Pain in the Ball of the Foot

If you have pain in the ball of your foot you are not alone. Pain in the ball of the foot is a common complaint. When someone is referring to the ball of the foot they are usually referring to the location of the metatarsal heads. The long bones of the foot are called metatarsals. The metatarsal heads are the knobby ends of the metatarsals that form a joint with the toes. Thus the ball of the foot is the area where the toes form a joint with the long bones of the foot, the metatarsals.

Pain in the ball of the foot can come from a problem with the nerves as seen in conditions such as neuropathy or a neuroma, which will be discussed shortly. Often, pain in the ball of the foot can is the result of one or more of the metatarsals taking more than their share of the load. Metatarsalgia is a general term which simply means pain in the metatarsal bones. For this discussion I am going to be talking specifically about pain in the metatarsal heads.

There are several reasons why one or more of the metatarsal heads can become overloaded.
• Some people gradually lose the fat pad that cushions the area under the metatarsal heads as they age. If there is less cushion the bones feel more of the load and this causes pain.

• Some people were born with a deformity known as Morton’s toe in which the first metatarsal bone (long bone of the big toe) is short. As a result the second metatarsal or second toe is longer than the big toe. This causes most of the body weight to be put onto the second metatarsal head. This overloads this bone and causes pain.

• Some people with high arches have pain in the ball of the foot. In the person with the high arch we often see that they load the foot primarily at the heel and then again in the ball of the foot. The mid-foot does not take its share of the load. This again overloads the metatarsal heads at the ball of the foot.

• Another painful condition felt in the ball of the foot is Morton’s neuroma. This is usually felt between the 3rd and 4th toes. One quick way to tell if you may have this condition is to grab your foot around the metatarsal heads and squeeze your whole foot. If you have a neuroma this squeezing will causes pain at the site of the Morton’ Neuroma.

Although the cause of pain in the ball of the foot is varied, the treatment, at least the initial treatment, is the usually the same. We try to reduce load and if necessary movement of the metatarsal heads. This is accomplished by adding a metatarsal pad to an orthotic or arch support. The metatarsal pad fits in the ball of the foot just behind the metatarsal heads. This allows more of the weight to be taken up by the long shafts of the metatarsals and less on the metatarsal heads. The metatarsal pads can be added to a custom arch support. They can also be purchased over-the-counter from a pharmacy or specialty shoe store. The correct placement of the metatarsal pad is critical so follow directions or ask your physician or podiatrist for help.

For more information please visit Archatomics

Flat Feet, Foot Pain and a Simple Solution

I love to see patients with flat-feet. In fact sometimes I feel that I should dedicate my medical career to educating people about flat-feet. Flat feet causes so much trouble for people and they just don’t realize that in most case it can be easily corrected with a good arch support. As a family doctor I spend a lot of time treating patients with chronic conditions they will have for the rest of their lives. Therefore I love it when patients come in with problems associated with flat-feet. This is one of the few problems I can actually fix and best of all it doesn’t require a medication to fix it.

Flat-feet in medical terms is known as hyperpronation, meaning over pronation. Pronation is the motion of flattening out of the arch as the foot rotates counter-clockwise (externally rotates). Pronation is important because it allows the foot to absorb shock. In addition, Pronation also allows all the bones of the mid-foot to unlock and become like a “bag of bones”. Being a loose “bag of bones” enables the foot to adapt to uneven surfaces (uphill, downhill, rocky surface, etc.). In moderation, pronation is a good thing. Hyperpronation is a bad thing.

The problem with flat feet or hyperpronation is that the foot remains pronated throughout the step. The foot does not supinate (soup-in-ate) as the foot moves into the later stages of the step. Supination is the opposite of pronation. In supination the foot internally rotates (rotates clock-wise). Supination re-locks the bones of the mid-foot and transforms the foot into a rigid lever arm to provide an efficient push-off and propel the body forward. If the foot cannot supinate it remains essentially a loose “bag of bones” and you are unable to use the foot as an efficient, firm lever arm for push off.

If the foot does not supinate it cannot form an efficient lever arm. As a result, the calf muscles have to work all that much harder in order to propel the body forward. This causes fatigue and ache in the muscles of the lower legs at the end of the day. In addition if the calf muscles are working harder they become very strong and bulky. This sometimes leads to a condition known as shin splints. The term "shin splints" usually refers to pain along the inside-front part of the lower leg. Shin splints is usually caused by an imbalance between the calf muscles on the back of the lower leg (posterior muscles) and the anterior muscles or muscles on the front part of the lower leg. The more powerful posterior muscles overwork the less powerful anterior muscles as the anterior muscles try to decelerate the body at heel strike. This causes excess strain, inflammation and pain where the anterior muscles attach to the shin bone.

Hyperpronation can cause the heel pain known as plantar fasciitis. The typical symptom of plantar fasciitis is severe heel pain when taking the first few steps in the morning or during the first few steps after sitting for a few minutes. Hyperpronation causes excessive flattening of the arch. This causes the ligament called the plantar fascia on the bottom of the foot to stretch out too much. The excessive pulling on the plantar fascia causes inflammation where the plantar fascia inserts into the heel.

In conclusion, someone with flat feet has very inefficient foot function and this can lead to heel pain, muscle fatigue and shin splints. By adding an arch support the foot is prevented from hyper-pronating and this improves the over-all efficiency of the foot function. Occasionally you can buy an arch support off-the-shelf that provides support. In most cases, however, the off-the-shelf insoles only provide cushioning and do not correct the hyper-pronation. Life is too short to suffer in pain, especially when the problem can be easily corrected. If someone is having pain as the result of flat-feet it makes sense to spend the extra money to purchase a custom arch support that will correct the problem once and for all.

For more information please visit Archatomics