Forefoot Pain
The incidence of forefoot pain and deformity increases with age. With early diagnosis, conservative therapy is often successful in treating common disorders of the forefoot. When a cause cannot be determined, any pain on the ball of the foot is generally referred to as metatarsalgia. It is most likely caused by improper footwear, particularly high heels, or by high-impact activities.
Calluses
Calluses are composed of the same material as corns, hardened patches of dead skin cells. Calluses, however, develop on the ball or heel of the foot. The skin on the sole of the foot is ordinarily about 40 times thicker than skin anywhere else on the body, but a callus can be double even this thickness. A protective callus layer naturally develops to guard against excessive pressure and chafing as people get older and the padding of fat on the bottom of the foot thins out. If calluses get too big or too hard, they may pull and tear the underlying skin.
Risk factors for calluses include the following:
- Poorly fitting shoes.
- Walking regularly on hard surfaces.
- Flat feet.
Of note, in people with diabetes, the presence of calluses is a strong predictor of ulceration, particularly in those who have a history of foot ulcers.
Neuromas
Neuromas occur when the tissue surrounding a nerve becomes enlarged and inflamed causing a burning or tingling sensation and cramping in the front of the foot. Tight, poorly-fitting shoes, injury, arthritis, or abnormal bone structure may also cause this condition. Mortons neuroma (also called interdigital neuroma) is the most common neuroma of the foot and develops when the third and fourth metatarsal bones to pinch together compressing an underlying nerve. Neuromas can also occur in other locations.
Treatment for Neuromas. Pain from Mortons neuroma can be reduced by massaging the affected area. Roomier shoes (box-toe shoes), pads of various sorts, and cortisone injections in the painful area are also helpful.
If these treatments are not effective, the enlarged area may need to be surgically removed. In one long-term study of one surgeon's experience, 85% of patients reported satisfaction as being good to excellent nearly six years after surgery. About 65% were pain free. Some numbness is common afterward but it rarely bothers patients. Occasionally, the nerve tissue may re-grow and form another neuroma.
Stress Fracture
A stress fracture in the foot, also called fatigue or march fracture, usually results from a break or rupture in any of the five metatarsal bones (mostly the second or third). These fractures are caused by overuse during strenuous exercise, particularly jogging and high-impact aerobics. Women are at higher risk than men are. A fracture in the first metatarsal bone, which leads to the big toe, is uncommon because of the thickness of this bone. If it occurs, however, it is more serious than a fracture in any of the other metatarsal bones because it dramatically changes the pattern of normal walking and weight bearing.
Treatment for Stress Fractures. Patients should seek treatment if pain persists for three weeks. In a study of young athletes, treatment after that time was associated with a lower chance for returning to their sport. Surgery may be needed if conservative measures fail. In most cases, however, stress fractures heal by themselves if rigorous activities are avoided. It is best to wear low-heeled shoes with stiff soles. Some physicians recommend moderate exercise, particularly swimming and walking. Occasionally, a physician may recommend wearing a special wooden shoe and a compressive wrap to make walking more comfortable.
Sesamoiditis
Sesamoiditis is an inflammation of the tendons around the small, round bones that are imbedded in the head of the first metatarsal bone, which leads to the big toe. Sesamoid bones bear much stress under ordinary circumstances; excessive stress can strain the surrounding tendons. Often there is no clear-cut cause, but sesamoid injuries are common among people who participate in jarring, high-impact activities, such as ballet, jogging, and aerobic exercise.
Treatment for Sesamoiditis. Rest and reducing stress on the ball of the foot are the first lines of treatment for sesamoiditis. A low-heeled shoe with a stiff sole and soft padding inside is all that is usually required. In severe cases, surgery may be necessary.
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