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Fore-foot Pain

Innovation Podiatry  >  Conditions  >  Fore-foot Pain

Common fore-foot pain condition symptoms and treatments are outlined below:

Hammertoe (click to open/close)
Overview

A toe that does not bend normally at the middle joint and points down in the shape of an upside down ‘V’ is called a hammertoe. Usually seen in the second toe, at first, it will keep some of its flexibility and lie flat when barefoot, only appearing as a hammertoe when wearing shoes. After a while, the toe will not be able to lie flat at all.

While anyone can get hammertoe, women tend to suffer from it more than men. Age plays a part – hammertoe is the type of injury that may follow repeated damage to the toe and so, becomes more common with age. It is also common in people with nerve damage (e.g. from diabetes, stroke, or heart disease) and in those with second toes that are longer than the big toe, as the second toe is forced to bend in order to line up with the shorter toes next to it.

Wearing high-heeled shoes and certain injuries – such as a stub or a break – can make toes more vulnerable to hammertoe. This is especially true if the injury is not treated properly when it happens.

Treatment

Your podiatrist may advise you to wear wide, comfortable shoes that allow the toes to lie flat, and to steer clear of high-heeled shoes. In some cases, prescription orthotics can be effective to correct the misalignment and allow the toes to lie flat. In extreme cases, where the tendons of the toe have contracted and stiffness or pain affects movement, surgery might be needed.

Stress fracture
Overview

Stress fractures are an injury to bone caused by unaccustomed stress from running, marching or walking. They are often seen in military recruits or athletes as they increase their training. They may also be seen in people with hormonal imbalances or prior surgery that has altered the way their foot or ankle functions.

Stress fractures may feel like an ache in the foot or ankle, or like a sharp pain when a lot of stress is placed on the foot or when doing heavy physical activity. Swelling often occurs around the site of the pain, but usually no bruising is present.

Treatment

By taking an x-ray or obtaining a bone scan, your podiatrist can determine if there is a break or crack in the bone. If stress fractures are present, you will need to stop whatever exercise you are doing that has resulted in your foot or ankle pain. You may self-treat with ice, over-the-counter pain medications, and comfortable shoes. If there is no decrease in pain over several days, you should see your GP.

After making the diagnosis of stress fracture, your doctor will tell you to decrease activity levels. You may either be instructed to wear athletic shoes, or a stiff-soled shoe, to reduce bending motions of your foot when you walk. Depending on the location and severity, your doctor may recommend a cast and crutches. As the pain becomes less intense, you may gradually resume your activity level.

First Metatarsophalangeal Joint pain
Overview

The first metatarsophalangeal joint or ‘MTPJ’ is the joint between the big toe and the first metatarsal bone of the foot. This joint plays an important part in foot function and can be a common area for pain.

Treatment

Coming soon…

Gout

Overview

Gout is an extremely painful form of arthritis associated with elevated levels of uric acid in the blood stream. The area may be swollen, red and warm to touch. If you think you might have gout, it is important to see us to rule out other possibilities. We can refer you for imaging, and to your GP to confirm the diagnosis.

Treatment

In the acute stages, your doctor may prescribe various oral medications. In chronic cases, your podiatrist can help treat your secondary foot deformity and assist you with your foot ulceration management.

Bunions

Overview

The medical term for a bunion is hallux abducto valgus (hallux = big toe). Often hereditary, they can lead to pain and stiffness in the big toe joint. There may also be redness and swelling around the joint and/or bony prominences at the top of the joint.

Treatment

Joint mobilisation, strapping, dry needling/western medical acupuncture, exercises and functional foot orthoses can all be useful in helping to reduce bunion pain. We can also advise on footwear and stock a small supply at our clinic.

Functional Hallux Limitus

Overview

When non-weight bearing, the toe is able to dorsiflex on the 1st metatarsal. When weight bearing, this functional ability is lost, leading to gait alterations, which can affect mobility and balance, and may possibly cause falls. Detrimental effects can also occur further ‘up the chain’ with reductions to dynamic hip, knee and ankle motion.

Treatment

Functional hallux limitus cannot be seen visually but there are various clinical assessments we can perform to diagnose this condition. Simple design features built into an orthotic device can facilitate desired function.

Structural Hallux Limitus

Overview

With structural hallux limitus there is limitation of big toe joint range of motion both when weight bearing and non-weight bearing.

Treatment

Physical therapies such as mobilisation, strapping, and dry needling/western medical acupuncture can be helpful. Correct footwear and/or functional foot orthoses can be effective by helping to stop the painful forced flexing upwards of the toe while walking. If indicated, we may also refer you for a corticosteroid injection to reduce joint inflammation. This can provide temporary and sometimes permanent relief.

