Pain in the ‘ball of the foot’ on walking
If you are suffering from pain underneath the forefoot when walking and standing that gets progressively worse overtime you may have a foot condition known as Metatarsalgia. As the name suggests it affects the heads of the metatarsal bones of the transverse arch deep within the ball of foot and causes pain with walking.
Metatarsalgia is most commonly caused by the collapse of the transverse arch, which is the arch situated in the ball of the foot (see illustration). The function of the transverse arch is to provide stability to the foot during weight bearing inward and outward twisting movements of the foot. The arch is formed by the heads of the metatarsal bones being raised from the ground by the actions intrinsic muscles that curl the toes of the foot. If there is breakdown in the tensile strength and flexibility of the extensor tendons that move the toes upwards and the flexor tendons that bend the toes downwards, then the stabilisation of the transverse arch is greatly affected. This will then result in the transverse arch collapsing with increased weight bearing pressure placed on the metatarsal heads causing bruising, inflammation and pain.
Signs & Symptoms
Pain in the ball of foot on weight bearing activity
Swelling & tenderness noted on ball of foot (transverse arch)
2nd & 3rd metatarsal heads are in a dropped position when compared to opposite foot
Callous or hardening of skin noted on ball of foot.
Forefoot appears wider than normal due to collapsed transverse arch.
Walking on the outside of the foot in order to avoid pain.
Treatment & Management of Metatarsalgia
Immediately stop wearing high heels or very flat shoes but instead wear a shoe with good forefoot cushioning with a wide fitting for the toes. Acute metatarsalgia should be treated initially with daily ice and anti-inflammatory gel with reduced walking. The goals of treatment are to elevate the transverse arch and lengthen the tight extensor tendons of the toes. My treatment would include light taping of the 2nd & 3rd toe into neutral position to help lift the collapsed arch; the patient would learn this taping technique and self-tape themselves daily. Finally in the chronic non-inflammatory stage placing a painless domed pad underneath belly of metatarsals coupled with manual release of the tight extensor toe tendons will improve transverse arch mechanics.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles. Contact Number: 0504 26672 Email your queries to: firstname.lastname@example.org