Pain in the ball of the foot is termed metatarsalgia. This is a vague non-specific term that includes everything from fat pad atrophy to inflammation of the joints (bursitis), inflammation of the capsule (capsulitis), or inflammation of the nerves (neuroma). Fat pad atrophy is one of the most common causes of pain in the ball of the foot.
Bursitis
Bursitis is an inflammation of a small fluid-filled sac, called a bursa, located near a joint, bone or tendon. The bursa, which protects the area from friction, can become inflamed from repetitive motion or irritation from shoes. In the foot, the heel and the toes are most often affected.
SYMPTOMS
- localized redness.
- localized tenderness.
- pain with joint ROM.
- swelling at the ball of your foot.
TREATMENT
- COLD LASER THERAPY – ask about our in office laser therapy
- Padding techniques – padding provides support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
- Orthotic devices – Making Custom made orthotic devices inserts for the shoes), are molded directly from your feet. They can provide the support needed to reduce pressure and compression on the nerves and any painful and distribute the ground pressures evenly across your feet.
- Activity modifications – Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
- Shoe modifications – Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
- Medications – Oral medications can be prescribed to reduce pain and inflammation.
- Injection therapy – Treatment may include injections of cortisone, local anesthetics or other agents at the affected site.
Capsulitis
Ligaments surrounding the joint form a capsule, which helps the joint to function properly. Capsulitis is a condition in which these ligaments have become inflamed. This inflammation causes considerable discomfort and, if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe. Capsulitis—also referred to as predislocation syndrome—is a common condition that can occur at any age.
CAUSES
It is generally believed that capsulitis is a result of abnormal foot mechanics, where the ball of the foot beneath the toe joint takes an excessive amount of weight bearing pressure.
Certain conditions or characteristics can make a person prone to experiencing excessive pressure on the ball of the foot. These most commonly include a severe bunion deformity, a longer metatarsal bone, or an arch that is structurally unstable and a tight calf muscle.
SYMPTOMS
- Pain, particularly on the ball of the foot. It can feel like there’s a marble in the shoe or a sock is bunched up
- Swelling in the area of pain, including the base of the toe
- Difficulty wearing shoes
- Pain when walking barefoot
- unstable toe or cross-over toe
DIAGNOSIS
An accurate diagnosis is essential because the symptoms of capsulitis can be similar to those of a condition called Morton’s neuroma, which is treated differently from capsulitis. In arriving at a diagnosis, we will examine your foot, apply pressure and maneuver it to reproduce the symptoms. We will also look for potential causes and test the stability of the joint. X-rays are usually ordered, and other imaging studies are sometimes needed.
Nonsurgical Treatment
The best time to treat capsulitis is during the early stages, before the corresponding toe starts to drift toward other toes( dislocates). At this time, nonsurgical approaches can be used to stabilize the joint, reduce the symptoms and address the underlying cause of the condition.
TREATMENT
- Taping/splinting. It may be necessary to tape the toe so that it will stay in the correct position. This helps relieve the pain and prevent further drifting of the toe.
- COLD LASER THERAPY -ask about our in office laser therapy
- – Stretching exercises may be prescribed for patients who have tight calf muscles.
- Shoe modifications – Supportive shoes with stiff soles are recommended because they control the motion and lessen the amount of pressure on the ball of the foot.
- Orthotic devices – Making Custom made orthotic devices inserts for the shoes), are molded directly from your feet. They can provide the support needed to reduce pressure and compression on the nerves and any pain and distribute the ground pressures evenly across your feet.
- Medication – Oral medication can be prescribed to reduce pain and inflammation.
Morton’s Neuroma (Intermetatarsal Neuroma)
A neuroma is a thickening of nerve tissue that may develop in various parts of the foot. The most common neuroma in the foot is a Morton’s neuroma, which occurs between the third and fourth metatarsals. It is sometimes referred to as an intermetatarsal neuroma.
The thickening of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates an enlargement of the nerve, eventually leading to permanent nerve damage.
CAUSES
Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box or high-heeled shoes that cause the toes to be forced into the toe box. People with certain foot deformities—bunions, hammertoes, flatfeet or more flexible feet—are at higher risk for developing a neuroma.
Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or court sports. An injury or other type of trauma to the area may also lead to a neuroma.
SYMPTOMS
If you have a Morton’s neuroma, you may have one or more of these symptoms where the nerve damage is occurring:
- Tingling, burning or numbness
- Pain
- A feeling that something is inside the ball of the foot
- A feeling that there is bunched up sock in your shoe
THE PROGRESSION OF A MORTON’S NEUROMA OFTEN FOLLOWS THIS PATTERN:
The symptoms begin gradually. At first, they occur only occasionally when wearing narrow-toed shoes or performing certain aggravating activities.
