Lindsey Ebbs Podiatry

Forefoot Pain

Forefoot pain (Metatarsalgia) is often used to describe pain in the front of the foot but it can be generalised and misunderstood.

These are the most common conditions that affect the forefoot.

Metatarsalgia - Central Area

Plantar plate injuries/tear

A plantar plate is a thick fibrocartilaginous or ligamentous structure. In the foot, plantar plates connect each of the metatarsals to the corresponding proximal phalange of each toe. People with plantar plate dysfunction will typically feel pain in the ball of the foot, under the affected joint, usually the second joint, there may also be swelling. The joint may be dorsiflexed (displaced upwards) in relaxed standing, and additional dorsiflexion may exacerbate pain further. Treatment depends on the severity of the condition from simple rest and ice to surgical intervention.

Stress fractures

A stress fracture is a small crack in a bone, or severe bruising within a bone. Most stress fractures are caused by overuse and repetitive activity, and are common in runners and athletes who participate in running sports, such as football and basketball. Stress fractures usually occur when people change their activities — such as by trying a new exercise, suddenly increasing the intensity of their workouts, or changing the workout surface (jogging on a treadmill vs. jogging outdoors). In addition, if osteoporosis or other disease has weakened the bones, just doing everyday activities may result in a stress fracture. The weight-bearing bones of the foot and lower leg are especially vulnerable to stress fractures because of the repetitive forces they must absorb during activities like walking, running, and jumping. Diagnosis is by x-ray and treatment can vary from RICE (Rest, Ice, Compression and Elevation) to walking casts.

Morton’s neuroma (plantar digital neuritis)

Morton's neuroma is a condition that affects the nerves that run between the long bones (metatarsals) in the foot, the nerve becomes impinged and thickened. Symptoms include pain, burning, numbness and tingling between two of the toes of the foot. About a third of people just need simple treatments including modification of their footwear. Sometimes surgery is needed for long-standing (chronic) symptoms. About three people out of four who have Morton's neuroma are women. It commonly affects people between the ages of 40 and 50 but can occur at any age.

Poorly fitting or constricting shoes can contribute to Morton's neuroma. It is more common in women who habitually wear high-heeled shoes or in men who are required to wear tight (constrictive) footwear. It may also be more common in ballet dancers and runners. In some people there is no obvious cause. . About a third of people just need simple treatments including modification of their footwear. Sometimes surgery is needed for long-standing (chronic) symptoms.

Capsulitis/ Synovitis/ Bursitis

Synovitis is inflammation of the tissues that line a joint causing increased fluid in the joint and even joint instability. In general Synovitis is commonly associated with specific diseases such as arthritis or gout, but may also be the result of overuse or trauma. Symptoms of synovitis may include redness, swelling, warmth, and pain with joint motion.

Bursitis is inflammation and a painful swelling of a small sac of fluid called a bursa. Bursae (plural of bursa) are fluid filled cushions that help absorb shock and lubricate areas where tendons, ligaments, skin, muscles, or bones rub against each other. People who repeat the same movement over and over or who put continued pressure on a joint in their jobs, sports, or daily activities have a greater chance of getting bursitis.

Ligaments surrounding the joint at the base of the toe form a “capsule,” which helps the joint to function properly. Capsulitis is a condition in which these ligaments have become inflamed. Although capsulitis can also occur in the joints of the third or fourth toes, it most commonly affects the second toe. This inflammation causes considerable discomfort and, if left untreated, can eventually lead to a weakening of surrounding ligaments that can cause dislocation of the toe. Capsulitis is due to abnormal foot mechanics combined with repetitive foot motion that exerts pressure on the ball of foot to cause connective tissue degeneration. Poor foot dynamics or chronic stress can cause MPJ( metatarsal phalangeal joints) capsulitis.

Inflammatory lesions of MPJ joint (synovitis, capsulitis, bursitis) usually responds to conservative therapies and surgery is not usually required in most cases.

Toe Deformaties

Bunions of the big toe (Hallux Valgus) and the little toe (Tailor’s Bunion)

Hallux valgus, often referred to as "a bunion," is a deformity of the big toe. The toe tilts over towards the smaller toes and a bony lump appears on the inside of the foot. Sometimes a soft fluid swelling develops over the area. The bony lump is the end of the big toe (the first metatarsal bone) which becomes exposed as the toe tilts out of place. A tailor's bunion deformity is similar to a normal bunion of the big toe but is located at the base of the little toe. It is named so because in the past tailors used to sit cross legged for prolonged periods, pushing their little toes inwards.

Bunions tend to run in families, but that does not mean that if you have a bunion, your children will inevitably have one too. The connection may be that bunions are a bit commoner in people with unusually flexible joints, and this can be hereditary. They are more common in women than in men.

Many people with bunions are quite comfortable if they wear wide, well-fitting shoes and give them time to adapt to the shape of their feet, surgery can be an option but bunions are not usually painful and function very well.

Hallux Rigidus/ Limitus

Hallux limitus is the term podiatrists and other healthcare professionals use to describe loss of motion in your big toe joint. Hallux rigidus is considered by many podiatrists to be the end stage of hallux limitus, or a state in which your ability to create motion in your big toe is lost or severely restricted. A large boney lump can develop on top of the joint instead of the inside of the joint with Hallux Valgus.

They are usually very painful and can result from an injury, such as stubbing your toe, or may be caused by inflammatory diseases, such as rheumatoid arthritis or simply a biomechanical fault. Both conditions can be treated conservatively before surgery is considered as an option.

Types of Lesser Toe Deformities

Although these deformities are all very similar to each other, a few minor differences exist

Mallet

This deformity is very similar to a hammer toe except the joint involved is the upper joint instead of the middle joint, giving the toe a mallet-like appearance at the end of the toe.

Hammer

The toe is bent at the middle joint causing a curling of the toe. It is most common in the second toe, but can occur in any toe. Hammer toes are often present along with a bunion.

Claw

This type of deformity involves an upward bending of the toe joint at the ball of the foot. At the middle joint and sometimes the end joint as well, the toes bend downward in a claw-like fashion, often digging into the sole of the foot. This can occur in any toe except the big toe.