Pain in the ball of the foot

introduction

The ball of the foot is a part of the sole of the foot, which is formed by the base joints of the toes and an overlying fat body (pad).
The ball of the foot is in contact with the ground and carries a large part of the body weight. The ball of the foot is therefore exposed to great stress in everyday life, which can lead to pain in the ball of the foot. In addition to high stress, the ball of foot pain can also be due to various diseases, which is why long-lasting pain in the ball of the foot should be clarified by a doctor.

causes

Most often, pain in the ball of the foot occurs when the ball of the foot is overloaded or overused, for example after a hike or after long periods of standing.
The development of pain in the ball of the foot is aided by wearing the wrong footwear. Even being very overweight can overload the ball of the foot and cause pain in it.

Diseases of the metatarsophalangeal joints that make up the ball of the foot can also cause pain in the ball of the foot. These include inflammation of the metatarsophalangeal joints of the toes, inflammation of the sensitive periosteum surrounding the metatarsophalangeal joints, as well as wear and tear or fractures of the metatarsophalangeal joints.

Furthermore, pain in the ball of the foot can also be caused by a gout or rheumatic disease, by a circulatory disorder of the foot or by damage to the nerves of the ball of the foot.

In the case of long-lasting pain in the ball of the foot that occurs without overloading the ball of the foot, a bone tumor can also be the cause.

Furthermore, congenital or acquired malformations of the foot can be the reason for pain in the ball of the foot.

The following diseases can cause pain in the ball of the foot:

• Fatigue fracture in the metatarsus
• Metatarsalgia
• Morton's neuroma
• gout
• Osteoarthritis of the toes
• Ledderhose's disease
• Buckle feet
• splayfoot
• Metatarsal osteoarthritis

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

• Lumedis - your orthopedic surgeon
  Kaiserstrasse 14
  60311 Frankfurt am Main

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Further information about myself can be found at Dr. Nicolas Gumpert

Metatarsalgia

The term metatarsalgia covers all diseases of the metatarsus. More precisely, this term refers to pain that occurs in the metatarsal or metatarsal bones extending from the second to fifth toes. Pain in the big toe area is considered separately.
So anyone who feels pain in the metatarsal is actually suffering from metatarsalgia.

The reasons for this are as varied as the feet of those affected. As a rule, it is foot misalignments or deformities that, for example, were not treated correctly in childhood and now cause problems in later years of life. Overloading, inflammatory processes or, in rare cases, tumors can also cause pain in the metatarsal area.

Fatigue fracture in the metatarsus

The fatigue fracture of the metatarsus can basically be traced back to two causes. On the one hand, the bones of the metatarsus can show structural damage. So they no longer have their actual bone density and thus no longer their hardness and resistance. Reasons for this can be bone diseases, but also drugs such as cortisone.

On the other hand, overloading the metatarsals is also a possible cause. In most cases it is the result of excessive physical activity without the body being used to it. But the wrong running shoes can also lead to an unfavorable distribution of forces while running.
The first early warning symptoms are the pain that occurs during exercise, which disappears again at rest. However, due to the fracture, the pain no longer disappears at rest and every step is painful to overcome. There is also a bruise near the affected bone, which gradually spreads.

For the attending physician, the information should give rise to an X-ray examination of the foot. Here you can see a fracture gap in the X-ray image, mostly in a metatarsal bone.

Read more about this under: Fatigue fracture in the metatarsus or fatigue fracture in the foot

Inflammation of the ball of the foot

As a rule, inflammation in the ball of the foot is caused by a wound that gives germs the opportunity to penetrate the body from outside. Accordingly, people who move barefoot are more at risk. Barefoot runners can suffer the smallest injuries to the soles of their feet, which they never actually notice themselves, but which give bacteria the opportunity to “enter” the human body and multiply there.

Typical signs of an inflammation on the ball of the foot are usually pain when the ball of the foot is put under pressure. Because of the invading bacteria, the foot is much more sensitive and loads that would normally not cause pain are perceived as painful. Additional signs of inflammation are swelling and reddening of the ball of the foot at the point. In addition, the ball of the foot feels much warmer in the reddened area. The final symptom of the ball of foot inflammation is difficulty walking on tiptoe.

You can read more information on this topic here: Pain ball of the foot

Morton's neuroma

Morton's neuroma is basically a nerve disease that is responsible for the sensation on the underside of the foot and the toes. These nerves run between the bones of the metatarsus and pass through a very narrow gap in the area of ​​the bone ends, through which they run. If the foot is overloaded or if the splayfoot is present from the start, this gap is additionally narrowed. The bones then begin to squeeze the nerve a little bit and slide along it.

