Pain at the ball of the foot can be caused by several different things, including stress fracture joint pain, ligament tears and such examination.
Careful review of the pattern and onset of pain, combined with a physical examination of the affected area helps differentiate these types of forefoot pain. One of the more common problems in this area of the foot is a pinched nerve, classically called a Morton’s Neuroma. This is technically not a true neuroma and is more of a nerve compression.
Symptoms include some of the following, including pain, swelling, tingling, burning, electric shooting pains, aching and numbness into the adjacent toes. It usually gets worse with tighter shoes, though can also be worse walking barefoot. People sometimes feel the sensation of walking on a pebble.
The plantar digital nerve passes between the heads of the metatarsal bones and just beneath a tight ligament before it branches off into the toes. This anatomic position is usually what contributes to the development of the nerve compression. Faulty foot mechanics can cause irritation of the nerve against the tight ligament, especially in cases of repetitive activities such as running or walking. Higher heels pull the toes into a flexed position, thereby pulling the nerve against the ligament. Tight shoes can pinch the metatarsal bones together and reduce the space for the nerve to pass into the toes. Chronic irritation over time can lead to swelling and inflammation of the nerve in this area.
Traditional treatments include cortisone injections, custom orthotics and surgery to cut out the affected nerve, leaving an individual with numbness into the adjacent portion of the affected toes. Our preferred approach in addition to orthotics and cortisone injections can include injection of an alcohol sclerosing agent, which is showing great results. If symptoms do not improve with conservative treatments, surgery is often considered. In most cases, our surgical approach is different than the traditional nerve resection. We usually offer a nerve decompression surgery, which includes releasing the deep transverse intermetatarsal ligament and releasing the nerve from scar tissue. This relieves the pressure and agitation on the nerve, allowing it to glide with the movement of the foot, giving the nerve the chance to heal and continue to provide normal function. This allows the nerve to continue to function and avoids the numbness that results from the traditional nerve resection surgery.
If you have pain at the ball of your foot, we welcome you at the Foot and Ankle Institute of Valencia.
For more information, please call 661-260-1180.