As forefoot pain and abnormalities have a diverse range of causes with very differing treatment requirements, it is important to have a thorough assessment and accurate diagnosis. Our podiatry team are highly skilled to help you effectively manage and resolve the following conditions and more:
Plantar plate injuries are the most common cause of pain beneath the 2nd metatarsophalangeal joint (your second toe joint at the ball of your foot), though also occur in any of the metatarsophalangeal joints. The plantar plate consists of ligaments attached into the base of your toes at the ball of your foot and function to stabilise the toes and hold them in place, preventing them from hyperextending, spreading out abnormally or overloading so your toes can easily bend up and down with every step. Injuries usually occur when a plantar plate undergoes repetitive stress and abnormal pressures that causes a tear in the plate. Increased activity loads combined with situation-based faulty biomechanics and unsupportive footwear are usually contributing factors, though injuries can also occur from trauma where a toe is pulled too far back. Symptoms can include pain, swelling and redness at a metatarsophalangeal joint, the feeling that you’re walking directly on a bone, and occasionally there may be a separation of the toes leading to a ‘V’ shape between two toes where a toe could begin to point upwards.
A Morton’s Neuroma is a swollen or thickened nerve in an interdigital space (space between the toes) at the ball of the foot, commonly occurring in between the 3rd and 4th toes. It is typically caused by repetitive compression of the nerve, which can be attributed to by foot biomechanics, tight footwear and high heels, or may arise from trauma. Symptoms include a sharp, burning pain in the ball of the foot, especially on compression of the nerve such as when walking or wearing tight footwear (and subsequent relief after removing footwear), feeling a ‘click’ on walking, numbness or tingling in the toes, and the feeling that you are standing on a pebble.
Metatarsalgia is a broad term used to describe pain and inflammation at the forefoot. The inflammation may be present at a joint capsule (capsulitis), within the capsule (synovitis) or surrounding tissues (bursitis) at the end of the long bones of your feet (metatarsals). The pain may be experienced as a sharp radiating pain, numbness/tingling, aching, throbbing, burning, or a bruising feeling at joints that tends to worsen when active on your feet, especially on a hard surface. Irritation and damage to this area is often caused by high-impact, repetitive activities such as running and jumping, through faulty foot biomechanics and improper footwear are also common contributors.
Plantar Fat Pad Atrophy describes the breakdown of the ‘fat pads’ on our feet - little cushion-like compartmental structures composed of fatty tissue and surrounded by elastin that serve to protect the bones and soft tissues our feet. They do so by absorbing impact forces and pressures during our daily activities, such as vibration and shock forces during walking. Over time, with age and many long days on our feet, these fat pads diminish, so we lose protection and become more susceptible to pain and injury. This can feel like walking on a bruise or a deep ache depending on the location of the damaged or diminished fat pad - this may be at the heel or the forefoot. Moreover, more shock is then forced onto the bones, ligaments and tendons, increasing the risk of injury to these structures. The skin can also be affected, with increased shear forces leading to wounds, lesions and ultimately ulceration. Alongside fat pad atrophy, trauma and repetitive high-impact activity may result in painful inflammation of the fat pad, and it may also displace or thin leaving the areas beneath with less protection. Additional contributor factors include an increased weight, poor footwear, diabetes and spending long periods of time on hard man-made surfaces.
Stress Fractures are small cracks in a bone that are often caused over time by repetitive high-impact forces and general overuse. As such, they are most commonly experienced by active individuals and those involved in running sports where the lower limb bones are currently absorbing shock and impact forces. Stress fractures may also occur where there is a decrease in bone mineral density such as in osteoporosis, a sudden increase in physical activity, improper footwear and situational faulty biomechanics. Stress fractures can occur in any bone but more commonly present in the second, third and fourth metatarsals (long bones of the foot), the calcaneus (heel bone), the talus (the bone in your ankle joint next to the heel bone), and the navicular (a bone on the inside edge at the mid-foot). Symptoms typically include pain that worsens throughout weight-bearing activities with periodic aching post activity and ceases during longer resting, inflammation and tenderness on palpation at the fracture site and occasionally bruising.