Forefoot pain can be caused by many different disorders. The most common condition is metatarsalgia, a painful disorder associated with the metatarsal (ball of foot) region of the foot. Metatarsalgia affects the bones and joints at the ball of the foot, and symptoms are generally located under the 2nd, 3rd and 4th metatarsal heads, which are the knobby tips of your metatarsal bones, located just under the fat pad. Often times, metatarsalgia is also thought of as a symptom of other ailments, such as hallux rigidus, bunions, hammertoes, Morton’s neuroma, diabetes, and Achilles tendonitis.
Excessive pressure over a long period of time causes the affected areas of the foot to become inflamed and painful. Most often, the pain comes on over several months, rather than all at once. The pain is usually recurrent or chronic and is quite acute. The root cause is often improper fitting shoes, such as those with pointed toes, high heels, and other restrictive-type footwear. Those who participate in high-impact sports are also likely to be affected.
Footcare specialists recommend wearing shoes with ample room around the toes so that the toes are not forced into a cramped environment. Poorly fitted footwear can (and often does) inhibit walking and running and can lead to severe foot discomfort.
Typically, forefoot pain is a direct result of persistent and excessive pressure and stress resulting from sports activities, abnormal weight distribution, and an alteration of the normal foot biomechanics that can create inflammation and irritation of the skin, ligaments, and tendons of the forefoot region of the foot. Additionally, the fat pads that provide cushion and shock absorption for the foot tend to thin out with age, making the ball of the foot more vulnerable to shock, damage, and pain.
The following factors often contribute to excessive localized pressure over the forefoot:
High level of activity
Tight-fitting shoes or high heels
Tight Achilles tendon
Weak toe muscles (flexors)
Tight toe muscles (extensors)
Protruding metatarsal heads
In the early stages of metatarsalgia, it is important to restrict usage of the foot and to use ice to help decrease foot swelling and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are also useful; however, these suggestions rarely provide a long-term solution. A podiatrist may recommend trying range of motion (ROM) exercises, but it is important to not disrupt the recovery process by over-using the foot while it heals. Stretching and strengthening exercises should be done carefully, and returning to high-level activities should be done gradually and with caution to prevent re-injury.
Changing to footwear that allows for more free movement in the toe area will help to relieve undue stress on the forefoot, and adding a good quality pair of replacement insoles designed to relieve ball of foot pain, usually through a biomechanical support with metatarsal pad, will not only help relieve pain from the affected area but will also serve to prevent other forefoot disorders from occurring.