BALL OF FOOT
Pain in the toes and/or ball of the foot are mainly caused by either an underlying soft tissue injury, some form of nerve injury, and/or some form of bone spur or injury. Symptoms typically include pain or discomfort while standing and walking. In the case of a soft tissue or bony injury, the pain tends to subside during rest. In the event of a nerve injury, the pain tends to stay constant. The pain/discomfort can range from a dull ache to a sharp, shooting pain. The typical root causes are briefly explained below.
Soft Tissue Injury:
A soft tissue injury refers to a wide variety of structures, such as ligaments, tendons, or joint capsules. More common injuries are based around the joint capsule, which is responsible for holding the toe joints together. The capsule forms around the bone/joint, and may tear in the event of a sudden pulling/traumatic event. Sometimes these events can be relatively low energy, but leave you with a lasting discomfort. Another common issue is called a transverse ligament tear. The transverse ligament is responsible for holding the bones that make up the ball of the foot together in a transverse manner. In a more traumatic injury, this ligament can tear which also causes pain/discomfort. Soft tissue injuries are more frequently seen in athletic patients as an overuse injury, but can occur to anyone.
Nerve injuries occur typically as a result of trauma. They can come on without any reason at times (also possible from an old injury). Nerve pain tends to be more constant, and does not change much regardless of activity. While this can happen to any nerve within your foot, it most commonly occurs in conjunction with a neuroma (a nerve inflammation/growth between the toes). A neuroma can occur in any toe and typically you may notice the pain originate from a specific area, then shoot out to the rest of the foot/toes.
Typically, a bone injury refers to a broken bone or fracture, though these tend to be on the very mild side with this general area. A true fracture is only seen under more traumatic events (ex. stubbing a toe very hard into something). Sometimes, you may have a stress fracture, which is more an injury to the bone through overuse rather than a true break. These stress fractures usually don't appear on X-rays immediately after injury. A bruise on the bone is also possible, but also arises following a more traumatic event. Typically, bony injuries only occur following direct trauma or excessive athletic activities.
Bone spurs can occur on the toes specifically and cause uncomfortable areas of pressure. They are usually hard to the touch. The spur itself may also be the cause of the pain against the skin. Spurs usually form as a result of an adaptation change within the joint (typically as a result of arthritis over time).
Treatment generally is conservative. Depending on the circumstances, we may either choose to immobilize (soft tissue and bony), padding (bone spurs) or try an injection (nerve). Other conservative therapies include offloading orthotics/supports and Ultrasound to name a few. In some circumstances, surgery may be warranted (but that is typically to smooth down bone spurs).
For more information, please feel free to get in touch with us.