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Forefoot Pain

Innovation Podiatry  >  Conditions  >  Forefoot Pain

Common forefoot pain conditions, symptoms and treatments are outlined below:

Bunions (click to open/close)

Overview

The medical term for a bunion is hallux abducto valgus (hallux = big toe). Often hereditary, they can lead to pain and stiffness in the big toe joint. There may also be redness and swelling around the joint and/or bony prominences at the top of the joint.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Joint mobilisation, strapping, dry needling/western medical acupuncture, exercises and functional foot orthoses can all be useful in helping to reduce bunion pain. We can also advise on footwear and stock a small supply at our clinic.

Hammertoe
Overview

A toe that does not bend normally at the middle joint and points down in the shape of an upside down ‘V’ is called a hammertoe. Usually seen in the second toe, at first, it will keep some of its flexibility and lie flat when barefoot, only appearing as a hammertoe when wearing shoes. After a while, the toe will not be able to lie flat at all.

While anyone can get hammertoe, women tend to suffer from it more than men. Age plays a part – hammertoe is the type of injury that may follow repeated damage to the toe and so, becomes more common with age. It is also common in people with nerve damage (e.g. from diabetes, stroke, or heart disease) and in those with second toes that are longer than the big toe, as the second toe is forced to bend in order to line up with the shorter toes next to it.

Wearing high-heeled shoes and certain injuries – such as a stub or a break – can make toes more vulnerable to hammertoe. This is especially true if the injury is not treated properly when it happens.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).
Treatment

Your podiatrist may advise you to wear wide, comfortable shoes that allow the toes to lie flat, and to steer clear of high-heeled shoes. In some cases, prescription orthotics can be effective to correct the misalignment and allow the toes to lie flat. In extreme cases, where the tendons of the toe have contracted and stiffness or pain affects movement, surgery might be needed.

Stress fracture
Overview

Stress fractures are an injury to bone caused by unaccustomed stress from running, marching or walking. They are often seen in military recruits or athletes as they increase their training. They may also be seen in people with hormonal imbalances, low bone mineral density or prior surgery that has altered the way their foot or ankle functions.

Stress fractures may feel like an ache in the foot or ankle, or like a sharp pain when a lot of stress is placed on the foot or when doing heavy physical activity. Swelling often occurs around the site of the pain, but usually no bruising is present.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).
Treatment

By taking an x-ray or obtaining a bone scan, your podiatrist can determine if there is a break or crack in the bone. If stress fractures are present, you will need to stop whatever exercise you are doing that has resulted in your foot or ankle pain. You may self-treat with ice, over-the-counter pain medications, and comfortable shoes. If there is no decrease in pain over several days, you should see your GP.

After making the diagnosis of stress fracture, your doctor or podiatrist will tell you to decrease activity levels. You may either be instructed to wear athletic shoes, or a stiff-soled shoe, to reduce bending motions of your foot when you walk. Depending on the location and severity, your doctor may recommend a cast and crutches. As the pain becomes less intense, you may gradually resume your activity level.

First Metatarsophalangeal Joint pain
Overview

The first metatarsophalangeal joint or ‘MTPJ’ is the joint between the big toe and the first metatarsal bone of the foot. This joint plays an important part in foot function and can be a common area for pain. Causes for this pain can be joint capsulitis, muscle strain or inflammation, inflammation of the sesamoids or ‘trigger toe’.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).
Treatment

When other diagnoses are ruled out such as Morton’s neuroma or sesamoiditis, your podiatrist will look at potential causes for the pain. The best time to treat this pain is in the early stages and your podiatrist will stabilize the joint through padding or strapping to prevent further pain. Your podiatrist may select one or more of the following treatments such as rest and ice, to help reduce the pain and swelling, oral over the counter pain medications, taping or splinting the toe to minimize movement, stretching exercises, shoe recommendations such as a supportive shoe with a stiff sole to decrease and control movement, lessening the pressure on the toe flexing or custom foot orthotics to provide support and re-distribute pressure points away from the affected joint. If the pain does not lessen over several days you should see your GP for further investigation.

