Tag Archives: Ball of Foot Pain

Pain in the ball of your foot could be Morton’s Neuroma

30 Jul

Does it feel like you have a pebble in your shoe between your 3rd and 4th toes?

Perhaps you have occasional shooting or burning pain in the bottom of your foot?

Do your 3rd or 4th toes occasionally sting or feel numb?

Any of these could be symptoms of Morton’s Neuroma, a painful thickening of the tissue around the nerves that lead to your toes.

mortons neuroma

Morton’s Neuroma is also known as Morton’s metatarsalgia, Morton’s neuralgia, plantar neuroma, or intermetatarsal neuroma. It typically has no outward signs, such as an obvious lump – only discomfort and pain on the bottom forefront of your foot or toes. Technically, a neuroma is a benign tumor of a nerve. Fortunately, a Morton’s neuroma isn’t a true tumor, but simply a thickening of fibrous tissue. If left untreated however, the neuroma can lead to permanent nerve damage.

How Morton’s Neuroma forms

Abnormalities in the anatomy of the foot, aggravated by injury, irritation, or wearing pointy shoes or high heels, compress and irritate the nerve that passes under the ligament connecting the toe bones in the forefoot. In response, the nerve enlarges and develops a nasty lump. It most commonly develops between the 3rd and 4th toes, and appears in women 10 times more often than in men. Those people who have bunions, flat feet, hammer toes, or unusually high arches, are prime candidates for developing Morton’s Neuroma. So are those athletes who perform on courts or hard surfaces – runners will notably feel the pain when they push off from the starting line.

Symptoms of Morton’s Neuroma

  • Feeling of having a pebble in your shoe
  • Burning or stinging pain and numbness in the area between the 3rd and 4th toes
  • Pain intensifies with activity and subsides with rest
  • Symptoms rarely appear at night

Causes of Morton’s Neuroma

Abnormality in foot biomechanics, aggravated by:

  • High heels, shoes that are too tight, or shoes that don’t fit correctly. This footwear can put pressure on the toes and ball of you foot, aggravating the nerve.
  • Sports that put unusual stress on your toes, like rock climbing, or snow skiing, or high impact aerobic sports like running or basketball.

Treatment of Morton’s Neuroma

  • Change your footwear. Swap high heels for flats, and wear shoes with a square toe box which will not constrict the movement of your toes. This lets the bones spread out, taking pressure off the nerve, and allowing it to heal.
  • Custom orthotics or pads may be worn inside your shoes. A podiatrist at PA Foot and Ankle Associates will customize an orthotic for you which will take pressure off of the sensitive area. This speeds healing by lifting and separating the toes, taking pressure off the nerve.
  • Steroidal injections can be used to reduce pain and inflammation in the affected area.
  • Over the counter anti inflammatory medicine like advil or aleve can be used to control pain, along with ice and rest.
  • If these treatments fail to relieve your symptoms, surgery may be recommended.

Which physician is best to treat foot and ankle pain?

25 Jun

We sure take our feet and ankles for granted, don’t we?

best doctor for foot pain ankle pain toe pain

That is, until the Millenium Falcon breaks our ankle, or a foul ball clips our right foot. Ouch.

When your feet are painful, you’re miserable. Your lifestyle is instantly affected – pain forces you to dial back or give up walking, running, dancing, standing, or your favorite sports. Prolonged pain might even cause you to go from star athlete to couch potato.

It’s appropriate to visit the ER if you have an unusual amount of pain in your feet or ankles, especially if the pain is sudden and intense, is accompanied by bleeding or swelling, or if your foot and ankle have been involved in a trauma like a fall down the stairs. Or if you tried to break a cement block in half with absolutely no martial arts training.

For less painful events, like a suspected fracture, or wounds that won’t heal, many people choose to see their primary physician, which may or may not be a good choice, depending on that  physician’s field of expertise.

And for even less worrisome injuries, like a minor sprain, or minor heel pain, some seek no medical attention at all – which is never a good idea, as both injuries can develop into more complicated conditions, especially for athletes.