This leads to nerve irritation at the relevant point and also to the fact that a covering of solid connective tissue forms around the nerve. This shell in turn ensures that the nerve has less space and is therefore constricted and squeezed even faster.

Typical signs of a Morton's neuroma are a slight tingling sensation or a disturbed sensation on the underside of the foot. When walking, those affected feel an uncomfortable shooting pain the harder they roll their feet. This can also be provoked by grasping the two long sides of the foot and compressing it. This also compresses the metatarsal bones, compressing the damaged nerve as well. In the majority of cases, the nerve between the third and fourth toes is affected by a Morton's neuroma.

Osteoarthritis in the metatarsus as a cause of pain

Metatarsal arthrosis is one of the rarer forms of arthrosis and is generally more common in women than men. As with any other form of osteoarthritis, the cartilaginous joint surfaces of the bones are damaged.

Overloading the joints - be it due to a misalignment of the feet or too much body weight - increases the abrasion of cartilage in the joints until it is mostly worn out. To compensate for this, the body forms small bone extensions (osteophytes) at the edge of the joint in order to be able to better distribute the pressure on the joint. However, since these are not as stable as the original bone and are partially peeled off again by movement, a permanent latent inflammation develops in the affected joints.

Those affected usually complain of pain in the area of ​​the metatarsus, which is particularly severe when rolling, i.e. when the foot is bent. This pain seems to be most likely to be located on the back of the foot, i.e. the top of the foot. Depending on how severe the osteoarthritis has already progressed, the "bone extensions" described above can also be felt by touching the joints. At the latest, however, they are visible when the foot is x-rayed. Furthermore, the affected area of ​​the metatarsus appears warmed up compared to the rest and the person concerned tries to adopt a compensatory protective posture with his feet in order to have to put as little strain on the metatarsus as possible.

Metatarsophalangeal joint pain

Pain in the metatarsophalangeal joint can have a variety of causes. However, pain in the big toe joint is a typical symptom of a gout attack, which is why this aspect should be discussed in more detail. The gout pain typically occurs in the cold season, as uric acid crystallizes out into small lumps more easily when it is cold. These in turn rub within the joint and cause pain when the foot is moved or rolled. A typical indication is that the pain decreases when the foot is warmed.

Also read our article on this topic: gout

Another possibility that could cause pain in the metatarsophalangeal joint is a fracture of a toe bone. Often the little toe or possibly the fourth toe are affected. Trapped in a door or clumsily stuck on an edge, this force can cause it to break.
The patient feels severe pain in the acute incident and also afterwards and a hematoma develops on the affected area.

Concomitant symptoms

On the basis of the accompanying symptoms, the orthopedic surgeon can draw conclusions about the cause of the disease.

Pain in the ball of the foot can, depending on the cause, be pulling or stabbing, be accompanied by tingling and numbness (Morton's neuroma), or be associated with painful pressure points and blisters after excessive strain (overload / fatigue fracture). If the pain is caused by inflammation, the ball of the foot may be red and swollen (gout).
Depending on the cause, the pain in the ball of the foot only occurs when the ball of the foot is put under stress, immediately after the ball of foot is stressed or even at rest.

Also read: tendinitis on the sole of the foot

Pain in the ball of the foot from gout

The clinical picture of gout is an intermittent metabolic disease in which there is too much uric acid in the blood.

Typically, uric acid crystals are deposited in the joints and lead to severe inflammation.
An acute gout attack causes very severe pain and often occurs in what is known as the metatarsophalangeal joint of the big toe.

In such a gout attack, the pain typically occurs more frequently after consuming alcohol and / or meat. In addition, the number of seizures increases, especially at night or in the morning. The pain in the metatarsophalangeal joint of the big toe can radiate into the entire foot, which is usually tender, reddened and swollen. A fever can occur at the same time. Normal walking is usually no longer possible during an acute gout attack. During such an attack, the attack is usually treated with pain medication or cortisone.

In order to reduce the likelihood of another gout attack, a change in diet (Low purine diet) as well as taking so-called uricostatic drugs if necessary.
If an acute gout attack is suspected, a doctor should be consulted for further clarification.

diagnosis

First of all, the person concerned is questioned in detail by the doctor in order to rule out some possible causes of the pain in the ball of the foot. The better the person affected can describe and localize the pain in the ball of the foot, the easier it is to make a diagnosis.