Gout

Overview

Gout is an extremely painful form of arthritis associated with elevated levels of uric acid in the blood stream. The area may be swollen, red and warm to touch. If you think you might have gout, it is important to see us to rule out other possibilities. We can refer you for imaging, and to your GP to confirm the diagnosis.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

In the acute stages, your doctor may prescribe various oral medications. In chronic cases, your podiatrist can help treat your secondary foot deformity and assist you with your foot ulceration management.

Hallux Limitus (Functional and Structural)

Overview

In functional hallux limitus, when non-weight bearing, the big toe is able to dorsiflex on the 1st metatarsal. When weight bearing, this functional ability is lost, leading to gait alterations, which can affect mobility and balance, and may possibly cause falls. Detrimental effects can also occur further ‘up the chain’ with reductions to dynamic hip, knee and ankle motion.

In structural hallux limitus, there is a limitation and restriction of big toe joint range of motion at all times, both weight bearing and non-weight bearing.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Functional hallux limitus cannot be seen visually but there are various clinical assessments we can perform to diagnose this condition. Simple design features built into an orthotic device can facilitate desired function.

In structural hallux limitus, physical therapies such as mobilisation, strapping, and dry needling/western medical acupuncture can be helpful. Correct footwear and/or functional foot orthoses can be effective by helping to stop the painful forced flexing upwards of the toe while walking. If indicated, we may also refer you for a corticosteroid injection to reduce joint inflammation. This can provide temporary or permanent relief.

Hallux Rigidus

Overview

Hallux rigidus is the medical term for osteoarthritis or ‘wear and repair’ of the big toe joint where the joint has stiffened and become rigid, unable to be dorsiflexed. Walking can become very painful, as the toe is unable to freely perform its normal function.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Physical therapies such as mobilisation, strapping, and dry needling/western medical acupuncture can be helpful. Correct footwear and/or functional foot orthoses can be effective by helping to stop the foot from attempting to painfully force the upward flexion of the big toe whilst walking.

If indicated, we may also refer you for a corticosteroid injection to reduce joint inflammation. This can provide temporary and sometimes permanent relief.

Sesamoiditis

Overview

The sesamoid bones in the foot are two small bones underneath the head of the first metatarsal. They have an anatomical and biomechanical function, and can become painful with certain activities such as running, netball, dancing and wearing high-heeled shoes. Changes to foot shape, such as can occur with bunions, can also lead to pain in this area due to displacement of the sesamoid bones.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Simple changes to footwear and temporary offloading with padding and strapping can be sufficient treatment. X-rays may be required to check for any fracture or avascular necrosis. If further intervention is necessary, foot orthoses designed to reduce the ground reaction force at the 1st metatarsal head can be prescribed.

Morton's Neuroma

Overview

This painful condition occurs in the ball of the foot, ranging from mild numbness and tingling to a severe burning, stabbing pain. It’s caused by compression of the nerves as they pass between where the long metatarsal bones meet the toes. Repetitive movement, flexible footwear, footwear tight around your toes and/or foot biomechanics are the main causative factors.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

One or a combination of the following may be used:

  • Simple padding and strapping to offload the painful area and reduce pressure on the nerve.
  • Orthotics to address causative biomechanical factors.
  • Footwear modification – avoidance of high heels which increase pressure at the forefoot. Ensure shoes have wide deep toe box to prevent lateral pressure on the nerve. Ensure that shoes have adequate torsional resistance and aren’t too flexible.
  • Activity modification – switching to low impact activity in the short term. It is also worth considering your activities of daily living – are you reaching up on tiptoes a lot, or squatting down onto your toes?
  • Ice therapy to help reduce inflammation.
  • ESWT – extra corporeal shockwave therapy.
  • NSAIDS (non steroidal anti inflammatory medication) under guidance from your GP and pharmacist.
  • Corticosteroid injection under guided ultrasound to help reduce inflammation.

