Houston Methodist. Leading Medicine

Foot FAQ

Question:

I had plantar fasciitis last year and found a good program on the Internet of stretching and exercises just for that problem. Now I'm getting pain in the ball of my foot but I can't find anything similar for this new problem. Are there stretching and strengthening exercises for the ball of the foot?

Answer:

You may be experiencing a problem referred to as metatarsalgia. Metatarsals refer to the long bones of the toe. The term -algia always indicates pain. So in metatarsalgia, the pain occurs at the base of the toes where the metatarsals join the phalanges (end of the toes). This area is also known more commonly as the "ball" of the foot. If you look up the treatment for metatarsalgia, you won't find a "one-size-fits-all" recipe. Every patient who presents to the surgeon with this problem has a different reason why it developed. And in order to get the best results, treatment must be individualized for each person. Some of the most common causes of metatarsalgia include congenitalfoot problems (deformities). Congenital means they are present at birth. This can include pes cavus (excessively high arch), equinovarus (clubfoot), or abnormal differences in the length of the toes. Acquired problems such as neuromas, malignant tumors, infection, arthritis, or fractures (especially fractures that don't heal properly) can contribute to metatarsalgia. Basically, anything that alters the way the foot hits the ground or changes the contact points for pressure and load through the foot can lead to metatarsalgia. There are still other potential causes such as trauma, failed foot surgery, or nerve entrapment. In order to get to the bottom of the problem, the surgeon will conduct a careful exam and look at the wear pattern of the shoes. X-rays or other imaging studies (e.g., MRIs) may be helpful. Often calluses on the bottom of the foot point right to the area of abnormal weight bearing and overload. The problem can be severe enough for the bones to form spurs or shift out of alignment. The end-result can be even more deformities such as hallux valgus (bunions). The examiner will check out the motion of each individual joint (ankle, forefoot, toes) and assess muscle strength and function. Pulses will be palpated (felt) to assess circulation to the foot and any skin changes (e.g., ulcers) or swelling will be noted. Most cases of metatarsalgia are treated conservatively (nonoperative care) first. Physical therapy may be a good idea. The therapist will help find the right shoe modifications, work on correcting postures that might be contributing to the problem, and address any muscle imbalances. Stretching and strengthening may be needed as well. The therapist's evaluation will guide the specifics of which muscles need additional training in either direction (flexibility or endurance training). Other noninvasive approaches may include corticosteroid injections into the painful area. This treatment technique is used carefully as there are often more side effects than benefits. If conservative care is unsuccessful in changing the pressure distribution along the bottom of the foot, then it may be time to try something else. Just what that "something else" is depends on the underlying pathology. An orthopedic surgeon or podiatrist can help you with this. Norman Espinosa, MD, et al. Metatarsalgia. In Journal of the American Academy of Orthopaedic Surgeons. August 2010. Vol. 18. No. 8. Pp. 474-485.

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