Foot and toe pain
There are several foot and toe pain problems including: Freiberg’s disease, Morton’s neuroma, plantar plate problems, sesamoiditis and tarsal tunnel syndrome.
If they are diagnosed early, many of these painful conditions can be treated non-surgically, returning patients to their normal way of life as soon as possible.
Freiberg’s disease
This unusual condition occurs when the second metatarsal bone becomes deformed. Most often found in young women, it normally happens during rapid growth at puberty. The bone’s shape has been likened to ‘a square peg trying to fit into a round socket’.
Causes of Freiberg’s disease are:
- A lack of blood supply to the bone’s tip, frequently at puberty
- Repetitive strain on the bone that prevents normal development
Symptoms normally manifest themselves in the teenage years or early 20s, including:
- Forefoot stiffness, swelling and pain, often close to the second metatarsal bone, which is exacerbated by wearing high heels
- Pain beneath the ball of the foot
- Some sufferers may walk with a limp
Your consultant will invite you to explain your symptoms in detail at your first meeting and will then normally perform X-rays, MRI scans, and, in some cases, bone scans to pinpoint any areas of bone damage.
Taking plenty of rest, wearing special medical shoes to minimise pressure on the toe and taking anti-inflammatory painkillers as directed by your doctor, may prove effective. Depending on the severity of the condition, your consultant may recommend surgery to clean up the joint to ease the pain. During surgery the deformed bone may be straightened to improve the joint’s effectiveness.
Morton’s neuroma
Morton’s neuroma, also known as Morton’s metatarsalgia, occurs when a nerve in the foot becomes irritated and extremely painful. It is normally found in the nerve between the third and fourth toes, but the second and third toes can be afflicted too. It may involve a single foot or both feet.
Morton’s neuroma can occur when the nerve gets trapped between the ends of the foot’s metatarsal bones, causing inflammation.
- Middle-aged women suffer it more than most, and narrow footwear or high heels could be contributing factors
- Greater pressure on the toes when playing sport or running
- Flat feet, high arches, hammer toes or bunions increase the chances that you will suffer from Morton’s neuroma
- Discomfort and a numb feeling between the toes
- Extreme pain in the ball of the foot, as if a stone is digging into the foot
- Walking exacerbates the pain, particularly if your shoes do not fit properly
- Pain may travel along the foot or move up the leg. Going barefoot may improve this
Morton’s neuroma can be problematic to diagnose because the swollen nerve isn’t visible under the skin. Your consultant will advise you on the most suitable course of treatment at your first meeting, once you have discussed your symptoms with him or her.
Surgery is by no means a foregone conclusion for people suffering with Morton’s neuroma. Frequently, a change in footwear, taking pain relief under medical advice, getting plenty of rest, maintaining a healthy body weight, and a personalised course of physiotherapy is sufficient to ease the pain. Steroid injections to minimise the inflammation may be offered. However if the injection is not placed in exactly the correct location it may lead to damage to the ligaments of the toes and discolouration of the overlying skin. In extremely painful cases, your consultant may opt to perform Morton’s neuroma surgery to cut away part of the nerve or to get rid of tissue that is placing pressure on the nerve.
Plantar plate problems
The plantar plate is the soft tissue on the sole of the foot, connected to the base of the toe and metatarsal bones. Its function is to cushion you when running or walking and assists in bringing the toe to the ground when you are standing. Plantar plate problems can trigger other conditions such as a dislocated toe or hammer toe.
Causes include:
- The metatarsal bones’ shape: a short first metatarsal combined with either a long second and third metatarsal or both heightens the chance of suffering plantar plate issues
- Placing too much weight on one of the metatarsals
- Being pigeon-toed
- Suffering from big toe arthritis or hallux valgus
- Having undergone steroid injections in the area previously
Common symptoms include pain in the ball of your foot, a positional change in your second or third toe over time or suffering with a Morton’s neuroma that has proved resistant to treatment.
Your consultant will invite you to give a full explanation of your symptoms at your initial appointment and guide you towards the most appropriate course of treatment. It may be that X-rays are performed to assess the alignment and state of the foot bones, along with an ultrasound and/or MRI scan to establish if there has been a plantar plate tear.