Which doctor is expert in treating foot and ankle problems?

When you have trouble with your ears, you should see an ENT. Trouble with your knees, an orthopedist. When you have pain or discomfort in your feet, toes, or ankles, you should see a podiatrist.

Podiatrists and podiatric surgeons are trained exclusively in the treatment of foot and ankle disorders – they do nothing but study the foot and ankle, it’s diseases and deformities. After all, 1/4 of all of the bones in your body are in your feet, and there are many conditions unique to this area of the body. That’s a lot of ground to cover in med school. If they choose to be a podiatric surgeon, they complete further schooling to study surgical techniques to correct these problems.

In 99% of cases, a podiatrist can resolve your ankle, toe, or foot problem much faster than a general physician. Podiatrists are also expert at spotting the early signs of diseases you can easily overlook, like diabetic foot disorders, rheumatoid arthritis and cardiovascular disease.

Without your feet in good working order, your life can be…. well, challenging. Don’t take them for granted.

Giants’ Jon Beason Sidelined With Sesamoid Injury

16 Jun

Here’s some potentially bad news for Giants fans: Middle linebacker Jon Beason injured his right foot during off season training Friday. It appears he suffered a ligament tear and a fracture of the sesamoid bone.

jon beason foot injury

Beason at work against the Redskins in 2013

“You have freak injuries,” Beason said. “I was just changing directions… the movement was a little unorthodox, I was flexing with the big toe in the ground and then I pivoted on it all the way around. It’s a movement that I often do… I literally felt like I stepped in like a sprinkler head hole. I just felt it give right away.

“I really felt that I that I had torn the extensor, which is the tendon with the muscle, it’s how your big toe functions. That would have been season-ending.”

After limping to the sidelines and huddling with the training staff, Beason was carted off the field and taken to the Hospital for Special Surgery where he underwent an array of tests: MRI, CT, and x-rays. A definitive treatment plan has yet to be announced, but Beason’s status for the Giants’ regular season opener in Detroit is up in the air, as an injury like his typically requires a 12 week recovery period.

Beason, a 3-time Pro Bowler, was drafted by the Carolina Panthers in 2007. He played only one game for the Panthers in the 2011 season when he ruptured his left achilles tendon, and in 2012, played in just four games before suffering a microfracture in his right knee, requiring surgery.

Beason was traded to the Giants in October of 2013, and played in all 12 remaining games. At the end of the season, he was second on the team with 93 tackles. The Giants re-signed him in March and expected him to be a cornerstone of their defense this year.

So what’s a sesamoid anyway?

Most bones in our bodies are connected at joints, but not the sesamoids, which are connected only to tendons or embedded in muscle. Your kneecap is the largest sesamoid in your body, and the smallest are those found in the foot, two tiny, pea-shaped bones in the front of each foot that most people are unfamiliar with until they’re injured.

Located just behind the big toe, the sesamoids act like pulleys, providing a smooth surface over which the tendons glide, increasing the leverage of the tendons controlling the big toe. The sesamoids also assist with weightbearing and elevate the bones in your biggest toe. But that’s assuming you have sesamoids – some people are born without sesamoids in their feet and experience no problems.

Read more about sesamoiditis

If you damage the sesamoid bones in your feet, you’ll feel the pain in the ball of your foot, just behind the joint of the big toe. You may simply have an irritation of the tendons around the bones – called sesamoiditis, or you may have actually broken one of the tiny bones.

If you suspect an unjury to the sesamoids, seek an evaluation from a podiatrist, the most knowledgeable physician to treat this uncommon injury. Before your appointment, stop the activity which caused the pain, take over the counter pain medicine like advil or aleve to manage the pain and soreness, and use ice to reduce swelling.

If after a diagnosis, your podiatrist confirms an injury to the sesamoid bones, she or he may recommend any of the following:

  • custom orthotics to shift your body weight off of the forefoot
  • steroid injections to relieve swelling and pain
  • immobilization with a surgical boot
  • physical therapy
  • strapping or taping the big toe
  • surgery to remove or repair the sesamoids

The podiatrists at PA Foot and Ankle Associates are experts at treating sports injuries and are the best qualified physicians to diagnose and treat uncommon injuries of the foot and ankle.

