First of all, it should be explained that pain in the ball of the foot complained of by patients is definitely localized at the point below the metatarsophalangeal joints of the toes. The ball of the foot is considered a separate area of the sole of the foot and actually contains only the region in the forefoot below the metatarsophalangeal joints. Colloquially, however, pain in the sole of the foot is hastily described as “pain in the ball of the foot“. Depending on the localization, the pain has certain characteristics or is causally related to diseases or bad posture. In the following, typical manifestations or conditions where the pain occurs will be explained in more detail.
Pain in the sesamoid bone
The sesamoid bone of the foot, the so-called “Ossa sesamoidea pedis” is a bony part of the underside of the foot in the area of the big toe joint in the forefoot. It is embedded in the sinewy parts of the foot muscles and has the function of increasing the angle of the big toe joint. Pain at the ball of the foot can therefore originate from this bony structure.
Fractures of the sesamoid bone are very rare, but they occur in the form of fatigue or stress fractures. However, such fractures usually only affect athletes due to heavy strain and repeated stress. A localized pressure pain over the bone parts is characteristic of the fatigue fracture.
Conservative therapeutic approaches aim to relieve the sesamoid bone with special and individually manufactured insoles so that the fracture can heal. If this approach does not help, surgical treatment may be considered. This involves the removal of the sesamoid bone (=sesamoidectomy).
A significant risk of this procedure is the malpositioning of the big toe. However, patients are free of pain in the ball of the foot after the operation. Other causes of pain in the big toe can be an inflammation of the sesamoid bone, known as sesamoiditis.
The inside of the ball of the foot is very painful and sometimes reddened and swollen. In most cases, the inflammation is caused by a foot malposition, such as the hollow foot, and the associated poor posture or incorrect weight bearing. In principle, the pain can occur at the ball of each individual toe.
A prominent example is the pain on the sole of the big toe, caused by an acute attack of gout. The big toe is the most frequent manifestation of an acute attack of gout. One speaks here of the clinical picture “Podagra”.
The pain at the ball of the foot can suddenly appear overnight. Other triggers are stress and excessive eating and drinking. The background of the pain-triggering acute attack of gout is the enormous increase in the uric acid level, which leads to the deposition of certain substances in the joint capsule of the metatarsal toe.
Of course, the attack of gout also manifests itself in other joints. In addition to the characteristic pain, overheating, redness and swelling must be described. Pain can also occur directly in the metatarsophalangeal joint of the big toe.
You have pain on the sole of your foot?causes for pain on the ball of the foot of the other toes can be summarized in general terms: Often the wearing of wrong or too tight shoes is the trigger. The result is, on the one hand, the wearing of incorrect and unhealthy foot or toe posture and, on the other hand, callus formation. This callus formation can also be defined as cornification (“Clavus”).
The skin changes due to increased stress and strain, resulting in a thickening of the skin with a firm inner core. The core protrudes into deeper parts of the skin, where it triggers a pain stimulus. Smaller warts or other lesions or wounds can also provoke pain in the ball of the foot.
Severe pain that recurs several times a week can cause discomfort at all the balls of the toes. Pain occurs as a leading characteristic, but redness, swelling and overheating are also typical characteristics, which are associated with inflammation-related pain at the ball of the foot, among other things. An incorrect rolling movement with every step can also cause pain in the ball of the foot of each toe.
The symptomatology increases especially after extreme and prolonged exercise and the simultaneous wearing of incorrect footwear. Pain in the ball of the foot at the metatarsus is more frequent when the rolling motion is incorrect. Normally, the load should end up on the big toe, since this is also where the push-off process takes place.
Since some patients have the longest toe, they have the longest contact with the ball of the foot when the rolling and push-off movement is incorrect and must withstand the load.Since these toes are not designed for such heavy strain, the metatarsals of both toes can break due to overstrain. One speaks then of a “fatigue break”. Pain in the middle of the ball of the foot can also have other causes, however.
In addition to foot malpositioning and discomfort due to muscular and sinewy lesions, the so-called “Morton syndrome” can also cause midfoot pain or pain in the middle of the balls of the feet. Morton syndrome is an irritation or lesion of the peripheral nerves of the foot, the “Nervi digitales plantares communes”, which run between the metatarsals. The nerve damage is caused by severe irritation and wearing shoes or high heels that are too tight.
The largest group of patients is that of women who walk long and intensively on high heels. Patients with a splayfoot also have an increased risk of Morton Neuralgia. The pain is ultimately caused by swelling in the surrounding tissue, which compresses and irritates the nerves.
This can lead to the formation of a so-called “Morton Neuroma”, a nodule in the nerve cord. This nodule is perceived by patients as very unpleasant, some describe it as a feeling like a pea or a small stone in their shoe. Morton’s neuroma is very sensitive to pressure and hurts especially when pressure is applied.
The radiation of the pain can extend from the sole of the foot to the toes; thus it also occurs in the area of the ball of the toes. It usually has a stabbing to pulling character. In the worst case, patients suffer from the pain with every rolling movement.
It often helps to take off the shoes, massage the foot slightly and keep it still for the time being. There are no particular noteworthy and characteristic causes for the pain in the ball of the foot on the inside. As with all other areas of the foot, the pain is caused by overloading and incorrect loading, long and repeated stress, incorrect rolling and poor footwear.
The pain character on the inside is often stabbing and can radiate into the sole of the foot. If the pain occurs mainly in the morning or after rest, there may be inflammation of the plantar aponeurosis, an inflammation of the plantar fascia. This structure extends from the heel to the forefoot, so that it can cause pain on the inside of the foot.
