This is where pain usually occurs at the ball of the foot.
Some of the conditions that may occur in the forefoot are: bunions, Morton’s Syndrome (short first toe), Morton’s Neroma (pinched nerve), and metatarsal fractures.
Common Causes of Metatarsalgia
- weakness of ligaments, muscles, tendons
- arthritis, diabetes, fibromyalgia, osteoporosis
- constant standing or walking
- fallen arch
- trauma to the forefoot
- high heeled shoes
- sports that force you to stop and start quickly
Common Complaints of Metatarsalgia
- tenderness and burning on the ball of the foot
- feeling of walking on small stones
- shooting pain
- painful callous
- possibility of an ulcer forming
- swelling on or under the foot
Othoses or Orthotics that are prescribed by a physician work well to treat the symptoms and relieve an individual of pain.
The orthotics would include a pad or bar to lift and separate the forefoot, soft material to rest the forefoot on, as well as hollowing out the orthotic to relieve the pressure directly under the forefoot.
Types of Footwear
Choosing the right, stable footwear is crucial to relieving an individual of pain. There are many different types of footwear that fit orthotics.
An indiviudal should consider choosing footwear with a cushioned sole, a rocker sole or a custom rocker sole to protect the forefoot even more.
This is where the first metatarsal bone is shorter and can’t provide enough stability. As a result, the second metatarsal bone must endure additional pressure. The ankle and arch roll down and inward until the first metatarsal touches the ground. This action can cause problems that lead to too much pronation, ankle eversion, and internal knee strain.
Common Causes of Morton’s Syndrome
- a congenital condition that exists among under 30% of the population
- bunion surgery can leave the first metatarsal bone shortened.
Common Complaints of Morton’s Syndrome
- callouses, soreness, significant joint pain and possible fractures
- people with diabetes may experience ulcers at the site
- for people who suffer from osteoarthritis or rheumatoid arthritis may experience swelling or inflammation in the second metatarsal joint
- if the forefoot turns inward it can cause shin splints, hip and back pain, and plantar fasciitis
Treatment Options for Morton’s Syndrome
Orthotics is a long term solution to support the body and keep it in the right position. Orthotics help to correct and target the cause of the problems.
In order to work efficiently, the orthotics should include thickening the orthotic under the first metatarsal; excavation under the second metatarsal to relieve the pressure; and finally a bar or pad to separate and lift the metatarsal heads.
Types of Footwear
Therapeutic and orthopaedic shoes are essential to the process, as they stabilize the foot.
A person diagnosed with Morton’s Syndrome is sized according to the length of the second toe, seeing as though it is longer than the big toe in this condition.
A forefoot rocker sole works to minimize the metatarsal joint from bending and succumbing to plantar pressure. A custom rocker sole fit to an existing shoe can provide a thicker rockered forefoot (much like an air cast would look like).
Hallux Valgus (bunions)
(This is a deformity at the flexing joint of the big toe. It’s when the end of the big toe leans to the smaller toes which causes the joint to enlarge and it looks like a lump or bump on the actual joint. This bunion can cause pain or swelling and can appear red or swollen).
Common Causes of Hallux Valgus (or Bunions)
- Significant rotation or overpronation
- anatomical abnormalities
- poorly fitted footwear such as high heels or pointy shoes
Common Symptoms of Bunions
- pain in the arches, knees, ankles
- pain and stiffness at the site of the bunion
- pain under the second metatarsal
- pain in the third, fourth, and fifth metatarsal joints
Treatment Options for Bunions
Orthotics before and maybe after surgery to ensure the bunion does not reoccur.
The orthotics should include: forefoot cushioning materials; medial longitudinal arch support; a thicker orthotic posting under the first metatarsal to provide extra support; metatarsal mound that supports posterior to the metatarsal heads.
Types of Footwear
Choosing stabilizing footwear that includes therapeutic and orthopaedic shoes are crucial to treating bunions.
Motion control footwear where there is a wide sole helps to stabilize the foot;
Dress shoes with lower heels and more width;
Forefoot rocker sole helps to minimize the joint from bending;
A custom rocker sole where the foot rests in an air cast design;
The width of the shoe must accommodate the bunion, so as not to create further problems.
(This occurs when the hindfoot and the ankle are in neutral alignment and the forefoot is not. The first metatarsal head and big toe are essentially off the ground. As an individual’s body weight shifts onto the first metatarsal ray, the ankle rolls in and down. This causes flattening of the arch).
Common Causes of Forefoot Varus
- a bony block in the mid-tarsals from birth
- a bony block due to an injury or trauma to the foot
Common Symptoms of Forefoot Varus
- ankle pain
- knee pain
- shin splints
- metatarsal pain
- sciatica (which is a shooting pain up the leg and hip)
- Achilles tendon pain
- heel pain
- pain in the arches of the foot
Treatment Options for Forefoot Varus
Orthotics must have a forefoot post that is prescribed by a physician. The orthotics must be custom made to support the body frame, muscles and fascia. Orthotics are a long term solution to control and correct the problem.
The orthotics should include a heel cup and medial arch support to align the forefoot to the hindfoot, and also a post or wedge under the first metatarsal head.
Types of Footwear
Stability footwear should include orthopaedic and therapeutic shoes as part of the treatment.
Motion control shoes are ideal. This type of footwear has a wide base that provides more stability.
A rocker forefoot sole allows movement without bending through the metatarsal joints when stiffness occurs.