If conservative measures fail, it may be worth seeking a surgical opinion. However, surgery is not normally recommended as a first line treatment.

Bursitis

Overview

This is a painful condition in the ball of the foot, often causing pain, swelling, redness and warmth. It can occur alone or alongside other conditions such as Morton’s neuroma. A bursa is a small fluid-filled sac found near tendons, ligaments, muscles, bones and skin. It cushions and reduces friction between bones and structures that glide over the bones.

Bursitis occurs when these sacs become inflamed and irritated, often through overuse or repetitive movement. This can be from sporting or leisure activities, or purely through certain foot or gait abnormalities. Other factors can include footwear and trauma.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Sometimes a bursa will settle fairly quickly through ice therapy and offloading the affected area. If your symptoms persist, we can discuss other therapies that may help, including shockwave therapy, padding/strapping, western medical acupuncture and foot orthoses.

If conservative measures fail, it may be worth seeking a surgical opinion. However, surgery is not normally recommended as a first line treatment.

Plantar Plate Dysfunction

Overview

The plantar plate is a fibrocartiliginous structure found under the metatarsal heads, attaching to the plantar fascia and the proximal phalanx of the toes. Repetitive overload can lead to pain, which may feel like an ache or bruising to the top and ball of the foot. Swelling may also be present.

You may notice your toe becoming a hammered toe or a floating toe (where the tip no longer touches the ground), and the space between the affected toe and the next toe may also increase (known as a ‘daylight sign’ or ‘victory sign’). The 2nd metatarsophalangeal joint (MTPJ, ball of foot joint) is the most commonly affected. However, it can occur at any of the MTPJs.

Many contributing factors can lead to repetitive overload, including:

  • Increased running or jumping
  • Bunions
  • Long 2nd metatarsal bone
  • High heeled shoes
  • Diabetes
  • Increased squatting onto tiptoes
  • Ballroom dancing, golf and surfing.

A plantar plate injury can range from elongation of the structure, to partial and full tear.

Plantar plate tears can also occur when significant trauma has affected the forefoot.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Early treatment is advised. We will refer you for imaging to gain a clear diagnosis. Strapping, footwear, orthotics and/or protective boot may be required. If surgery is indicated, we work closely with local orthopaedic surgeons, which ensures fantastic multi-disciplinary care for you.

Frieberg's Infraction

Overview

Coming Soon

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Coming soon

Ganglion's and other deep cysts

Anytime you notice a lump or mass, you should have it checked out by a doctor as soon as possible, even if it isn’t painful. If the cyst isn’t painful, it may be best to just watch it to see if it changes over time. If you have a painful ganglion, you can try padding the area around the lump or try changing your shoe gear to relieve the pressure.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Your podiatrist will look at and feel the lump and usually organise for imaging to confirm this diagnosis. If it is a ganglion, we will refer you to your GP who may numb the area, then try to pull as much fluid out of the cyst as possible using a syringe. Many GPs will then inject a steroid or hardening agent into the cyst to try to prevent it from filling again. About half of the time, the cyst will fill up again after the treatment. We will then give you the option of having it removed surgically. Throughout this, your Podiatrist will work with your GP to assist with offloading the area and ensuring that you have supportive footwear.

Arthritis of the Toes

Including inflammatory arthritis such as rheumatoid, osteoarthritis and psoriatic arthritis

Overview

Coming Soon

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

For treatment and more information about Osteoarthritis click here 

Avascular Necrosis of the Sesamoids

Overview

Coming Soon

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Coming soon

Chronic Regional Pain Syndrome (CRPS)

Overview

Coming Soon

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Coming soon

Chilblain's and Raynaud's Phenomenon

Overview

Coming Soon

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Coming soon

Charcot's Neuroarthropathy of the Toes and Forefoot

Overview

Click Here 

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Click Here 

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