What Is A Crossover Toe?

5 Jun

Crossover toe is a painful condition in which the second toe drifts out of place, eventually crossing over and lying on top of the big toe. In some cases, the second toe lies under the big toe. Crossover toe can occur at any age, but is most commonly found in middle age and older adults.

crossover toe treatment

Crossover toes are frequently associated with bunions. This man has both.

Don’t confuse crossover toe with hammertoe. While both conditions involve a toe (any toe can be affected) that doesn’t lie in its normal position, they are quite different, and crossover toe is a much more complex condition. When a toe is described as being a crossover toe, it has become buckled, contracted, or crooked, and has literally crossed over or under the big toe (or adjacent toe).

Crossover toe is a progressive condition, usually occurring over a period of time. But it may also appear after an injury, from overuse, or after a steroid injection to an area near the second toe.

What causes crossover toe?

It’s generally believed that crossover toe is caused by abnormal foot structure and faulty biomechanics, as are bunions. The combination of these conditions leads to repetitive stress on the joint of the second toe, weakening the structures which stabilize it. The result is a toe that drifts out of place and becomes a crossover toe.

Other foot conditions accompany and may contribute to crossover toe, such as bunions, hammertoe, neuroma, arthritis in the big toe joint (hallux rigidus deformity), an elongated second metatarsal (2nd toe is longer than the big toe), a tight calf muscle, or an unstable arch.

What causes Crossover Toe?

In a normal foot, the plantar plate and associated ligaments stabilize the 2nd metatarsal joint. When chronic inflammation or damage occurs in this area, the stabilizing structures of the joint slowly change. One by one, the supporting ligaments fail, leading to chronic hyperextension on the toe joint, which then stretches or re-attenuates the plantar plate. This change in the toe’s supporting structures causes an imbalance, leading to instability in the toe, which eventually dislocates in the direction of the big toe.

Crossover toe can be difficult to diagnose in its early stages, when it’s most easily treated. A patient may have pain in the ball of the foot, but the toe exhibits no signs of dislocation. Unfortunately, without treatment, the toe will worsen and eventually dislocate. But if the crossover toe is detected by a podiatrist at an early stage, non-invasive treatments like bracing, strapping, taping, and orthotics can be employed to keep the toe from becoming a crossover toe. Once the second toe begins to drift towards the big toe, it will not return to its original position.

Symptoms of Crossover Toe

  • Pain and swelling at the base of the second toe, and/or the ball of the foot. The discomfort on the bottom of the foot is often described as feeling like there’s a marble in your shoe
  • Difficulty wearing shoes, as the toe becomes irritated by footwear
  • Pain when walking, especially in the ball of the foot
  • Soreness to the top of the crossover toe

Treatment for Crossover Toe

Taping positions the affected toe in it’s original alignment, which provides stability and relieves pain and swelling. As the inflammation of the joint decreases, healing can occur over a period of months.

Metatarsal pads and orthotics can alleviate pressure on the plantar plate and/or metatarsal and redistribute body weight across the surface of the foot. Healing can slowly occur as inflammation subsides.

Over the counter anti inflammatory medicine like aleve and advil can decrease inflammation and pain in the symptomatic joint.

If these conservative treatments fail, or if the displacement of the toe is far advanced, surgery to re-align the toe followed by physical therapy may be recommended by your podiatrist.

Landscaping: How To Protect Your Feet From Injuries

15 May

Which would you rather say to your podiatrist?

“I got this monumental ankle sprain when I was pushing my lawnmower and rolled my foot in a gopher hole.”
or
“I got this monumental ankle sprain when I rolled my foot AFTER THE MOST SPECTACULAR JUMP SHOT EVER!

If you picked “gopher hole”, you’re in the minority.

