Forefoot pain, also referred to as metatarsalgia, is pain at the ball of the foot (around the ends of the metatarsal bones). You may experience pain of varied intensity and discomfort, from numbness or tingling sensation in your toes to a sharp, aching or burning pain in the ball of your foot. The pain usually worsens during standing, walking, running or when the affected foot is flexed. In most cases, the skin overlying the affected area becomes thick and hard, rough-textured, along with either complete/partial loss of sensation. This is referred to as hyperkeratosis or callosity.
There are many causes for forefoot pain. Some common causes include:
- Overweight: Excess body weight tends to put more pressure on the metatarsal bones and cause pain.
- Overuse: Pain from overuse is seen in athletes. This condition exhibits from inflammation and irritation of the bone and adjacent tissues.
- Shape of the foot: Hammer toes (toe is bent at the middle joint) and bunion (painful bump at the base of big toe) can cause metatarsalgia.
- Big toe arthritis: Arthritis is an inflammation of the cartilage and lining of the bone joints. Osteoarthritis is the most common type which causes excessive trauma and wearing away of the cartilage in the joints of the foot.
- Gout: It is an inflammatory joint disease, which causes swelling, redness and stiffness of the joints. It usually affects the big toe and leads to severe pain.
- Stress fractures: Stress fractures of the foot which may occur in athletes or walkers can result in pain.
- Morton’s neuroma: Morton’s neuroma is a painful condition affecting one of the nerves between the toes (interdigital nerve). Morton’s neuroma refers to the thickening of the nerve tissue between your third and fourth toes due to the compression or irritation of the nerve.
- Pescavus: This is characterized by a highly-arched foot. The gap between the sole of a foot and the floor is higher than normal, and places excessive pressure on the balls of the feet.
- Loss of fat pad under the ball of the foot: With aging, the protective fat pad under the ball of the foot tends to thin out with overuse and may increase the susceptibility to pain in the region.
- Poorly-fitting shoes: Wearing tight, narrowed or high-heeled shoes can put constant strain on the metatarsal bones causing forefoot pain.
A diagnosis must be cautiously made using a comprehensive history of the condition and direct questioning. Your doctor may order X-rays, ultrasound or MRI of the affected foot or ankle to confirm the diagnosis.
Early treatment is critical to relieve pain. Mild to moderate cases of forefoot pain can be managed by conservative treatment. The following conservative measures help to ease the pain of metatarsalgia:
- Medications: Your doctor may prescribe medications to reduce pain and inflammation.
- R.I.C.E: Resting your feet, applying ice packs wrapped in a towel over the sole of the affected foot, compression and elevation of the foot can reduce pain and swelling.
- Weight-loss: Adaptation to a weight-loss dietary regimen, if you are overweight.
- Activity modification: Avoid vigorous activities that exert excessive stress on bones and tendons of the feet. Begin specific exercises to help strengthen the foot muscles.
- Orthotics: Use customized orthotics or insoles to support and protect the foot. It also helps cut back the pressure placed on the metatarsal bones. Extra-fit toe pads, softening or gel pads can be placed inside your shoes to help in shock absorption while walking.
- Simple footwear modifications: This can include wearing low-heeled shoes and broad toe box shoes.
Surgery is considered as the last option if symptoms fail to resolve with conservative treatments and depends on your age and activity level, extent of damage to the tendon or bone or nerve, and other factors. Surgical treatment involves realigning or reshaping the metatarsal bones.