Forefoot Ailments & Treatments

Although most common foot ailments include many parts of the foot, for simplicity, refer to the part where the symptom appears: Forefoot (toes and ball of the foot), Mid-foot (top of the foot and arch), and Hind foot (heel and ankle).  help you understand the anatomy of the foot.

Forefoot Pain

Metatarsalgia, also known as “ball of foot pain.”

There are a number of reasons that the mid-foot collapses; one of the most common is the shortening of the Achilles tendon (or calf muscle) which pulls up the heel bone earlier than in a normal gait cycle. As it does, the ankle bone (talus) tilts downward causing the midfoot to collapse, forcing the 1st metatarsal (big toe joint) upward which transfers weight to lesser metatarsals joints that are not equipped to carry this weight. Wearing rigid, supportive shoes and avoiding high heels helps reduce the pain in the ball of the foot. Metatarsal pads which are teardrop-shaped pads placed directly behind the ball of the foot help transfer pressure away from the ball of the foot.

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Metatarsal Stress Fractures

A stress fracture usually starts as a small crack in the outer shell (the cortex), often invisible to an X-Ray, but over time can progress into the bone. Most common are stress fractures of the 2nd and 3rd metatarsal bones. The pain, and sometimes swelling, will occur on top of the foot.

Stress fractures are common among runners, dancers, military personnel and athletes. Stress fractures are usually caused by ‘overuse’ or too much pressure on the metatarsal due to a foot deformity such as bunions or abnormal foot structures. Initial treatment of a mild to moderate stress fracture should include an orthotic support or brace with a metatarsal pad which redistributes the weight away from the stressed metatarsal.

red and swollen bunion feet

Redness, pain or swelling of the big toe joint

The symptom of redness, pain and swelling of your big toe joint is indicative of one of the following:

• Arthritis (Hallux limitus or Hallux rigidus): A common arthritic condition that forms a bump on top of the big toe joint. It can grow and cause much pain as it rubs against your shoe. Supporting the foot and decreasing the workload on your joint with a firm insole and arch support is the most common way to treat it. Also, shoes in which you rock in as you walk help relieve pressure.

• Bunions: This symptom provides an early warning of a mild to moderate bunion (Hallux valgus) which can be treated with a flexible hinged splint, Bunion Aid®. Daily wear helps correct the malpositioning of your big toe through the range of motion, and in many cases, prevents further progression of the bunion. For more information about bunions, download When the Foot Hits the Ground from Toe to Heel, Series 1: Bunions.

• Gout: The build-up of uric acid crystals in the bloodstream crystallize and deposit in the joints, especially those of the feet. Anti-inflammatory medication and a change in food diet are most commonly prescribed for this painful condition. *8

foot with metatarsalgia

Hammertoe, severely bent toe(s)

A hammertoe is a permantly bent toe, usually one of the four smaller toes. The fourth and fifth toes tend to rotate under slightly as well as bend. A more severe hammertoe will actually start to cross over the toe next to it. Because of the bent nature of hammertoes, painful calluses and corns form over time. Treatment includes wearing shoes that avoid pressure on your toes and using gel toe sleeves and hammertoe splint loops. As a hammertoe becomes progressively more bent, pressure on your joint between the toe and the ball of the foot increases resulting in a condition called capsulitis – an inflammation of the joint. Wearing metatarsal pads can help redistribute pressure away from your toes. *9

There are two types of hammertoes:

1.  ‘flexible’ hammertoes can be straightened with the fingers and are usually easy to treat with metatarsal pads to alleviate pressure and splints to decrease the contraction of the toes.

2. ‘rigid’ hammertoes cannot be straightened with the fingers and often require surgical treatment.

"Metatarsals are the long bones in the forefoot. There are five in each foot, one leading up to each toe and forming the metatarsophalangeal
(MTP) joints with the phalanges (toe bones) at the base of each toe. They also form the tarsal-metatarsal (TMT)
joints with the tarsal bones towards the ankle." *6

describe the image Basketball is just one
example of a popular sport that results in ‘overuse’ or ‘acute’ injuries – an estimate of over 1.5 million injuries per year. *7

It is misleading to think you do not have a bunion unless you incur pain. In general, it can take many years for a bunion to develop, and especially to the point of pain. Early signs of a bunion include:

• Early movement of the big toe towards the smaller toes

• Bump on the base joint of the big toe

• Deep dull “in the joint” pain

• Pain on top or side of the big toe from shoe pressure