- Do you suffer from forefoot pain and don't know why or what to do about it?
- Do you wonder why your toes are curling or why you have callouses?
This post is going to be a crash course in what forefoot problems you may be causing and what you can do about it. Whether you're athletic, on your feet alot at work, or just walking around the house, most people experience some form of pain in the front of the foot at some point in time. I'll try to go over as many causes of these problems as I can in one blog. If I don't get to them all and you think you may have something other than what's listed, feel free to give me a call to discuss it. Also, if there is a solution to any one of these ailments you didn't see, please e-mail me so that I can add it.
Athletic Forefoot Problems
Most athletic forefoot problems are gait related. You're putting an inordinate amount of pressure on your feet, and if that pressure isn't on just the right spots of your feet it'll probably cause injuries pretty quick.
Stress fractures: Generally a "prick" sensation when you put any weight on it. The little bones in the front of the foot and the narrow bones through the mid foot are very susceptible to stress fractures if misused.
Forefoot callouses: 1) If they're like a ridge on the toes, usually caused by wearing shoes with the wrong toe shape for your foot. The average person tends not to look at shoe shape when buying athletic shoes. Take out the shoe liner, put it on the floor, and stand on it. If any part of your foot overlaps the side of the liner, then it's the wrong shape for your foot. There are many shoe lasts (which is what creates the shape of the shoe). If you visit a professional shoe-fitting facility, they'll help you determine what lasts will work best for you. 2) If they're on the ball of your foot, then they're caused from excessive pressure. That usually means that you've been bearing too much weight on the front of your feet. The heel is meant to bear weight, not the toes. Do not run on the front of your feet unless you're in an actual race. The average person does themselves a great injustice by not heel striking properly during athletic activities. If you're in a sport like tennis that force more forefoot pressure, then you'll have to be careful to use a shoe built specifically for tennis AND putting a support inside of the shoe that helps to distribute pressure more evenly across the foot to prevent stress fractures and ankle sprains.
Other Forefoot Problems
Callouses
Cause: The combination of moisture and friction/pressure. So you're feet are trying to protect themselves against poor gait and bad shoes.
Medical solutions: none besides cutting them off periodically
Non-medical solutions: See a pedorthist at the Denver Foot Solutions about evaluating your footwear and gait. Depending on what cause is determined, the treatment will vary. An easy way to cut down on moisture and friction is switching from a cotton sock to a moisture-wick sock.
Numbness/Tingling/Burning
Cause: Usually nerves. If your heel is elevated higher than your forefoot, the likelihood is that you're pinching the nerves between your toes from being shoved into the end of the shoes. This also happens if your shoes are too narrow in the toe box, or if you've developed a slouchy posture. If left untreated can develop into a Morton's neuroma, which is a thickening of the nerve in the area of pinching.
Medical solutions: Cortisone shot
Non-medical solutions: Orthotics; wide/deep toe-box shoes; flat sole shoes or rocker sole shoes; Metatarsal pads/bars
Hammer Toe
Definition/cause: The interphalangeal joint of toe is bent upwards causing rubbing on the top of the joint from pressure of shoes. Cause is usually from the arch of your foot not operating properly. When the arch isn't working right, the tendons and muscles on the top of the foot try to compensate. They're not designed to take over the duties of the bottom of the foot, so they tighten up and pull back on the toes. This causes the joints to bend. If left untreated the joints begin to lose range of motion and become rigid. If you can catch them before they become rigid, it is more likely reversible than if you let them become rigid.
Medical solutions: surgery/pins
Non-medical solutions: If the hammer toe is still Flexible: Hammer toe splint, deep toe box shoes, Custom Bio mechanical Arch Support (CBAS), metatarsal pads/bars.
If the hammer toe is Rigid: Hammer toe crest, deep toe box shoes, Custom Bio mechanical Arch Support (CBAS), metatarsal pads/bars.
Claw Toe/Mallet Toe
Definition/cause: Toes are bent under to look like claws. Again, the cause is arch related. Cause is usually from the arch of your foot not operating properly. When the arch isn't working right, the tendons and muscles on the top of the foot try to compensate. They're not designed to take over the duties of the bottom of the foot, so they tighten up and pull back on the toes. This causes the joints to bend. If left untreated the joints begin to lose range of motion and become rigid. If you can catch them before they become rigid, it is more likely reversible than if you let them become rigid. Sometimes the cause is congenital in cases of Charcot Marie Tooth and other such rigid foot deformities.