Other important questions are when exactly and in which situation the pain occurs, whether the person affected has other complaints in addition to the pain in the ball of the foot and whether the person concerned also suffers from other diseases.

This is followed by an assessment and examination of the ball of the foot.
An x-ray of the foot can also provide clues as to the cause of the ball of foot pain. Wear to the metatarsophalangeal joints, fractures or bone tumors are often visible on x-rays. Furthermore, computed tomography (CT), magnetic resonance tomography of the foot (MRT foot) and an examination of the patient's blood can also contribute to the diagnosis.

Where are your complaints?

Pain on the outside of the ball of the foot

In general, pain on the ball of the foot is usually due to overstressing the corresponding area.

If there is pain on the outside of the ball of the foot, it can have different causes. Overloading, which mainly affects the foot from outside, can be influenced by a misalignment of the legs. Such a misalignment usually leads to a pathological rolling process when running and consequently to an overstressing of only a certain part of the ball of the foot.
But even without a misalignment of the legs, isolated pain on the outside of the ball of the foot can occur. Overloading due to extreme obesity or physical activity, even with correct rolling behavior, can mainly be seen on the outside.

In the case of continuous pain, a doctor should be consulted who will rule out other diseases, such as warts on the sole of the foot in this area, and possibly carry out a running analysis. The ball of the foot can be supported by shoe insoles in the event of noticeable rolling behavior. In some cases, additional therapy with medication or physiotherapy may be necessary.

Pain in the ball of the back of the foot

Strictly speaking, the ball of the foot only comprises the front part of the foot behind the toes, which is in direct contact with the ground when running. The ball of the foot is located in the front of the foot. Pain in the ball of the back includes complaints that occur in the middle to front of the foot.

Pain that occurs further back on the ball of the foot, like any other pain on the ball of the foot, is mostly due to excessive strain.
For example, a non-optimal rolling behavior with simultaneous high stress on the ball of the foot can lead to this symptom. In order to better localize the cause of the pain on the ball of the foot, the type of movement during which the complaints occur and the exact localization of the pain are decisive. If, for example, a new shoe is used and the pain occurred shortly after changing the shoe, this is very likely the cause of the discomfort.
Warts or muscular problems resulting from splayfoot can also cause pain in this area. A running analysis and physical examination by a doctor can help determine the exact causes of the symptoms.

Pain in the middle / outer ball of the foot

Pain that occurs on the outside and center of the ball of the foot can generally develop differently.

The main reason for ball pain, regardless of the exact location, is overstressing the affected area. Especially if the complaints only occur in certain areas of the ball of the foot and possibly even on both feet, this speaks for a noticeable rolling behavior when walking and running which can be held responsible for the complaints.
Such rolling behavior can be precisely diagnosed with a running analysis and treated with insoles. Other causes that cause pain only on the outside and in the middle of the ball of the foot are wearing unsuitable shoes or performing special activities that put stress on these areas in particular.

A misalignment of the hips can also result in incorrect loading of the ball of the foot and thus cause pain of this kind. Especially if the pain does not go away after a long time and no obvious cause for the symptoms can be found, a visit to a doctor is recommended, who can find the individual diagnosis and initiate a suitable therapy.

Pain in the ball of the foot and big toe

If the big toe causes pain, this can have different causes, depending on the symptoms. A common reason for a sore big toe is an acute attack of gout which causes severe pain due to uric acid crystal deposits in the joint. In addition to the pain, other symptoms such as swelling of the toe and reddening of the area occur during an acute gout attack.

Other causes that can cause pain in the big toe area are warts and skin lesions, commonly known as corns. In addition, it can lead to pain in the case of unfavorable rolling behavior and an overload of the foot area on the big toe. When changing shoes or the activity or type of sport performed, it should be critically questioned whether the technique is being carried out correctly and whether the footwear fits the respective foot.

In addition to the correct size of the shoes, attention should also be paid to special features such as special shoes for flat feet or splayefeet.

With chromic pain in the ball of the foot and big toe, one should also consider osteoarthritis, which is known as hallux rigidus.

You can find further information under our topic: Pain in the big toe

Pain in the ball of the foot and toes

Strictly speaking, the toes do not belong to the area of ​​the sole of the foot known as the ball of the foot.

However, since these are directly adjacent to the ball of the foot and contribute to the natural rolling movement of the foot, they are also often affected by pain when the foot is overloaded. However, pain in the toes can have other causes in addition to excessive stress caused by noticeable rolling of the foot.
The choice of shoes is particularly essential for pain-free walking and running.