Pain in the ball of the foot in the rear area, like pain on the inside, does not have a classic main cause. Here, too, the typical causes such as overloading and incorrect loading, long and repeated strain, as well as incorrect rolling and poor footwear are among the triggers of ball of foot pain. Especially during the push-off movement after rolling, the back of the sole of the foot is strained, so that pain often occurs then.
If there is a fatigue or stress fracture of the sesamoid bone or a metatarsal bone, the pain tends to be located in the posterior part of the foot. However, the pain can always radiate, so that the origin of the pain is often difficult to determine. A medical examination or treadmill analysis can be helpful in finding the cause of the pain.
Pain at the balls of the feet can occur immediately after getting up, the so-called treadmill pain. One notable cause among many is the presence of an inflammation of the plantar aponeurosis, the so-called “plantar fasciitis”. This is an irritation of the plantar aponeurosis, which radiates from the heel to the metatarsophalangeal joints of the toes.
It therefore runs over the balls of the feet, so that it can cause pain there in case of inflammation. Plantar fasciitis is often triggered by extreme or repetitive strain. It is typical that the pain is more intense after a resting phase, for example after a night’s rest when getting up.
Although the pain also occurs at the balls of the feet, the heel region is the more characteristic manifestation site. Therapeutic measures against plantar fasciitis include cold and anti-inflammatory treatment. It is also important to train the plantar aponeurosis with strength and stretching exercises.
With the help of conservative therapy, the majority of patients heal, making surgical treatment unnecessary. After getting up, the sole of your foot also hurts?pain on the outside of the foot is usually caused by mechanical imbalances. Incorrect rolling as the main symptom causes the majority of ball of foot pains.
The physiological rolling process distributes the pressure load from the heel, over the outer side of the foot with slight internal pronation, to the forefoot in the ball of the foot. Due to an unphysiological rolling process, the outer side of the foot can be put under too much pressure, causing pain.In addition, general misuse and overloading can also be the cause of pain in the sole of the foot. Sometimes the cause is not in the foot itself but in the leg.
A knee joint malposition such as the “bow leg” has a negative effect on the foot mechanics due to the malposition of the axis and the resulting incorrect pressure/load distribution. Our foot construction is designed for a physiological and correct rolling movement. This requires that the heel touches the ground first, ideally in the rear outer area.
The rolling movement of the rest of the foot takes place over the outer edge. The weight is shifted slightly to the middle, i.e. towards the longitudinal arch. This form of pronation is still considered physiological.
The preparation for lifting the foot for the next step already begins: After the rolling movement over the outer edge to the ball of the foot has taken place, the push-off movement occurs. This takes place mainly via the big toe. According to the current state of science, some people agree that the big toe should point slightly outwards during the rolling movement.
Approximately 15°degrees are sufficient to achieve maximum muscular support for the foot and the lowest possible joint stress. Depending on the foot malposition, the load distribution of the foot regions can vary or even load areas that are not designed for this. An example of an increased forefoot load is the pointed foot.
Patients with a pointed foot cannot put the heel down during the rolling movement. The cause lies in the ankle joint: the mobility of the upper ankle joint is restricted, so that a fixed plantar flexion position is assumed. This means that the foot is extremely flexed in the direction of the forefoot.
The load, which is actually transferred to the heel for the most part during the physiological rolling movement, is placed on the forefoot and thus on the ball of the foot. It is obvious that the ball of the foot hurts after years of pointed foot or heavy strain. Overpronation caused by foot malpositions, incorrect footwear or muscular components can also cause pain.
Overpronation is the pathological increased bending inwards, i.e. towards the middle of the foot, during the rolling movement. A slight inward shift of the load towards the longitudinal arch is quite normal, but excessive pronation results in discomfort. Although this also manifests itself in the area of the ball of the foot and the entire sole of the foot, the main complaints are located in the area of the Achilles tendon, the ankle and knee joint and the lower leg muscles.
Predisposed are runners or overweight people. In addition, a flat foot or a flat knee increase the risk of overpronation during the rolling movement. With the help of a treadmill analysis, possible causes such as the pointed foot or overpronation can be identified and then treated.
Swelling (“tumor”) is one of the 5 characteristic signs of inflammation, along with redness (“rubor”), pain (“dolor”), overheating (“calor”) and functional impairment (“functio laesa”). This means that all inflammatory processes in the area of the ball of the foot can cause swelling at the same place. The swelling typically occurs together with other signs of inflammation, such as pain.
An acute attack of gout and also sesamoiditis (= inflammation of the sesamoid bone) can be accompanied by swelling and pain at the ball of the foot. Depending on the localization, conclusions can be drawn as to the cause of the swelling and pain. Do you have suddenly appearing pain in the ball of your foot?especially after sports, there is an increased pain in the ball of your foot/sole area.
Frequent exercise, especially jogging, increases the risk of a fatigue fracture of the sesamoid bone at the ball of the big toe. Patients with this disease are almost without exception athletes. Otherwise, this fracture is considered a relatively rare injury.
After sports, however, muscular tension or irritation or inflammation of sinewy parts can always cause pain under the ball of the foot. Specific, noteworthy examples include inflammation of the plantar aponeurosis. The main pain localization is in the area of the heel. The occurrence of pain under the ball of the foot after exercise can also be explained by increased stress. If the patient then also has a foot malposition, such as overpronation as a result of a pointed foot, the risk of painful complaints after sport is very high.
