Ask the podiatrist: Pain in the ball of the foot

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Allan says: My right foot becomes very painful after 10 miles or so. The space between the third and fourth toe on the ball of my foot feels like it's got a solid rock in the middle of it.

Hi Allan. There are two potential causes of this type of pain which are fairly common and unpleasant! Firstly, it may be plantar digital neuritis, also called Morton’s Neuroma. The commonly held theory proposes degenerative changes occurring within the plantar digital nerve in this area with increased fibrous deposition around the nerve fibre. This is accompanied by acute pain on walking and running, a burning, tingling sensation in the third and fourth toes and a solid mobile mass feeling when palpating the area. Accompanying the changes in the nerve fibre is often an intermetatarsal bursitis. There are bursae (jelly-like fluid filled protective sacs) between the second/third, third/fourth and fourth/fifth metatarsal heads on the bottom of the feet. These bursae can become inflamed with persistent pressure, with an increase in size which then can create pressure on the nerve fibre situated beneath it and consequent symptoms arising.

The most common cause is lateral pressure to the bursae from footwear that is too tight in the forefoot area. This includes everyday footwear and training footwear. Previous injury to the right foot and an increasing BMI may also be considerations as well as increased forefoot motion within the shoe following excessive sub talar joint (rearfoot) pronation (rolling in of the foot). In addition, the arthritic changes to the tarso-metatarsal joints may alter the range of motion available within the metatarsals and increase friction between the metatarsal heads. People with rheumatoid arthritis can suffer with intermittent intermetatarsal bursitis as part of the disease process.

Please visit a podiatrist to establish a correct diagnosis. In the meantime, check your footwear for fit in the toe area - you should be able to wiggle your toes freely within this area and the toes should not be in contact with the end of the shoe. The balls of your feet should not make the shoe sides bulge over the sole - there should be adequate room for this area. You may have to wear foot orthotics to establish correct forefoot function during walking and running, and should consider the use of local massage and icing therapy to provide symptomatic relief. Activity modification with a reduction of activity to offload the overloaded area must be also considered. A graded return following symptomatic relief can then be undertaken.

Michael Ratcliffe is a podiatrist and advisor for Carnation Footcare.