Medical solutions: surgery/pins
Non-medical solutions: Custom Bio mechanical Arch Support (CBAS), Metatarsal pads/bars, Wide/deep toe box shoes
Morton’s Neuroma
Definition/cause: Tissue buildup around pinched nerve usually located between the 2nd & 3rd or 3rd & 4th bones in the ball of the foot, causing shooting pains and numbness. Some of the causes are from wearing shoes too narrow for your foot shape, wearing shoes that have an elevated heel, running on the balls of your feet, and having a slouched posture.
Medical solutions: cortisone shot
Non-medical solutions: Wide/deep toe box shoes; Rocker-sole shoes; Met pads/bars; Arch Supports
Metatarsalgia
Definition: General term for undiagnosed forefoot pain
Medical solutions: padding
Non-medical solutions: Wide/deep toe box shoes, Metatarsal bars/pads, Custom Bio mechanical Arch Supports, Rocker-sole shoes, socks with additional padding on the soles.
Dropped Metatarsal Head
Definition/cause: One or more metatarsal bone(S) of forefoot are dropped or set lower than the others. Sometimes structural, sometimes developed from excessive flexibility/pressure, and collapse of the arch.
Medical solutions: Reconstruction; excavation
Non-medical solutions: Excavation of shoes or orthotics, wide/deep toe box shoes, Rocker-sole shoes, Metatarsal pads/bars
Bunion / Tailor’s Bunion
Definition/cause: Big toe (bunion) or little toe (tailor's bunion) joint is enlarged or dislocated; usually develops osteo-arthritis, and heavy callousing around joint; may develop bone spurs if untreated. Cause can be either from poor foot bio mechanics, poorly fit shoes, or hereditary. And just because your parents had bunions doesn't make it hereditary. Chances are that you have the same feet as your parents, therefore just as predisposed to getting the same foot-neglect deformities. Hereditary bunions usually look much different than developed bunions.
Medical solutions: Fusion of joint; removal of bone
Non-medical solutions: Custom Bio mechanical Arch Supports (CBAS), wide/deep toe box shoes, shoes without any elevation in the heel or Rocker-sole shoes to take pressure off forefoot, stretch pockets in shoes for bunions, metatarsal bars/pads
Arthritis - Rheumatoid
Definition/cause: The body’s immune system attacks the joints, causing inflammation
Medical solutions: Inflammation management, pain management, possible surgery
Non-medical solutions: Nonrestrictive footwear with structure and shock absorption, Custom Bio mechanical Arch Support (CBAS) to take pressure off joints and balance bone structure, possibly try Rocker-sole shoes for shock absorption and increased circulation factor depending on pain level
Arthritis - Osteoarthritis
Definition/cause: The cartilage of the joints is worn away from overuse, stress, or misalignment.
Medical solutions: Pain management, possible surgery to fuse or replace joints
Non-medical solutions: Nonrestrictive footwear with structure and shock absorption, Custom Bio mechanical Arch Supports (CBAS) to take pressure off joints and balance bone structure, possibly try Rocker-sole shoes for shock absorption and increased circulation factor depending on pain level.
Gout
Definition/cause: Crystal-like Uric acid buildup in joints, usually the big toe causing pain when joint bends. It can be a form of arthritis or dietary related. You want to contact the doctor if your big toe is swollen, red, and tender to the touch to have gout diagnosed and treated as soon as possible.
Medical solutions: Dietary, Medications
Non-medical solutions: Limit range of motion in irritated joint, flat-sole shoe or negative-heel shoes, Consult a nutrition expert
The Custom Orthotics that the Denver Foot Solutions store fit are usually the best solution for the more common forefoot conditions:
Our custom orthotics help Denver residents to….
· Distribute weight evenly across the foot to reduce and eliminate pain
· Improve balance and stability
· Improve posture and align knees, hips, and back to remove pain
· Keep bunions and other foot conditions from getting worse
· Absorb shock from walking/running on hard surfaces
· Help with shin splints and other sports injuries
· Maximize athletic performance
*In some cases medical attention is imperative for both diagnosis and treatment. If there is a combination of discoloration and swelling, you should consult the doctor right away. Most of the other conditions are treatable by non-medical solutions without a diagnosis being necessary. Working with a Pedorthist who specializes in preventative foot care is my first recommendation for the more common foot ailments. The Pedorthist will send you to the doctor if there are signs of necessary medical care, or if the ailment is unresponsive to treatment.*