Landscaping – and even gardening – cause their share of foot and ankle injuries, especially in spring when we’re out of shape. We tend to jump right in where we left off in October, and our bodies just aren’t up to it. Bending, twisting, and lifting or pushing heavy and sharp equipment can cause an injury quite quickly if you don’t take a few precautions.

chainsaw

We hope he’s wearing a good pair of work boots

Wear proper footwear.

It may have been fine when you were a teenager to wear worn-out sneakers when you cut the lawn. As an adult, you should wear athletic shoes which support your feet well and will protect them if you step on a rock you didn’t expect to be there. Or in the groundhog hole which magically appeared overnight.

If your ankles or feet have been subject to injuries in the past, or if you’re landscaping with sharp equipment, wear a quality pair of work boots (not garden boots, which offer little protection beyond moisture). If you’re a landscaper, work boots with good support and metal-tipped toes should always be on your feet. Work boots will also protect your feet in the event you accidentally drop any equipment with sharp blades or heavy bottoms (like a tamper).

Don’t work on a wet lawn.

When grass is even a little wet, it can be very slippery. If you have a slope or hill on your lawn, cutting it when wet can be especially dangerous. Wait to mow your lawn until the turf is completely dry.

Use equipment with safety shutoffs.

Decades ago, equipment with sharp blades only stopped turning when you intentionally shut it off, which allowed chainsaws to run out of control, and feet to slide under lawnmowers while the blades were still turning. Fortunately, most modern lawnmowers, edgers, tillers, cultivators, post hole diggers, chain saws, and other equipment with high speed, rotating blades or teeth, stop as soon as you let go of the handle or trigger. If you’re still using decades-old equipment which doesn’t have a shutoff feature, it’s time to upgrade.

Shovels and other step-on equipment can cause surprising damage to your feet.

If you’re doing a project that requires a lot of digging, or using equipment like manual aerators for your lawn, wear quality work boots at all times. The repeated stepping-on-with-force required with these tools can cause injuries like sesamoiditis, plantar fasciitis, sprains and fractures.

If you have ankle, foot, leg, or back issues, stretch before you start.

In gardening and landscaping, lots of bending, squatting, twisting and turning is required, sometimes while holding or moving heavy equipment. Injuries happen remarkably quickly when your body isn’t prepared for them. We recommend that those who have previous injuries of the back, hip, legs, feet, or ankles, or are over 50, stretch before they begin their activities.

Taking these precautions and wearing work boots when you garden or landscape may not make you look like the coolest guy or girl on the block, but they’ll keep you out of the podiatrist’s office. Or the ER.

 

Pain under your second toe? It could be Freiberg’s Infraction

23 Apr

Frieberg’s Infraction (aka Frieberg’s Disease) is a disorder of the metatarsal bones in the foot (the long bones between your ankle and your toes). Pain is felt in the ball of the foot due to damage to the front of the metatarsal bone. Frieberg’s Infraction can occur in any metatarsal but most frequently, the second or third metatarsals.

Freiberg's Infraction

Freiberg’s Infraction usually appears in adolescent female athletes whose 2nd toe is longer than their big toe

**Note – the word “infraction” in this case, is a combination of Infarction (obstruction of the blood supply, leading to the death of tissue) and fracture (as the infarction is usually caused by microfractures).

Typically, Freiberg’s Infraction is seen in adolescents 13-18 years of age who are very active. Females are 5 times more likely than males to have this condition.  The patient usually has a longer second metatarsal or toe than the others and may have had previous stress fractures of this bone.

When this deformity is present, the longer metatarsal takes more of the weight when walking, running, and jumping. This repeated stress on the bone and joint can result in microfractures or joint damage, interrupting blood supply to the bone and cartilage. If undiagnosed, and the lack of blood flow continues, bone cells may die (avascular necrosis). This is called Freiberg’s Infraction.

When bone tissue dies, it undergoes changes such as flattening of the joint surface, and moving the joint may cause pain and swelling. As the damage increases, the joint between the affected metatarsal and the toe degenerates. The damaged bone may fracture, leading to small, loose bone fragments in the joint area causing further pain.

