Pain in the ‘ball of the foot’ on walking & standing

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 metatarsal bones of the transverse arch deep within the ball of foot and brings about pain, inactivity, frustration and sometimes depression.

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 the intrinsic muscles become weak it results in the collapse of the transverse arch causing weight bearing pressure to be placed on the metatarsal heads. This leads to the formation of painful calluses and corns in the transverse arch. Reasons why the intrinsic muscles become weak include a tight Achilles tendon which restricts the ability of the foot to bring the toes towards the shin bone during walking (foot dorsiflexion), excessive weight gain and the wearing of high heeled shoes.

Signs & Symptoms

Pain in the ball of foot on weight bearing activity

• Forefoot appears wider than normal due to collapsed transverse arch.

• Walking on the outside of the foot in order to avoid pain.

• Awoken at night with foot pain.

• Pain typically occurs when weight bearing on the foot such as during walking or standing

• Examination reveals tenderness along the ball of the foot (transverse arch) particularly along 2nd and 3rd metatarsophalangeal joints.

Treatment & Management of Metatarsalgia

With patients suffering from Metatarsalgia, I find that initial gentle mobilisation techniques to the metatarsophalangeal joints of the forefoot and surrounding joints are important in order to reduce restrictions in that area. Stretching of the Achilles tendon and tendons of the front of the foot coupled with strengthening exercises for the transverse arch are essential in order to attain pain relieve and improved foot function.

Other treatment tips include:

• Bathing of the foot in cold water to reduce any swelling

• Avoid wearing high heeled or narrow fitting shoes

• Wearing of a metatarsal dome pad in the shoe in order to lift the dropped transverse arch.

Next week I will discuss a painful conditions of the shoulder joint.

Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles.

Contact Number: 086 3275 753

Email your queries to: info@tipp-phyiscaltherapy.ie