Pain on the ball of the foot is typically caused by a variety of foot problems. The most common causes are neuroma, capsulitis, callus, and foot deformity. Luckily these problems are easily remedied if a speedy diagnosis is determined. This article will cover the basics of these pathologies and will have hyperlinks to more detailed information.
A neuroma is in its simplest definition is a swollen nerve. Nerves in the bottom of the foot can become swollen due to repetitive trauma or the way the foot functions. If one runs on the balls of the feet, wears high heels, or has a flat foot these factors can greatly increase the risk of developing a neuroma. Essentially the nerves travel down from the through the foot and between the metatarsal bones. The previously mentioned activities cause the bones to become closer together and therefore compress the nerve leading to trauma. The nerve then reacts to the trauma with swelling. This swelling can cause debilitating nerve pain when walking. A typical symptom is the feeling of swelling in the ball of the foot or feeling like there is a pebble in the bottom of the foot. Treatments include injections, icing, rest, orthotics, and if severe surgery.
Capsulitis is when the soft tissue surrounding a joint becomes inflamed. The bottom of the 2nd metatarsalphalangeal joint is the most common place for this injury to occur. The 2nd metatarsal bone is the longest bone in the foot and bears a lot of weight during ambulation. The capsule after chronic/acute trauma becomes inflamed and any pressure on that bone can cause pain. The treatment for this problem includes icing, rest, injections, orthotics, and physical therapy. If there is a tear of the ligamentous structures surrounding the area and increased pain then surgical intervention may be required.
Calluses are created when pressure and friction is applied to the skin for a period of time. The calluses on the bottom of the foot can cause pain because they can be very hard and can press into the skin. Oftentimes the calluses are related to the foot structure. If the metatarsal heads are prominent on the bottom of the foot then calluses will develop due to the increased pressure and friction. Shaving of the calluses will help to decrease symptoms but if the increased pressure and friction continue then the problem will reoccur. Orthotics help to offload the pressure on the bottom of the foot by supporting the foot completely. With the custom inserts the foot is supported throughout the arch decreasing pressure to the ball of the foot.
Decreased arch height and Increased arch height can both cause pain in the ball of the foot. The more prominent the bones are the more pressure they will create when walking. The shape of the foot is typically the main cause of the problems described above. When the arch of the foot is low this can cause strain between the bones which could lead to the development of a neuroma. When the arch is too high this will cause increased pressure to the metatarsal heads therefore creating problems such as calluses, stress fractures, and capsulitis. Custom orthotics can solve the root of the problems by properly supporting the foot so that deformities do not cause increased pressure to the foot. The less strain and pressure to the foot the less problems will occur.