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Metatarsalgia

Pain in the area between the arch and toes, or ball of the foot, is generally called metatarsalgia. The pain usually centers on one or more of the five bones (metatarsals) in this mid-portion of the foot. Also known as dropped metatarsal heads, metatarsalgia can cause abnormal weight distribution due to overpronation.

Metatarsalgia occurs when one of the metatarsal joints becomes painful or inflamed. People often develop a callus under the affected joint. Metatarsalgia also can be caused by arthritis, foot injury (from sports, a car accident, or repeated stress), hard surfaces (cement or tile floors), and specific footwear (rigid-soled work boots).

A simple change of shoes may solve the problem. In more severe cases, custom orthotics may be prescribed to alleviate the pain and prevent overpronation.


Plantar Fibroma

Plantar fibromas are benign tissue tumors or growths on the plantar, or bottom surface of the foot. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band of ligaments, called the plantar fascia. The presence of the tumor can cause pain or pressure on other parts of the foot structure that can lead to other foot problems.

Nonsurgical measures used in treating plantar fibromas such as custom orthotics or steroid injection may provide adequate relief of symptoms. Surgical correction can be successful under certain conditions, however complications, such as plantar nerve entrapment or recurrent fibromas can occur that may be worse than the original problem.


Sesamoiditis

Sesamoiditis

Sesamoids are small bones that are connected only to tendons or are embedded in muscle. This structure appears in only a few places in the human body, one of which is the foot. Two very small sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the big toe-one on the outer side of the foot and the other closer to the middle of the foot.  Sesamoids provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. In the foot, sesamoids assist with weight-bearing and help elevate the bones of the big toe.

Like other bones, sesamoids can fracture. Additionally, the tendons surrounding the sesamoids can become irritated or inflamed, which is called sesamoiditis and is a form of tendonitis. Sesamoiditis is a common condition among ballet dancers, runners, and baseball catchers because of the pressures placed on their feet.

Symptoms include:

  • Pain under the big toe or on the ball of the foot
  • Swelling and bruising
  • Difficulty and pain in bending and straightening the big toe

Surgery is usually not required to treat sesamoiditis. Treatments generally include:

  • Discontinuation of the activity causing the pain and inflammation
  • Over-the-counter pain medications and anti-inflammatories, such as ibuprofen and aspirin.
    Note: Please consult your physician before taking any medications
  • Icing the sole of the foot
  • Wearing shoes that are stiff-soled and low-heeled
  • Using cushioning in shoes to relieve stress
  • Injection of a steroidal medication to reduce swelling

If symptoms persist, you may need to wear a removable brace on the leg for four-to-six weeks to give the inflammation time to subside and the bones to heal.


Neuroma

Neuroma

Morton''s Neuroma is a common, painful foot condition that affects women more commonly than men and becomes very chronic if left untreated. The pain and numbness that affects the toes makes walking unbearable at times, necessitating people to stop, take off their shoes and massage their foot. This particular condition becomes even worse when wearing heels or narrow fitting shoes.

The condition is a result of nerves that are irritated or pinched between the bones in the ball of the foot. There are five metatarsal bones that comprise the ball of the foot. These are the long bones that extend back from the toes. Nerves course between these metatarsal bones on their way to providing sensation to the corresponding toes. Walking and wearing tight shoes squeezes the two metatarsals together sending a painful sensation into the two affected toes. The sensation can be sharp, electric shock like, burning, pins/needles and/or numbness. The affected nerve can become irritated and inflamed.  Over time it becomes scared and enlarged. A number of treatments are currently available to treat neuromas. Sometimes the pain is relieved by taking off the offending shoe and massaging the ball of the foot.  Cortisone injections, custom orthotics and anti-inflamatory measures have also been successful in treating this disorder.  Approximately fifty percent of Morton''s Neuromas can be effectively treated with conservative therapy. While conservative treatment can sometimes relieve the symptoms, a large percentage of patients require surgical intervention.

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