What Causes Pain in the Ball of the Foot (Metatarsalgia)?

Pain in the ball of the foot behind the toes is a very common problem that we see as podiatrists.  Metatarsalgia is a term that can be used for chronic pain over the metatarsal heads, but this does not really explain the reason it is happening. The 3 most common reasons people get pain in the ball of the foot are tearing of the plantar plate around the second metatarsophalangeal joint, a Morton's neuroma, or a stress fracture of the metatarsal.

Morton's neuromas more commonly cause pain between the third and fourth toes, and they will cause the third and fourth toes to sometimes go numb or tingle and also can give strange sensations around the ball the foot including a feeling like a sock is balled up in that area.

The most common reason we see pain in the ball of the foot is actually from tearing of the plantar plate around the second metatarsal phalangeal joint. We have several different terms we use for this including capsulitis of the joint, pre-dislocation syndrome, or plantar plate attenuation. Essentially what is happening is that the joint is being overloaded, which causes tearing to occur of the ligaments around the bottom of that joint, which causes pain in the ball of the foot.

Most people we see with pre-dislocation syndrome seem to be genetically set up to have this problem, because their second metatarsal is a little bit longer than it should be for normal foot function to occur. Many people also have a hallux valgus or bunion type deformity where a bump is over the medial aspect of the foot which also predisposes people to this problem, because of abnormal function of the first metatarsal phalangeal joint.

Treatment for this problem can include trying to tape the second toe in a plantarflexed position, orthotics with a metatarsal pad to try to offload the joint, immobilization in something like a Cam walker boot, potential steroid injections although there can be problems associated with these, or surgical correction of the ligament tear. Most of the time when we repair the ligament we also do recommend shortening the second metatarsal to try to decrease the forces that cause the tearing in the first place.

The last common reason we see pain in the ball the foot is from a stress fracture. Especially during the current times, many people are exercising more and this is typically an overuse type injury but also can occur with osteoporosis when the bone is not as strong as it should be. As long as the fracture does not displace or move, we can typically treat this with immobilization in a cast boot. If the fracture displaces too much, these can need to be surgically fixed and reduced in anatomic position with screws and plates.

As your expert podiatrists in Colorado Springs, all the surgeons here are expertly trained to help you with any of your foot and ankle problems.  Our podiatrists are well trained to provide you with all of your options to make the best decision about how to treat your foot pain. They will strive to offer you both surgical and nonsurgical options to meet your needs. Call us at 719-488-4664 today if you are having any foot and ankle pain so we can help you!

Dr. Matthew Hinderland Board Certified Podiatrist and Foot and Ankle Surgeon

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