Diagnosing Forefoot Pain
Forefoot pain is typically caused by sesamoiditis, metatarsalgia, or a neuroma. If you are experiencing forefoot pain, we will perform an exam to determine the area of tenderness. We may manipulate your bones slightly or ask you to move your toes. We may also request X-rays and if they appear normal, follow up with an MRI, ultrasound or bone scan.
Treating Forefoot Pain: Sesamoiditis & Sesamoid Factures
Sesamoiditis refers to an inflammation of the sesamoids in the foot, which are bones about the size of a popcorn kernel that are found on the sole of the foot near the big toe. Symptoms include pain and tenderness under the big toe. To treat sesamoiditis, we recommend taking a break from activities that aggravate your symptoms, taking anti-inflammatory medications, and applying ice to the soles of the feet. You should also wear cushioned shoes without a high heel and may use cushioning pads to relieve stress. If symptoms do not improve, we may recommend taping techniques, a steroid injection, or an orthotic device for your shoe.
Sesamoid fractures can also occur. Symptoms include pain under the big toe and there can be swelling or bruising. Sesamoid fractures are usually treated with a fracture brace or stiff soled shoe with a rocker bottom. If rupture of the plantar plate occurs surgery for repair is indicated.
Metatarsalgia is a pain in the ball of the foot. Pain is usually aggravated by walking or running but generally grows over time rather than beginning suddenly. Causes include abnormal length of the metatarsals (foot bones), hammertoe or claw toe deformities, thinning of the fat pad that usually protects the metatarsals and calluses. Treatment begins with rest, ice, and cushioning pads. If symptoms persist, we may continue with ultrasound treatments and passive range-of-motion exercises. Metatarsal pads and orthotic devices can also provide relief. Surgery may be needed to realign the toes, repair a ruptured plantar plate or removed prominent parts of bones if pain persists.
Forefoot Pain Caused by Neuromas
A neuroma is caused by fibrosis around a small digital nerve to the toes. It may present with symptoms similar to metatarsalgia due to inflammation of the nerves. It can cause you to feel as though you are walking on a marble, but there is typically no externally visible symptom. Patients may experience a burning pain the ball of the foot or numbness, both of which may worsen when shoes are worn or with activity. Removing shoes may help relieve symptoms temporarily. Conservative treatment includes a change in your shoes, metatarsal pads, orthoses, or injections of a corticosteroid to reduce swelling and inflammation. If treatment does not relieve symptoms, surgery may be needed to relieve pain.