Hallux Rigidus

Overview

Hallux rigidus is the medical term for osteoarthritis or ‘wear and repair’ of the big toe joint. Walking can become very painful, as the toe is unable to freely perform its normal function.

Treatment

Physical therapies such as mobilisation, strapping, and dry needling/western medical acupuncture can be helpful. Correct footwear and/or functional foot orthoses can be effective by helping to stop the painful forced flexing upwards of the toe while walking. If indicated, we may also refer you for a corticosteroid injection to reduce joint inflammation. This can provide temporary and sometimes permanent relief.

Sesamoiditis

Overview

The sesamoid bones in the foot are two small bones underneath the head of the first metatarsal. They have an anatomical and biomechanical function, and can become painful with certain activities such as running, dancing and wearing high-heeled shoes. Changes to foot shape, such as can occur with bunions, can also lead to pain in this area due to displacement of the sesamoid bones.

Treatment

Simple changes to footwear and temporary offloading with padding and strapping can be sufficient treatment. X-rays may be required to check for any fracture. If further intervention is necessary, foot orthoses designed to reduce the ground reaction force at the 1st metatarsal head can be prescribed.

Morton's Neuroma

Overview

This painful condition occurs in the ball of the foot, ranging from mild numbness and tingling to a severe burning, stabbing pain. It’s caused by compression of the nerves as they pass between where the long metatarsal bones meet the toes. Repetitive movement, flexible footwear and/or foot biomechanics are the main causative factors.

Treatment

One or a combination of the following may be used:

  • Simple padding and strapping to offload the painful area and reduce pressure on the nerve.
  • Orthotics to address causative biomechanical factors.
  • Footwear modification – avoidance of high heels which increase pressure at the forefoot. Ensure shoes have wide deep toe box to prevent lateral pressure on the nerve.
  • Activity modification – switching to low impact activity in the short term. It is also worth considering your activities of daily living – are you reaching up on tiptoes a lot, or squatting down onto your toes?
  • Ice therapy to help reduce inflammation.
  • ESWT – extra corporeal shockwave therapy.
  • NSAIDS (non steroidal anti inflammatory medication) under guidance from your GP and pharmacist.
  • Corticosteroid injection under guided ultrasound to help reduce inflammation.

If conservative measures fail, it may be worth seeking a surgical opinion. However, surgery is not normally recommended as a first line treatment.

Bursitis

Overview

This is a painful condition in the ball of the foot, often causing pain, swelling, redness and warmth. It can occur alone or alongside other conditions such as Morton’s neuroma. A bursa is a small fluid-filled sac found near tendons, ligaments, muscles, bones and skin. It cushions and reduces friction between bones and structures that glide over the bones.

Bursitis occurs when these sacs become inflamed and irritated, often through overuse or repetitive movement. This can be from sporting or leisure activities, or purely through certain foot or gait abnormalities. Other factors can include footwear and trauma.

Treatment

Sometimes a bursa will settle fairly quickly through ice therapy and offloading the affected area. If your symptoms persist, we can discuss other therapies that may help, including shockwave therapy, padding/strapping, western medical acupuncture and foot orthoses.

Plantar Plate Dysfunction

Overview

The plantar plate is a fibrocartiliginous structure found under the metatarsal heads, attaching to the plantar fascia and the proximal phalanx of the toes. Repetitive overload can lead to pain, which may feel like an ache or bruising to the top and ball of the foot. Swelling may also be present.

You may notice your toe becoming a hammered toe or a floating toe (where the tip no longer touches the ground), and the space between the affected toe and the next toe may also increase (known as a ‘daylight sign’ or ‘victory sign’). The 2nd metatarsophalangeal joint (MTPJ, ball of foot joint) is the most commonly affected. However, it can occur at any of the MTPJs.

Many contributing factors can lead to repetitive overload, including:

  • Increased running or jumping
  • Bunions
  • Long 2nd metatarsal bone
  • High heeled shoes
  • Diabetes
  • Increased squatting onto tiptoes
  • Ballroom dancing, golf and surfing.

A plantar plate injury can range from elongation of the structure, to partial and full tear.

Treatment

Early treatment is advised. We will refer you for imaging to gain a clear diagnosis. Strapping, footwear, orthotics and/or protective boot may be required. If surgery is indicated, we work closely with local orthopaedic surgeons, which ensures fantastic multi-disciplinary care for you.

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