Forefoot pain

Pain towards the front of your foot can be complicated. Make sure you treat it right.

Conditions
Common questions
Locations for treatment

Metatarsalgia

  • Together with heel pain, metatarsalgia is one of the conditions most frequently seen by Advanced Podiatry and it involves ligaments in the forefoot which have become inflamed.
  • Some symptoms include
  • Pain on the ball of the foot. It can feel like there’s a marble in the shoe or a sock is bunched up
  • Swelling in the area of pain, including the base of the toe
  • Localised pain when forward pushing off
  • Localized pain when walking barefoot
Treatments
This condition responds best to a combination of some but not necessarily all of this list of treatments
Foot controlling orthotics
Pre-formed or custom if required
Laser soft tissue treatment
Reduces pain and increases blood flow and healing.
Specialised taping designed by Advanced Podiatry
Padding and taping can be a very useful trial before foot orthotics might be suggested.
Supportive shoes
Support the foot and lessen the amount of pressure on the ball of the foot.
Rest and ice
Staying off the foot and applying ice packs help reduce the swelling and pain. Apply an ice pack, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
Oral medications
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
Stretching
Stretching exercises may be prescribed for patients who have tight calf muscles.

Morton’s neuroma

  • A neuroma is a thickening of nerve tissue. The most common neuroma in the foot is a called a Morton’s neuroma and it most often occurs between the third and fourth toes.
  • Some symptoms include
  • Tingling, burning or numbing that is radiating down the toes
  • A feeling that something is inside the ball of the foot
  • Feeling that there’s something in the shoe or a sock is bunched up
  • The symptoms begin gradually. At first they occur only occasionally, when wearing narrow-toed shoes or performing certain activities.
Treatments
Foot controlling orthotics
Can reduce pressure and compression on the nerve.
Laser soft tissue treatment
Reduces pain and increases blood flow and healing.
Padding
Can support the metatarsal arch and reduce compression on the nerve.
Shoe modifications
Wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels.
Activity modifications
Activities that put repetitive pressure on the neuroma should be avoided until the condition improves.
Injection therapy
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
Oral medications
Treatment may include injections of cortisone, local anesthetic or other agents.

Stress fracture

  • Stress fractures are tiny, hairline breaks that can occur on the surface of a bone, in this case, the foot. They can be caused by over-training or overuse, improper training habits or surfaces, improper shoes, flatfoot or other foot deformities, and even osteoporosis.
  • Some symptoms include
  • Sudden onset, localised bone pain usually without trauma
  • Swelling, redness or bruising
Treatments
Foot controlling orthotics
Can reduce pressure and stress around the bone.
Rest
A stress fracture will generally heal in 6 weeks.
Specialised taping designed by Advanced Podiatry
Compression taping can help during the rest period.
Supportive shoes
Support the foot and lessen the amount of pressure on the fracture.
Immobilisation in a Cam Walker boot

Sesamoid injury

  • A sesamoid is a bone embedded in a tendon, and they are found in many joints in the body. You normally find in the foot two sesamoids which are pea-shaped bones located in the ball of the foot, beneath the big toe joint.
  • Some symptoms of injury include
  • Sudden or gradual onset pain under the ball of the big toe
  • Pain is greatest when you push off
Treatments
This condition responds best to a combination of some but not necessarily all of this list of treatments
Padding, strapping or taping
A pad may be placed in the shoe to cushion the inflamed sesamoid area, or the toe may be taped or strapped to relieve that area of tension.
Immobilization
The foot may be placed in a cast or removable walking cast. Crutches may be used to prevent placing weight on the foot.
Physical therapy
Can include exercises (range-of-motion, strengthening, and conditioning) and ultrasound therapy.
Oral medications
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help relieve the pain and inflammation.
Steroid injections
In some cases, cortisone is injected in the joint to reduce pain and inflammation.
Foot controlling orthotics
For long-term treatment of sesamoiditis to balance the pressure placed on the ball of the foot.
(When sesamoid injuries fail to respond to non-surgical treatment, surgery may be required.)
Some of the common questions for this treatment
 Call us at (03) 9882 7221 or email us if you couldn't find an answer to your questions here
Metatarsalgia
Morton’s neuroma
Stress fracture
Sesamoid Injury
  • What is Metatarsalgia/Capsulitis?
  • Ligaments join bone ends together to form a joint. These ligaments which surround the joint form a “capsule,” which helps the joint to function properly. Capsulitis is a condition in which these ligaments have become inflamed. It can be caused by deformity of the joint or the plantar plate, or deformity of an adjacent joint such as a bunion. The result is overload pressure to the 2nd metatarsal joint and its surrounding soft tissue structures.