In addition to the correct size of the shoes, the shape of the sole is also crucial. A treadmill analysis can help find the right model when buying shoes. Diseases such as the skin changes known colloquially as corns also occur frequently on the toes and can cause discomfort. The same applies to warts in the area of ​​the toes and the transition between the ball of the foot and the toes. In the case of complaints that persist for a long time, a doctor should be consulted so that, in addition to the diagnosis, treatment of the complaints can also be started.

Pain in the ball of the foot and metatarsus

The term “ball of the foot” anatomically describes the region of the sole of the foot which is in contact with the ground during the typical rolling movement in the front foot area.

The foot itself is made up of a multitude of different bones and muscles.
A specific area of ​​the foot that lies behind the toes is called the metatarsus. This area is formed by five metatarsal bones (Os metatarsalia I-V). A number of different muscles run in this area of ​​the foot and allow the toes to move smoothly. They are therefore essential for the foot to roll while running. Pain in the metatarsal area can have various causes.

A simple overuse of the muscles and tendons in the metatarsal area can cause severe pain. This is also the most common reason for complaints in this area.

You can find more on this topic at: Tendonitis in the metatarsus

If the metatarsus is injured with high force, the metatarsal bones can also break. Especially with the colloquial "Twist“These breaks can occur. A metatarsal fracture is usually accompanied by severe pain, swelling and a bruise in the affected area. If these accompanying symptoms do not occur, a bone fracture is unlikely. If the symptoms persist for a long time, a visit to a doctor is recommended, who will find the cause of the symptoms and initiate suitable therapy.

Also read: tendinitis on the sole of the foot

therapy

The treatment depends on the cause of the ball of foot pain and includes conservative, medicinal or surgical measures.

Pain which after Overload or Overuse of the ball of the foot often go away on their own and can be replaced by a Immobilization of the foot are relieved. Furthermore, the application of Cold or warm for the treatment of ball of foot pain.

The pain is in the ball of the foot Inflammation can base anti-inflammatory and pain reliever drugs, like for example Diclofenac, be used in the form of tablets or ointments.

Is a Bone tumor often responsible for the pain in the ball of the foot surgical removal the method of choice for the tumor. Also Misalignments of the foot can be corrected during surgery.

forecast

The forecast depends on the cause of the ball of foot pain. Pain in the ball of the foot, which occurs as a result of incorrect loading or excessive strain on the ball of the foot, often disappears on its own after a short time.

prophylaxis

The best way to prevent pain in the ball of the foot is to use a Avoids overuse of the ball of the foot. If you plan to put a lot of strain on the ball of the foot, for example a hike, then you can cause pain in the ball of the foot by wearing suitable footwear avoid.

Figure ball of foot pain

Pain in the ball of the foot
(Ball of the foot is part of the sole of the foot)

1. Toe phalanx -
   Phalanx distalis
2. Big toe joint -
   Articulatio interphalangea
3. Phalanx -
   Phalanx proximalis
4. Metatarsophalangeal joints -
   Articulationes metatarsophalangeae
5. Ball of the big toe
6. Metatarsal bones -
   Os metatarsi
7. Ball of the little toe
8. Sole of foot -
   Planta pedis
   Causes:
   - Overwork or overuse
   of the ball of the foot (hike,
   long standing)
   - wrong footwear
   - very overweight
   - Disease of the metatarsophalangeal joints
   (Inflammation, wear and tear, or fractures)
   - gout (deposits of uric acid crystals)
   or rheumatic disease
   - bone tumor

You can find an overview of all Dr-Gumpert images at: medical illustrations

Figure pain ankle

Foot pain

1. Achilles tendonitis /
   Achilles tendon rupture
2. Broken bones - toes,
   Metatarsus, tarsus
   (here outer ankle fracture)
3. Ligament stretch / torn ligament
   at the ankle
4. Lower and upper heel spurs
   Calcaneus spur
5. Hammer toe and claw toe
   (Deformities of the toe bones)
   Digitus malleus
6. Plantar warts
   Verrucae plantares
7. Hallux valgus -
   (Deviation of the big toe
   in the base joint)
8. Hallux rigidus -
   (Joint wear of the
   Metatarsophalangeal joint)
9. Inflamed nails / nail fungus
10. Osteoarthritis / arthritis -
    degenerative change of
    Joints / inflammation of the joints

You can find an overview of all Dr-Gumpert images at: medical illustrations