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Having pain at the front of your foot can make it difficult to walk and live comfortably. As forefoot pain has a wide range of causes with different treatment requirements, it’s important to have your pain assessed by a trusted podiatry team who is experienced in treating forefoot pain and takes an evidence-based approach, like our team of Brisbane podiatrists.
The foot is a complex structure, consisting of many joints, muscles, tendons, ligaments, blood vessels and nerves that comprise the
forefoot. With so many structures there are many problems that can arise. Often, practitioners are quick to label pain at the forefoot as ‘metatarsalgia’,
despite this not being a specific condition, but a broad term that encompasses a range of forefoot problems and conditions. Metatarsalgia is
also often the default when the formal diagnosis is uncertain.
Forefoot pain is common because of the large amount of weight the joints and tissues at the balls of your feet and the toes take with every step. During every part of your gait cycle where one foot is in the air, the other is bearing your entire body weight. This is a very large demand on any structure of the body, and why it’s essential to always support our feet with the right footwear, take good care of our feet, and treat any aches or niggles as they arise - before they get worse.
As forefoot pain has a wide range of causes, we’ve focused on five of the top causes that our podiatrists see and treat in our clinic.
Capsulitis means that the capsule surrounding one of your joints (in this case being present in the forefoot) has been damaged and inflammation has resulted. This can compromise the function of the joint, and you can become vulnerable to injuring the tissues and structures surrounding the joints, suffering joint dislocations, and experiencing a great deal of pain.
Capsulitis is typically an overuse injury, meaning that it arises when the joint capsule is excessively overloaded over
time. Overuse can occur from anything like having a long day hiking uphill and placing much more pressure on the forefoot than usual,
wearing high heels which place the most pressure on the forefoot, having tight calf muscles that cause an early heel lift and greater
pressure on the forefoot with every step, or from foot deformities like bunions or claw toes.
Capsulitis may also occur alongside synovitis, where the connective tissue that lines the joint capsule, called the synovium, becomes swollen and inflamed. Learn more about capsulitis here.
Each of the joints at the ball of your foot is surrounded and protected by a joint capsule. The plantar plate is a thick tissue that sits at the bottom of each of these joints. As the ball of the foot takes a lot of pressure with every step, the plantar plate is often exposed to high loading forces. When the plantar plate is excessively overloaded, it can become damaged and may tear.
If you’ve injured your plantar plate, you may experience pain and swelling directly beneath a joint at the ball of the foot, you may notice a ‘V’ sign where the affected toe and the one next to it appear to drift apart, you may feel like you’re walking on the bones of your feet, and your pain is likely to worsen when you toes are pushed upwards (dorsiflexed) towards the sky. These symptoms occur because the plantar plate plays an important role in stabilising the toes, helping prevent your toes from being pushed too far upwards (hyperextending), helping you push up off the ground during walking and running, and more.
A Morton’s neuroma, also known as an ‘intermetatarsal neuroma’, describes the irritation and swelling of the tissue that surrounds a nerve in your foot. As our nerves are responsible for our ability to feel, a swollen nerve can produce an array of unusual sensations in our feet, including tingling, burning and numbness. A Morton’s neuroma most often develops between the third and fourth toes and occurs when the nerve is repetitively compressed or irritated, resulting in swelling.
With a neuroma, you can often feel a distinct, painful mass between two long bones of the feet - and this mass may ‘click’ if you move the bones around it with your fingers, up and down. It may feel like you’re walking on a pebble. If you put your hands on the outer borders of your foot, and squeeze them together, this usually causes pain with a neuroma - as will anything that puts pressure on it like tight or heeled shoes.
Neuromas are often differentiated from other causes of foot pain by the presence of the nerve-related symptoms we mentioned earlier - numbness, tingling, pins and needles, burning and more. Muscle and joint problems don’t tend to carry these symptoms unless a nerve is involved. Learn more about a Morton’s neuroma here.
Bursitis describes the inflammation of a bursa - a small, fluid-filled sac that sits between structures in the body to help prevent painful friction and rubbing, while promoting lubrication and healthy movement. There are bursa located all around our body, including the forefoot, particularly between the long bones of the foot.
Bursitis occurs when a bursa is overloaded, which may occur from excess pressure of walking, standing for long periods, or even from rubbing against tendons or other structures. This results in swelling, pain and tenderness in the area, which can make it difficult to walk and wear shoes comfortably. As inflamed bursae can press on a nerve, you may also experience neural symptoms like tingling, burning or numbness. Sometimes, both bursitis and a neuroma can occur simultaneously. Learn more about bursitis here.
Arthritis is another common cause of pain at the front of the foot. While there are over 100 different types of arthritis, the three that we see and help manage most commonly include:
Forefoot pain can be assessed and diagnosed in the clinic by our podiatrists. As podiatrists are specialists in foot pain, they will differentiate the cause of your forefoot pain from other similar symptoms. If there is any uncertainty, medical imaging can also be used to confirm your diagnosis.
As forefoot pain can have a wide range of causes that go far beyond the five we’ve provided today, caring for your feet at home is focused around managing your symptoms to give you relief until you can book in with your podiatrist. You may be able to try:
If you’re experiencing pain at the front of your foot, your appointment will start with a comprehensive assessment to understand which structures have been injured, and how and why this has occurred. Once we know this, our podiatrists will put together an evidence-based management plan that supports you in getting the best outcome for your pain and injury, while helping reduce the likelihood of the problem recurring in the future. This may involve:
Due to the location of the injury or pain, if you continue to walk and apply pressure to your forefoot without seeking the right medical care, there is a strong chance that your injury and pain may worsen. Booking an early appointment will help get you out of pain and back to walking comfortably as quickly as possible.
What are some other causes of forefoot pain?
As there are so many structures in the forefoot, the causes of forefoot pain can be numerous and include bunions, turf toe, corns and calluses beneath the ball of the foot, toe deformities (hammertoes, claw toes), ingrown toenails, plantar warts, stress fractures, sesamoiditis, ganglion cysts and more.
Warts are a growth on the skin that is caused by a viral infection from the Human Papilloma Virus (HPV). They can cause significant pain when they arise on a weight-bearing area on the bottom of your foot.
Morton's neuroma develops in the plantar digital nerves that run between the long bones in your foot. These nerves can become irritated from compression and friction trauma of the surrounding tissue.
Pregnancy can cause a range of pains and problems not just to our feet but throughout the body. This is why many pregnant women also experience lower back pain, hip pain, knee pain, ankle pain and more.
A bunion is a bony bump on the inside border of the foot that is caused by a change to the alignment of your big toe. Bunions progressively worsen in their severity over time, and may be either painful or asymptomatic.
Plantar plate tears cause pain at the ball of the foot that can make it difficult to bear weight on the feet, especially when bending the toes upwards.