Understanding & Treating Ball of Foot Pain

Ball of foot pain is a general term used to describe pain that can be in the front of the foot such as the metatarsal heads, the toes or the ligaments and tendons that connect these structures together. A Plantar plate tear is when the small ligament that attaches the metatarsal head to the toe is overstressed and leads to a small tear or at times a complete rupture. This can result in the toe lifting off the ground, localised swelling and can feel like you have a small pebble under the ball of your foot.

A Morton’s neuroma is a condition of the nerves that lie between the metatarsal heads. If the nerves become irritated, the nerve starts to become inflamed and thickens. This can develop into changes to the feeling in the toes that the nerves supply. People can also describe the feeling of having a pebble under the ball of the foot just like a plantar plate tear.

The Cause

Pain in the ball of your foot could be related to many things due to a complex combination of bones, ligaments, muscles, nerves and blood vessels. This can cause numbness in the toes if left for too long.

Pain in the ball of the foot can be caused by many different things such as:

• Sudden increase in level of exercise / activity – If you are not an active person and suddenly increase your walking, start to run, or start going to a lot of fitness classes in a short period of time, your muscles and tendons are not able to cope with this big increase and this can often lead to the development of pain in the ball of your feet.
• Ill fitting footwear - Wearing footwear which has a narrow and shallow toe box can lead to compression of the nerves that lie between the metatarsals (bones) in your feet. If the outsole is flat and made of a thin material this may also be the cause of the pain. Pointed footwear such as high heels are a common shoe that contributes to this.
• Flat feet – Having flat feet can cause more pressure being placed through the front of your feet. When you add this to a sudden increase in activity, or wearing the wrong footwear, this can lead to the pain in the balls of your feet.
• High arches – People who have high arches have a higher load placed through the front of their feet, as their foot may not pronate enough to absorb the pressure being applied from the ground and body. They can also have more ankle and calf muscle stiffness which can lead to an increase in pressure through the balls of your feet.

How to prevent the pain in the ball of the foot

There are many ways in which you can try to prevent ball of foot pain, such as, a Plantar plate tear or a Morton’s neuroma and avoid the factors above that cause the pain. The list below on how to prevent these conditions is not exhaustive but can be a good place to start. Sometimes there is more than 1 factor that can help, these include:

• Gradual increase in exercise – If you have always been a person who does not exercise, you are looking to be more active, or training for a marathon, it is important that it is done gradually. By taking a gradual increase in exercise (i.e. Two 30 minute walks a week for 2 weeks, then increase it to 3 walks and so on) it allows the muscles and ligaments to become stronger at a rate at which they can adapt to.
• Footwear – Avoid wearing shoes which have a narrow and shallow toe box for long periods of time. Make sure the footwear is wide and deep enough to accommodate all your toes. Things you should be looking for in a good shoe are a firm heel counter (the back of the shoe doesn’t fold down), lace up or Velcro, firm midsole (shoe can’t fold in half) and a toe spring (the front of the shoe bends up). Having your feet measured for length and width is also very important. If you are not sure what type of footwear would suit you best, feel free to book an appointment to discuss this further.
• Rest/Recovery – Making sure you have at least a day off after exercising is important to help prevent pain in the ball of your feet. By giving your muscles and tendons time to rest and recover, this allows them to be ready for the next time you train/exercise. If you were to exercise every day, this would result in a big increase in muscle/tendon use and eventually the cells that make up the muscles and tendons will begin to fail and break down causing pain.
• Sleep – It has been found that not having enough sleep (7-8 hours) can dramatically increase your likelihood of developing heel pain. The quality of your sleep is also important.
• Stretch and Strength – Specific exercises can be given to help improve the pain with a Morton’s neuroma or a Plantar plate tear.
• Orthotics – People often respond well to orthotics which are customised to reduce the pressure on the forefoot and relieve symptoms.

How to self-manage pain in the ball of your feet

Now that you know what a Plantar Plate tear and Morton’s neuroma are, the causes and ways to prevent them, it is time to discuss the means in which you can self-manage them.

You should check your footwear and change them if you notice they are worn on the outsole or are not providing you with support like they used to. You should also make sure you are wearing footwear which is wide and deep enough to prevent compression of the toes and metatarsal bones.

Applying an ice pack to the ball of the foot for 5-10 minutes, three times a day will also help manage any localised inflammation that may be present. Remember to wear a sock on your foot when applying the ice to prevent a cold burn. *if you have neuropathy (where there is no feeling) you should avoid doing this until you have spoken to your health care practitioner.

Stretching your calf muscles will also help reduce the pressure on the front of the foot and can help manage your pain. A straight leg calf stretch is sufficient enough, holding a stretch for 30 seconds and repeating 3 times on each leg.

Taping the toes can also help with improving your symptoms, click on this link (How to tape the toe) to see how to do this.

What if there is no improvement in my symptoms?

At Sports & Injury Management, we work with athletes and weekend warriors, who are struggling with persistent, stubborn, niggling injuries, and work together on a specific treatment plan to help fix this pain.

This allows those athletes and weekend warriors to become stronger, return to exercising, training, participating in sports and live pain free.

Recovery takes time, so please be patient and persistent. If, however, you are still experiencing problems, you have tried all of the above and are seeing very little or no improvement after a couple of weeks, come and see your local Diamond Creek podiatrist. Call now or book online , and start your journey to getting back to doing what you love sooner rather than later.

With over 15 years as a Podiatrist, I have successfully treated lots of patients with this and similar conditions. Come and join our community of active happy people.

SIM – Getting stronger, staying active