    Although capsulitis can also occur in the joints of the third or fourth toes, it more often affects the second toe joint. This inflammation can cause quite a lot of discomfort and if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause a dislocation of the toe.
  • What can I expect from treatment?
  • Capsulitis of the second toe responds very well to treatment. It can be a progressive disorder and can worsen if left untreated, so early recognition and treatment is important.
  • Is Advanced Podiatry metatarsalgia treatment covered by insurance?
  • Private health insurance will cover part of your podiatry treatment if you have the appropriate level. If you are covered by an EPC plan you can claim up to $54 a treatment for a maximum of 5 treatments.
  • What is Morton’s neuroma?
  • A neuroma is a thickening of nerve tissue. The most common neuroma in the foot is a called a Morton’s neuroma and it most often occurs between the third and fourth toes. This is where the thickened nerve gets squashed between the metatarsal heads.
  • What causes Morton’s neuroma?
  • The progression of a Morton’s neuroma often follows this pattern
    - The symptoms begin gradually. At first they occur only occasionally, when wearing narrow-toed shoes or performing certain activities.
    - The symptoms may go away temporarily by removing the shoe, massaging the foot, or by avoiding narrow shoes or certain activities.
    - Over time the symptoms progressively worsen and may persist for several days or weeks.
    - The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.
  • What results can I expect?
  • If the Morton’s neuroma is identified in the early stages, conservative treatment can be very successful. If the neuroma is not treated it can enlarge permanently and may require surgery
  • Is Advanced Podiatry Morton’s neuroma treatment covered by insurance?
  • Private health insurance will cover part of your podiatry treatment if you have the appropriate level. If you are covered by an EPC plan you can claim up to $54 a treatment for a maximum of 5 treatments.
  • What is a stress fracture?
  • Stress fractures are tiny, hairline breaks that can occur on the surface (periosteum) of a bone, in this case, the foot. They can be caused by over-training or overuse, improper training habits or surfaces, improper shoes, flatfoot or other foot deformities, and even osteoporosis.

    Occasionally these tiny breaks in the bones feet can lead to a complete break if left untreated.

    A stress fracture will not show on x-ray for 2 weeks and will generally heal in 6 weeks. However, if the stress fracture is in the Navicular bone this must be treated very carefully. This bone has very poor blood supply and is prone to not healing if treated incorrectly.
  • What results can I expect?
  • A stress fracture is most commonly found in the 2nd 3rd or 4th metatarsal. With treatment and rest  it will resolve in 4-6 weeks.
    If a stress fracture is located in the navicular bone this can be more serious. The foot may need stabilisation with a cam walker boot and if conservative management is unsuccessful a surgical approach may be necessary.
  • Is Advanced Podiatry treatment for a stress fracture covered by insurance?
  • Private health insurance will cover part of your podiatry treatment if you have the appropriate level. If you are covered by an EPC plan you can claim up to $54 a treatment for a maximum of 5 treatments.
  • What is a sesamoid?
  • A sesamoid is a bone embedded in a tendon, and they are found in many joints in the body.

    You normally find in the foot two sesamoids which are pea-shaped bones located in the ball of the foot, beneath the big toe joint. Sesamoid injuries are often associated with activities requiring increased pressure on the ball of the foot, such as running, basketball, football, golf, tennis, and ballet.

    People with high arches are at risk for developing sesamoid problems. Frequent wearing of high-heeled shoes can also be a contributing factor.
  • What results can I expect?
  • With the appropriate treatment program in place the outcome is usually very successful.
  • Is Advanced Podiatry treatment for a sesamoid injury covered by insurance?
  • Rebate is possible by insurance with the appropriate level of cover.
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