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(Forefoot Pain or Pain in the Ball of the Foot)
 Description: The above terms all refer to pain in the balls of the feet (the area between the toes and the arch). The most important structures in the balls of the feet are the five metatarsal heads (the ends of the metatarsal bones that connect to the toes) and the protective fatty pad that cushions the ball of the foot. Each time we take a step forward, we push-off with our toes and the ball of the foot, forcing ourselves forward. To do this, we force 100% of our body weight on these structures. If they are not aligned perfectly, or if we have insufficient fatty padding, we experience pain in the ball of the foot.
Causes of Pain in the Balls of the Feet: The normal foot consists of bones and joints that are held together in perfect alignment by soft tissue structures known as ligaments, muscles, and tendons. When this alignment is abnormal in the ball of the foot, we not only feel pain, but we frequently also develop painful calluses in the underlying skin. Calluses are symptoms of some abnormality in the bones and joints of the ball of the foot. The most common causes of pain in the balls of the feet are:
• Dropped metatarsal (also known as plantarflexed metatarsal head or displaced metatarsal head): Each foot has five metatarsals that connect to one of our five toes. The metatarsals sit in a precise relationship, one to the other, forming the metatarsal arch (also called the transverse arch). As we step down on the ball of the foot, the metatarsal arch begins to flatten in response to our body weight. This allows the ball of the foot to function as a shock absorber. If one or more of the metatarsal heads sits lower than the other heads, it will bear a greater amount of our body's weight than it should bear. After a time, the dropped metatarsal head becomes "beaten up" from all of the extra or abnormal weight it is carrying, and it becomes inflamed and painful. Also, because the metatarsal head has "dropped," it is sitting closer to the skin on the bottom of the foot, and it pushes its protective fat pad away, so that you may actually feel the protruding metatarsal head with your finger. Due to this lack of normal fatty pad under the metatarsal head, the head will apply abnormal pressure on the underlying skin. The skin may respond to this increased pressure by building up a painful callus. Causes of a dropped metatarsal include:
- A flexible foot. In this type of foot the ligaments, tendons, and muscles are too lax to allow them to hold the bones and joints together in their most optimum alignment. The most common cause of a flexible foot is a biomechanical defect known as pronation.
- High heeled shoes. When the heel is raised, our weight is thrown forward onto the ball of the foot. This increased weight stretches the soft tissues that maintain the metatarsal arch, allowing one or more of the metatarsal heads to drop.
- Injuries to the ball of the foot. When fractured metatarsals or dislocated joints are not properly treated, they may heal in an abnormal position, allowing the metatarsal head to drop.
• Thinning or destruction (atrophy) of the protective fat pad in the ball of the foot: The fat pad in the ball of the foot functions as a shock absorber for the underlying bones, joints, and soft tissue structures. When the pad is not of optimum thickness, the force and weight of each step we take is passed on to the underlying structures, rather than absorbed and whisked away by the fat pad. This eventually produces inflammation and pain in the soft tissues, bones, and joints in the ball of the foot. The most common causes of a thin or absent fat pad include:
- As we age, the fatty protective pad begins to absorb. The rate of this absorption will depend on your genes.
- A metatarsal head which has dropped will destroy the fatty pad between it and the skin.
- Some diseases will cause the fatty pads in the feet to become thinner. Examples of these diseases include rheumatoid arthritis, connective tissue disorders, and some endocrine diseases.
- Excessive and prolonged pressure on the ball of the foot will cause the fat pad to be thinned or destroyed. Some causes are high heel shoes, walking bare foot, or walking in shoes with very thin soles.
• Feet with high arches: This foot type is usually rigid, and will not allow the high arch to come into contact with the ground when we step down. Therefore, as we step forward, all of our weight is thrown on to the balls of the feet, rather than some of the weight being carried by the arch. This will force the metatarsal heads in the balls of the feet to bear excessive weight. The results of this repetitive and excessive weight on the metatarsal heads is pain, inflammation, and swelling in the balls of the feet.
During my 30 years of private practice I have found that custom-made orthotics are one of the most effective treatments for reducing or eliminating pain in the balls of the feet.
How Custom-Made Orthotics Work:
Custom-made orthotics are considered to be the "Gold-Standard" of medical treatment—that treatment most recognized by doctors to be effective in the treatment of this diseases. Our custom-made orthotics for Metatarsalgia are constructed of comfortable, shock-absorbent "space age" materials which gently and effectively:
• Rebalance the metatarsal heads, so that the dropped metatarsal heads are raised to their normal and most optimum positions. This will insure that each metatarsal head will bear its "fair share" of our body weight. When this occurs, the pain in the balls of the feet will gradually subside. Just padding the ball of the foot will not provide this relief. In order to rebalance the foot, we must use a custom-made orthotic. Each person's problem is truly unique. In order to provide lasting relief, the treatment must be directed toward elevating your specific metatarsal head, by the exact amount it has dropped. When this is accomplished, the pain will subside, and the metatarsal arch is re-formed, allowing it to function as the body's shock absorber. This type of relief can only be obtained by using custom-made orthotics, which are made from molds of your feet.
• Replace the fatty pad protection to the balls of the feet. In the construction of our custom-made orthotics, we protect the balls of the feet with materials that will absorb friction and excessive pressure, rather then passing them to the balls of the feet. The materials we use act as though more fat and padding were added to the feet, without adding excessive bulk.
• Support high arches in order to relieve excess pressure on the balls of the feet. Our custom-made orthotics are designed to comfortably allow this type of arch to function as if it were of a normal height. By doing this, we allow the arch to bear its normal weight, thus reducing the weight that the ball of the foot must bear. This will reduce the pressure on the metatarsal heads and fatty pad, thus reducing pain and fatigue.
• Adjust and accommodate for any abnormal walking patterns you have, such as pronation, intoeing, outtoeing, etc., that affect the way weight is distributed across the balls of your feet when you walk. Our custom-made orthotics will allow the feet to function in a normal position when they strike the ground, rather than in a twisted position, thus removing the excessive weight and pressure from the balls of the feet.
When these things are achieved, the inflammation and pain of Metatarsalgia will gradually be reduced or eliminated. Custom-made orthotics are also very effective in preventing recurrences of these painful problems.
Our Custom-Made Orthotics for Metatarsalgia are constructed from the impressions of your feet that you make with our Foam Impression Kit. Using these impressions and the information you provide us, we design and construct a pair of orthotics that will help to stabilize your feet, reduce pressure on the balls of the feet, support the arch and metatarsals, and help to alleviate your foot pain. These orthotics will fit in any shoe with a heel height up to 1 1/2 inches . Click here for information on how to order these uniquely effective custom-made orthotics.
People with metatarsalgia have also found these products to be effective:
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