"Doctor, I have pain under the ball of my foot."
When a patient complains of this symptom, it is usually one of two problems: Capsulitis or a Neuroma.
Capsulitis is pain and swelling of the joint where the 2nd toe connects to the foot. This joint is referred to as the 2nd metatarsal phalangeal joint or MTPJ. Sometimes there is pain when walking barefoot and difficulty wearing shoes.
Neuroma is a swelling of a normal nerve in the forefoot usually between the 2nd and 3rd or 3rd and 4th toes. It is sometimes accompanied with a burning, stinging or tingling sensation.
Both of these problems can cause pain at the bottom of the forefoot and swelling. Sometimes patient's state that they felt like their sock has bunched up inside their shoe or like having rocks in the ball of their foot. Capsulitis hurts with local pressure directly on the joint where neuroma pain is generated with pressure between the joints or in what we call the interspace.
The three most influential contributing factors to the development of capsulitis or a neuroma are:
- Shoe Type
- Type of Activity / Exercise
- Biomedical factors of the foot.
Shoe heel height is directly proportional to the amount of pressure that goes throughout the forefoot. The higher the heel, the more pressure. Even an athletic shoe that is too flexible can cause abnormally high pressure through the foot. Certain exercises can cause high pressure throughout the forefoot like soccer, dancing and tennis. I have also seen many neuromas develop due to a tight cycling/spinning shoe. Certainly biomedical factors can contribute to overload of the lesser metatarsal area.
A simple bunion means the big toe joint is unable to function to its capacity therefore that pressure will be distributed into the 2nd through 5th metatarsals, also known as the lesser metatarsals. Flat feet, big toe joint arthritis and a tight Achilles tendon are other well known contributing causes of capsulitis and neuromas.
Treatment is essentially addressing the three most common causes: shoes, activity and biomechanics. Wear good shoes. Be mindful of your activity/exercise type and see your podiatrist for any biomechanical factors.
Dr. Jeffrey S. Hurless
DPM, FACFAS Board Certified Foot & Ankle Surgeon/Podiatrist
Medical Director, HealthyFeetStore.com