Causes of Freiberg’s Infraction

  • Growth spurts during adolescence
  • Heredity
  • Trauma
  • Infection

Symptoms of Freiberg’s Infraction

  • Usually occurs only in those whose second toe (2nd metatarsal) is longer than their big toe (1st metatarsal).
  • A dull pain in the ball of the foot behind the second toe. Pain gets worse when walking, especially in high heels.
  • Ball of the foot may become swollen, callus may appear, and skin become red
  • The joint in the toe may be stiff and painful
  • The joint may make a cracking or grinding sound when moved

In many cases, no symptoms are present, and Freiberg’s is discovered during a routine foot exam

Treatment for Freiberg’s Infraction

Some patients have no symptoms (asymptomatic) and the Freiberg’s Infraction resolves without treatment. But it’s advisable to seek treatment from a podiatrist as soon as symptoms appear, because if left untreated, tremendous damage can occur to the metatarsal, requiring surgery.

Early Treatment

  • Rest
  • Ice
  • No weight bearing activities for 4-6 weeks
  • Over the counter medicine like advil or aleve to control pain and inflammation
  • Custom orthotics molded to relieve pressure on the ball of the foot
  • Wear padded and supportive athletic shoes – no high heels. Use over the counter padding in shoes if necessary
  • If swelling and pain are advanced, a cast may be applied to the foot to immobilize it for 4-6 weeks

Advanced Treatment

If the Freiberg’s Infraction fails to resolve with conservative treatments, more aggressive treatment may be necessary. This may include:

  • Removing the damaged bone
  • Bone grafting to create a new bone
  • Shortening the length of the affected metatarsal
  • Reconstructing the joint to eliminate pain and stiffness
  • Joint removal and implant

If you have pain in the ball of your foot, please make an appointment with the podiatrists at PA Foot and Ankle Associates to determine if your pain is caused by Freiberg’s Infraction or another condition.

What is Plantar Fasciitis?

4 Dec
plantar fasciitis

Kobe Bryant famously suffered with Plantar Fasciitis

Plantar Fasciitis is the leading cause of heel pain. In medicine, the suffix itis refers to irritation or inflammation of an organ, and in this case, to the plantar fascia, a band of tissue which connects your heel bone (calcaneus) to the ball of your foot. Pain can be felt anywhere along this path.

The classic sign of plantar fasciitis comes in the morning, when you step out of bed – a sharp pain in your heel. Gradually, as the tissue warms up and becomes flexible, the pain fades – maybe not completely, but substantially. It may then return if you stand on your feet all day or exercise, especially if you run or exercise strenuously.

What causes the heel pain of plantar fasciitis? When the plantar fascia is constantly stressed, small tears occur in the tissue. The tears make the plantar fascia weaker, less able to do its job of support and shock absorption. This offloading of the work causes stress on the surrounding tissues, which is the actual cause of the pain.

Plantar fasciitis also makes itself known to those who are carrying more body weight than normal, like pregnant women or obese individuals. You might also develop plantar fasciitis if you made a poor choice in shoes and wear a style which doesn’t support your feet correctly. People with flat feet also frequently suffer from plantar fasciitis, as do long distance runners .

Symptoms of Plantar Fasciitis
  • A sharp pain at the back of your heel, sometimes described as “knife-like”
  • Pain is most common with your first few steps in the morning, but may also occur after physical activity, or climbing stairs
  • In most cases, pain increases gradually
  • Usually appears in one foot, but occasionally both
  • Foot may be stiff and difficult to bend
heel pain plantar fasciitis

Click for larger view

The Plantar Fascia acts like a shock absorber for your foot, and also supports your arch. If the plantar fascia receives repetitive stress, such as from exercising on hard surfaces, unsupportive footwear, or too much pressure from weight, small tears form in the tissue. These tears cause irritation in the surrounding tissue, which triggers pain.

If plantar fasciitis is left untreated, the condition may get substantially worse. Knee pain is also frequently reported in patients with plantar fasciitis, due to their change in gait to compensate for the heel pain.

