can make fitting shoes harder and as they progress in angle that can give pain with walking. Wider shoes are suggested and in certain cases we find off the shelf orthoses or custom orthoses to be helpful in easing pain in the joint. There are no other treatments other than surgery that can correct a bunion but a number that can ease it significantly including the previously alongside wide footwear.


Joint capsule tears

There are strong, tough ligaments that join under the knuckles in the forefoot and support the underside of the joints that connect into the toes. Over time with wear and tear (and more commonly in the presence of a bunion) there can be additional forces placed on the forefoot region, most commonly under/behind the 2nd toe. This can lead to the joint becoming painful and in some cases unstable. You may experience a burning or achy feeling under the ball of the foot. There are strappings that can help and custom orthoses can reduce the loading forces around the painful area helping it to settle. Shoes that are stiffer in the forefoot can also help. Rarely surgery is needed but a referral can be made if there is a failure to respond to conservative therapies.


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