Forefoot Pain

Pain in the front or ball of foot (forefoot) is a common finding. The term ‘Metatarsalgia’ is often used to describe this, this is an umbrella type term, meaning an un-descript pain in in the front part of the foot.
There are many reasons for pain and discomfort to occur within the forefoot including thickened nerves, inflamed joints and fractures, or pressure from shoes being to tight, thin soles and heels.
Here at Evolution Podiatry we aim to focus on the influencing factors of your presenting problem.
When walking the foot mechanically transports the body’s weight through repeatedly through the forefoot as the foot loads and pushes off, altered foot mechanics or mal-alignment can change and increase loads through certain areas creating increased stress being loaded on the foot.
High heeled shoes are cause of forefoot pain; they create an increased pitch and load up the pressure, the higher the heel the higher the pressures.

Specific Conditions causing forefoot pain

Thickend nerve (Neuroma)
This is caused by a fibrous thickening of a nerve from in between the long bones (metatarsals) in the forefoot, commonly found between the 3^rd and 4^th metatarsals as Dr Morton first described, it is often also found between the other metatarsals.
Symptoms are frequently described as a burning, tingling and numbness radiating up into the toes. This is often predominantly when wearing shoes, footwear that are tight and restrictive is the primary cause, this can secondary to having a wide forefoot. Lower limb mechanics can play a role as altered foot mechanic’s can place strain on the nerve.
Joint Inflammation (Synovitis)
Synovitis is an inflammation of a joint, within the forefoot it is commonly found where the long bones (metatarsals) meet the toe bones (known as the metatarso-phalangeal joints), commonly this affects the 2^nd metatarsal as it generally the longest bone.
It is commonly bought by an overload of pressure through the forefoot, often being footwear related in wearing heels in ladies and hard soled shoes in men.
Stress fractures
This is where a small fracture occurs within one of or multiple metatarsals usually within the neck or midshaft of the bone, it id also referred to as ‘March fracture’ from Army recruits Marching with weighted backpacks. High repetitive impact sports are a common cause; however those who have osteopaenic or osteoporosis or have used steroids for a long duration are also at a risk of injury.
It is commonly seen following long periods of walking, or when people are increasing their training intensity or training regimes.
Sport
Sporting activities like football, rugby, racket sports including tennis and squash, place multi directional, and increased pressures through foot and can also contribute to problems.
Medical Conditions
Arthritis- causing degeneration to occur within the joints. Neurological conditions such as a Stroke or Parkinson’s causing muscular weakness changes in walking.