Health Column:

The ball's in your court:Offloading weight can help

By Dr. Brent Harbin
Blount Memorial Hospital

Have you experienced pain in the ball of your foot while standing, walking or squatting? Have you ever felt stinging or numbness shooting into your toes? If so, you’re not alone. Many people experience pain in the ball of the foot quite regularly, and many of them also feel they will simply have to live with the pain. Fortunately, the pain can be treated successfully, often non-surgically.

Pain in the ball of the foot usually is caused by a neuroma, metatarsalgia or capsulitis of the metatarsalphalangeal joint. A neuroma is, by definition, a tumor of a nerve. This is a very common, non-cancerous enlargement of a nerve. When this occurs in the ball of the foot, it usually produces burning and/or numbness extending into the toes. Some individuals with a neuroma say they have noticed their toes spreading, and it often causes a clicking sensation while walking. Shoes with a narrow toe box tend to make this worse, and individuals with this problem usually find relief by removing their shoe and massaging the foot.

Neuromas are treated with shoe modification, offloading the ball of the foot and typically injection with a corticosteroid. For most, this provides relief. If not, a series of injections designed to destroy the nerve can be given, or the neuroma can be surgically decompressed or excised.

Metatarsalgia is a term simply meaning pain in the metatarsals. This pain often is secondary to hammertoe deformities, the surfaces a person spends time on, loss of the fat pad in the ball of the foot, and wearing shoes without adequate support.

This pain can be sharp, achy, and/or burning. People experiencing this typically find relief with rest and usually say they have tried several different types of shoes looking for lasting relief.

Metatarsalgia most often is successfully treated by changing the type of shoe an individual wears and with modification of the shoe to properly offload the ball of the foot. In some cases, a custom orthotic is needed to provide adequate offloading.

Capsulitis is inflammation of the joint and the capsule surrounding it. This can occur at the joint where a toe attaches to the foot, and most often is associated with a hammertoe deformity. The hammertoe deformity produces a downward force on the metatarsal head causing increased pressures. This also can be caused by a bunion deformity that transfers additional stress to the second metatarsal head. This, however, can occur independent of a hammertoe and/or bunion deformity. The associated pain usually is quite severe and is described as burning and stabbing.

Identifying and treating the cause of capsulitis is essential. The joint first must be offloaded. Injecting with a corticosteroid can relieve the inflammation, and if the joint is offloaded, provide lasting relief. If the cause is a deformity such as a bunion or hammertoe, surgical correction may be needed.

If you are living with pain, you probably don’t have to. Contact a podiatrist, and find out what can be done to relieve your pain.

Dr. Brent Harbin is an associate member of the American College of Foot and Ankle Surgeons, and he’s a podiatrist with Foothills Podiatry and Blount Memorial Hospital.

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