Causes of Pain in the Ball of the Foot

Pain in the ball of the foot usually falls under the umbrella of “metatarsalgia.” This term describes any pain or inflammation in the metatarsal region, which includes the ball of the foot. Causes of metatarsalgia can vary and many remain unknown. Doctors may use metatarsalgia as a general diagnosis if they are unable to determine a more specific cause of ball of the foot pain.

Morton’s Neuroma

A neuroma is a pinched nerve. Morton’s neuroma is a specific type that involves a thickening of the tissue around a nerve leading to the toes. This most commonly affects the ball of the foot between the third and fourth toes. Some people with Morton’s neuroma feel a sharp pain. Others experience numbness, burning, or tingling in their foot or toes. Minor Morton’s neuromas may feel more like discomfort as if there is a rock in the shoe or a fold in the sock.

Plantar Plate Injuries

Between the metatarsals and the toes are fibrous structures known as planar plates that support and stabilize the joints. Structural issues, traumatic injuries, and chronic, repetitive stress can damage these structures, causing intense pain. Often, this pain seems to originate from the ball of the foot under the second toe. Doctors often misdiagnose plantar plate injuries as similar issues like metatarsalgia or a neuroma.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic form of arthritis. It is an autoimmune disease, which means that it stems from a person’s immune system overreacting and attacking their body. Rheumatoid arthritis affects everyone differently, but the most common symptoms are pain, swelling, stiffness, and general fatigue. This pain can manifest in many locations, including the ball of the foot.

Bunion

Some people develop bony bumps near the base or underneath their big toe. This growth, a bunion, can force the big toe to bend toward the other toes, causing pain and discomfort. Bunions also affect how a person stands, walks, or runs, which can lead to strain that worsens the pain in the metatarsal region.

High Heels

A person’s footwear is almost always a contributing factor for foot pain and injuries. High heels are particularly harmful because they shift the weight of the foot and squeeze the toes together. High heels may directly cause metatarsalgia because of this. They may also trigger more specific issues, like Morton’s neuroma.

Gout

Gout is a form of arthritis that causes sudden, severe pain, as well as swelling, redness, and tenderness. It often occurs in the joint at the base of the big toe but can affect any joint. With gout, the pain may suddenly worsen and persist for several hours. This condition occurs when urate crystals build up in a joint, causing inflammation.

Freiberg’s Disease

Rarely, pain in the ball of the foot results from Freiberg’s disease. This unique condition primarily affects the area below the second toe but may occur anywhere in the metatarsal region. Physical stress creates many tiny fractures where the metatarsal bones meet the growth plate. These fractures inhibit blood flow, resulting in the death of bone cells.

Risk Factors

Many factors indicate a higher risk that a person will develop pain in the ball of the foot. The heavier a person is, the more stress their feet experience. Extremely active people are more likely to injure themselves or experience issues from chronic overuse. Shoe choice is also a major contributing factor. Additionally, some people are born with structural differences that contribute to metatarsalgia.

Diagnosis

When diagnosing pain in the ball of the foot, doctors begin by asking the patient to describe their symptoms, when they began, and their severity. Doctors will also perform a physical examination of the foot, specifically the metatarsal region. An x-ray, MRI, or ultrasound may be necessary to fully diagnose the cause of the issues.

Treatment

Treatments are generally specific to the underlying cause. Most cases of metatarsalgia are easily treatable without surgery. A shoe insole or a surgical shoe can help alleviate pressure on the ball of the boot. Doctors may advise patients to avoid walking barefoot or to soak their feet often. Some conditions, such as arthritis, require prescription medications or surgery.