Treatment for Plantar Fasciitis
  • Custom orthotics (not off the shelf) prescribed by your podiatrist
  • Physical therapy
  • Rest, elevate, and ice the heel
  • Over the counter anti inflammatory pain medicine such as Ibuprofen (Advil) or Naproxen (Aleve)
  • Athletic shoes which provide excellent arch support and padding at the heel
  • If exercising, train on soft surfaces instead of hard surfaces
  • If overweight, start a weight management program

If these methods aren’t successful in relieving your pain, your podiatrist may recommend steroid injections, PRP injections, EPAT (shockwave) therapy, Radiofrequency Ablation (RFA), or in extreme cases, surgery.

Help! The Arches In My Feet Are Falling!

6 Aug
adult aquired flat foot

In a normal foot, only the smallest toe is visible when viewed from behind.

A common problem among the elderly and increasingly middle aged patients is collapsing arches, medically known as Adult Acquired Flat Foot Syndrome (AAF), or Posterior Tibial Tendon Dysfunction (PTTD). This is a progressive condition in which the arch of the foot collapses and the bones of the ankle and foot fall out of proper alignment.

A magnitude of foot problems develop as we age and many of these complaints begin about the age of 60. Among the most serious from a biomechanical standpoint is Adult Acquired Flat Foot Syndrome (AAF).  Treated early enough, symptoms can be arrested or at least slowed. Untreated however, AAF becomes an extremely painful condition which ultimately affects the entire body and the patient’s lifestyle, as gait is significantly altered by the out-of-line foot and ankle. This malalignment can create pain, fatigue, and discomfort throughout the entire body.

As we age, many of our muscles, tendons, and ligaments lose their ability to stretch and support our bones.  If you’ve ever discovered an old rubber band in the bottom of a drawer, you’ll get the idea – it’s more likely to snap than stretch. The Posterior Tibial Tendon, which attaches the calf muscle to the bones in the foot, is largely responsible for the support of your foot when walking, and to hold up the arch. With aging, overuse, or trauma, this tendon degenerates and loses its function, along with associated ligaments and joints on the inner side of the ankle and foot. Ligaments are responsible for holding bones in place, and when they fail, bones shift and deformity is the result. The deformity causes malalignment, which leads to more stress and failure of the ligaments, and a slow collapse of the arch which becomes debilitating in its later stages.

AAF is most frequently seen in women, especially those who start out with somewhat flat feet or a pronated (rolls inward) foot. These attributes place extra stress on the soft tissue structures, along with the posterior tibial tendon and the ligaments on the inner side of the foot. Other contributing factors are diabetes, obesity, rheumatoid arthritis, and hypertension. People who play high impact sports may also develop tears in the posterior tibial tendon, eventually leading to AAF.

pttd out of alignment foot ankle

The foot and ankle become malaligned as AAF progresses

Symptoms of PTTD/AAF

The symptoms of posterior tibial tendon deformity change considerably as the condition progresses. Initially, pain may be felt along the tendon’s path on the inside of the foot and ankle. This area may also be red, warm, and swollen. As the arch starts to flatten, in addition to pain, the foot and toes turn outward and the ankle rolls inward. As the arch flattens even more, the pain shifts to the outside of the foot, just below the ankle. Arthritis develops in the foot, and later may develop in the ankle, sometimes causing the ankle joint to lock.

Treatment of PTTD/AAF

Treatment of adult acquired flatfoot depends on the stage of the condition and its severity. Mild cases may only warrant rest, ice, and custom orthotics. Advanced cases may require immobilization, bracing, or even surgery. Early intervention by a podiatric surgeon is key to slowing the progression of PTTD.

At the onset of PTTD, a boot or brace is used to support the arch and relieve strain on the soft tissues, including the tendon. When pain has subsided, custom orthotics are used to reduce the stress on these tissues. However, as the arch has already fallen, the deformity may progress. If pain persists after these conservative measures, surgery to correct the deformity may be recommended.

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