Ask A Doc: Fall Foot Pain

October 20, 2016

StaskoPaul
Paul Stasko, DPM
Newark-Wayne Community Hospital

Dear Doctor:

I have pain underneath my ball of my feet.  This pain has been going on for a few months.  I want to see what the issue could be.

Dear Reader:

The pain that you are describing is a common type of foot pain that occurs.  Pain that is underneath the forefoot can be caused by a variety of problems.  There are numerous structures in the forefoot that can contribute to pain underneath the ball of the foot.  This pain is sometimes generalized as "metatarsalgia."

It is important to see a podiatrist/foot and ankle surgeon if the pain is persistent and is keeping you from working and doing regular activities.  This way, the pathology can be correctly diagnosed and further injury can be avoided.

The causes of forefoot pain range vary. The first thing that comes to mind is a condition called sesamoiditis which is inflammation of the sesamoid bones.  These are two bones that run underneath the ball of the foot.  When overstressed or overused, the tendon surrounding these bones can become inflamed.  In more severe cases, stress reactions can occur to these bones.

If the lesser toe joints are involved, oftentimes, capsulitis can be a cause of the foot pain.  This is inflammation of the joint capsule to the lesser toe joints.  It can also be caused by overuse, unsupportive shoe gear, acute injury, or foot type. Oftentimes a plantar plate injury can occur in lesser toe joints that can go undiagnosed.  This is a small structure that supports the lesser toe joints.  In certain cases, this plate can be weakened, which can lead to tearing or rupture. This can lead to pain and instability of the lesser toes.

Foot type can play an important role in forefoot pain.  A higher arch foot can lead to increased pressure and pain to the forefoot.  It is important to wear shoes that have adequate padding as well as custom orthotics to help to support the foot. 

Treatment can range from nonsurgical to surgical depending on the severity of the pain and pathology.  The majority of patients get better with nonsurgical intervention such as rest, ice, anti-inflammatories, immobilization, shoe gear modification, orthotics, and splinting.  If foot deformity is the main cause of pain, then reconstructive surgery can be done to fix the issue. 

Overall, forefoot pain is a problem that should be addressed by a podiatrist/foot and ankle surgeon to correctly diagnose the problem and the cause in order to get you on the quickest path to pain free activity.  Thank you very much for your question.           

Paul Stasko, DPM, a foot and ankle surgeon earned his medical degree from Des Moines University College of Podiatric Medicine and Surgery and completed his residency training at Geisinger Community Medical Center in Scranton, Pennsylvania. In addition, he completed a Foot and Ankle Fellowship at the Rubin Institute for Advanced Orthopedics, International Center for Limb Lengthening at Sinai Hospital in Baltimore. Dr. Stasko sees patients at Finger Lakes Bone and Joint in Newark and Geneva and performs surgeries at Newark-Wayne Community Hospital. 

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Rochester Regional Health is an integrated health services organization serving the people of Western New York, the Finger Lakes and beyond. The system includes 150 locations: five hospitals; more than 100 primary and specialty practices, rehabilitation centers and ambulatory campuses; innovative senior services, facilities and independent housing; a wide range of behavioral health services; and ACM Medical Laboratory, a global leader in patient and clinical trials. Rochester Regional Health, the region’s second-largest employer, was named one of “America’s Best Employers” by Forbes in 2015. Learn more at RochesterRegional.org.