Plantar plate problems do not always require surgery. Frequently, resting the foot in combination with the regular application of an ice pack, along with taking anti-inflammatory pain relief, under medical advice, can solve the problem. Shoe insoles or a change of footwear can also help. If your consultant considers that the plantar plate is at risk of tearing, or he feels it may result in hammer toe, a surgical route may be recommended. Depending on the specifics of your plantar plate problem, this can involve:
- Repair of the plantar plate
- Toe realignment
- Ligament repair on the sides of the toes
- In cases where the metatarsal bone is long, bone realignment can be performed to ease pain and pressure
Sesamoiditis
This condition involves pain in the sesamoid bones lying under the big toe joint. Unlike the foot’s other bones, sesamoids are attached to the tendons and muscle around them, rather than bones.
The sesamoid bones’ smooth surface enables tendons to glide over them. The tendons allow the muscles to function properly, are key in weight bearing exercise and are needed to move the big toe. When the tendons surrounding the sesamoids get inflamed or irritated, this is termed sesamoiditis, a type of tendinitis. Sesamoiditis occurs more frequently in runners, ballet dancers and participants in some team sports. When sportspeople damage the sesamoid bones, it is referred to as turf toe injury because the toe is bent backwards. Long-term wear and tear to the big toe joint can lead to big toe arthritis, which in turn results in pain in the area around the sesamoid bones.
Pain is often experienced beneath the big toe near the ball of the foot. Bruising and swelling may also occur and flexing the big toe can prove problematic.
When you meet your consultant for the first time, he will invite you to give a full explanation of your symptoms and will use that information to advise you regarding treatment options. X-rays to look for fractures and an MRI or CT scan may be arranged.
Frequently, resting, taking anti-inflammatory pain relief as directed by your doctor, using your foot as little as possible, together with keeping the foot iced can minimise pain. Comfortable, soft shoes are recommended, and an insole can help with cushioning – a shoe or insole that reduces the load on your toe is particularly useful. Your consultant may advise you not to engage in activities that involve placing weight on the balls of the feet and also suggest you wear a leg brace for 4-6 weeks. A personally tailored course of physiotherapy may also be suggested. Should the pain persist, surgery to repair fractures or remove the troublesome sesamoid bone may be an option, allowing you to resume your usual activities.
Tarsal tunnel syndrome
The tarsal tunnel is located on behind the small bump on the inside of your ankle, the medial malleolus. Tarsal tunnel syndrome is caused by compression of the tibial nerve as it travels through the tarsal tunnel, under the flexor muscles by the ankle. Another name for the condition is ‘posterior tibial neuralgia’ and it can sometimes be accompanied by, or be mistaken for, other conditions such as heel spurs (bony lumps on the heel bone) or plantar fasciitis.
Common causes are:
- Ankle sprain or other injuries that result in swelling close to the tarsal tunnel and compress the nerve
- Suffering from flat feet, causing the heel to lean outwards and therefore stretch the nerve on the ankle’s inner
- A ganglion or similar swelling that exerts pressure upon the nerve
- Diabetes or other condition like midfoot or hindfoot arthritis that may be responsible for swelling near the tunnel
Symptoms include an initially sporadic numb feeling or tingling sensation, which gradually becomes more severe. Pain in the arch of the foot may also be experienced.
Your consultant will invite you to explain your symptoms during your initial consultation and will suggest the best treatment option. X-rays to examine your foot for conditions like bone spurs or arthritis, and an MRI scan to investigate tendon swelling, may also be organised.
Having tarsal tunnel syndrome does not automatically mean you will need surgery. Wearing special medical shoes and/or insoles can minimise pressure on the posterior tibial nerve. Your consultant may also suggest you take anti-inflammatory pain relief and possibly also have steroid injections to tackle tendon inflammation. Your consultant may recommend a personalised programme of exercises, supervised by a physiotherapist. If your condition persists despite non-surgical treatment, surgery to remove the tissue responsible for the nerve compression may be carried out.
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