The symptoms may go away temporarily by removing the shoe, massaging the foot or avoiding aggravating shoes or activities.
Over time, the symptoms progressively worsen and may persist for several days or weeks.
The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.
DIAGNOSIS
To arrive at a diagnosis, we will obtain a thorough history of your symptoms and examine your foot. During the physical examination, we will attempt to reproduce your symptoms by manipulating your foot. Other tests or imaging studies may be performed.
The best time to see your foot and ankle surgeon is early in the development of symptoms. Early diagnosis of a Morton’s neuroma greatly lessens the need for more invasive treatments and may help you avoid surgery.
NON SURGICAL TREATMENT OPTIONS MAY INCLUDE:
Treatment approaches vary according to the severity of the problem.
- COLD LASER THERAPY – ask about our in office laser therapy
- Padding techniques – provide support for the metatarsal arch, thereby lessening the pressure on the nerve and decreasing the compression when walking.
- Orthotic devices – custom made orthotic devices (inserts for the shoes), are molded directly from your feet. They can provide the support needed to reduce pressure and compression on the nerves and any pain and distribute the ground pressures evenly across your feet.
- Activity modifications – Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
- Shoe modifications – Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
- Medications – Oral medications can be prescribed to reduce pain and inflammation.
- Injection therapy – Treatment may include injections of cortisone, local anesthetics or other agents.
When Is Surgery Needed?
Surgery may be considered in patients who have not responded adequately to nonsurgical treatments. Your foot and ankle surgeon will determine the approach that is best for your condition. The length of the recovery period will vary depending on the procedure performed.
FAT PAD ATROPHY
Fat Pad Atrophy is a condition that refers to the thinning and loss of the protective fat cushion that sits under the bones in the ball of the foot. Fat Pad Atrophy is a normal aging process and is commonly seen in the elderly. As the shock absorption from the fatty tissue is no longer present to protect the bones in your feet from the ground you stand on, the force and pressure of the body’s weight cannot distribute evenly across the foot. Weight and pressure subsequently accumulate onto the ball of your foot leading to significant pain, inflammation, and possible damage to the bones and surrounding soft tissues.
Fat Pad Atrophy affects both men and women equally. However, women are more susceptible to experiencing pain and calluses in the ball of the foot because they are more likely to sacrifice comfort over fashion in their choice of footgear such as high-heeled footwear. High-heels shift the body’s center of gravity forward, placing increased load and pressure on the ball of your foot leading to the accelerated progression of fat pad atrophy and subsequent damage.
Although conservative options are available including the use of highly cushioned insoles, they are impractical for extremely stylish shoes and do not eliminate pain in the ball of the foot while barefoot. If you must wear Christian Louboutin, Jimmy Choo, and Manolo Blahnik, to name a few, you may be a candidate for Fat Pad Restoration.
SYMPTOMS
- Pain in the ball of the foot (Metatarsalgia) that worsens with prolonged standing, wearing heels or thin-soled shoes, or when walking barefoot on hard surfaces.
- Feeling the bones in the ball of your foot, feeling of walking on marbles
- Formation of painful diffuse or nucleated calluses on the ball of the foot.
CAUSES
Age: With increasing age, fatty tissue deteriorates and the formation of new tissue decreases in the foot as it does throughout the body.
Anatomy: Certain anatomical characteristics, such as high arches can result in fat pad atrophy as increased pressure and weight accumulates in the ball of the foot.
Collapsed Metatarsals: Depression of the metatarsal heads can wear out the fat pad protecting the area over time and cause increased pressure on the ball of the foot.
Diabetes: Thinning and loss of fat pad are common especially if you suffer from neuropathy.
Footwear: As previously discussed, footwear selection or walking barefoot can initiate or exacerbate fat pad atrophy.
Genetics: Some people can inherit the predisposition to lose fat pads on their feet.
Injury or Surgery: Injury to the ball of the foot from activity or previous surgery can lead to displacement and deterioration of the fat pad.
Overpronation: Excessive flattening of the arch can place increased pressure on the ball of the foot.
Medications: Chronic use of steroids are also known to cause fat pad atrophy.
Rheumatoid Arthritis: Clawing of the toes associated with this condition causes the head of the metatarsals to become more prominent towards the balls of the feet.
Steroid Injections: Frequent Steroid injections in the foot can cause fat pad atrophy.
What is the Treatment for Plantar Fat Pad Atrophy?
- Activity modification – Switch to low-impact alternatives, such as cycling, swimming, or non-weight-bearing weight training.
- Shoe gear modification – Wear supportive footwear that also provides cushioning to the feet.
- custom made orthotics – Wear custom-molded orthotics to distribute weight evenly across the soles of the feet while providing adequate shock absorption and comfort.
- Fat pad restoration – Ask about Collagen Dermal Fillers to replace fat pad loss.