What's Really Causing Pain in the Ball of Your Foot?

Got pain in the ball of your foot that just won’t go away? This is a common complaint in our Houston podiatry practice. And, in today’s post, we’ll help you understand why your foot hurts, so you can take action to finally stop the pain.

Ball of Foot Pain: Taking a Closer Look

Let’s start with the basics. What exactly is the ball of your foot? Put simply, it’s that rounded area of your foot, just behind your toes, where your metatarsal bones meet your toe bones. The ball of your foot contains five metatarsal heads. These are the rounded ends of the long foot bones. Between your skin and these bones, you have a natural fat pad that acts like a built-in cushion. This fat pad is absolutely crucial, because it absorbs the tremendous force that goes through the ball of your foot with every step you take.

Think of your foot like a tripod, with three main contact points: your heel, the outer edge of your foot, and the ball of your foot. When you walk or run, these three areas work together to distribute your body weight and help propel you forward. When you’re walking normally, the ball of your foot can experience forces up to three times your body weight; the force is greater when you’re running or jumping. And, if anything in this delicate system goes awry, you can experience pain in the ball of your foot. That pain isn’t random: it’s your body’s way of telling you that something needs attention. So it’s important to properly interpret that message if you want to find effective pain relief.

Common Causes of Pain in the Ball of Your Foot

If you have ball of foot pain, it could be due to:

1. Metatarsalgia

   
   Literally meaning pain in the ball of foot area, this concern usually develops from overuse and excessive pressure on the ball of your foot that’s caused it to become inflamed and painful. It could be the result of an imbalance in the way weight is distributed across your foot. Maybe you have a high arch that puts extra pressure on this area; maybe you’re wearing shoes that don’t fit properly; or perhaps you’ve increased your activity level too quickly, without giving your feet time to adapt. Whatever the cause, the result is inflammation that can make every step painful. Treatment options range from activity and footwear modifications to the addition of a custom orthotic to help redistribute pressure more evenly across your foot.
   
   

2. Capsulitis

   
   Behind every joint in your body, there are ligaments that provide support and stability. In the ball of your foot, these ligaments form what we call a joint capsule and, when it becomes inflamed, that’s capsulitis. This condition can make it feel like you’re walking on a marble or a small rock. The pain is usually very localized, right behind one specific toe—most commonly, the second toe. If this condition is not recognized and treated properly, it can progress to a more serious problem—the persistent inflammation can actually cause the ligaments to weaken and tear, leading to toe deformities that may require surgical correction. Fortunately, with regenerative medicine treatments such as PRP, or platelet rich plasma, we can use your body’s own healing factors to prevent this outcome by reducing inflammation and promoting tissue repair.
   
   
   

3. Fat Pad Atrophy

    
   Remember that natural cushion we mentioned earlier? It can start to thin out, either naturally as we age; as a result of repetitive high-impact activities; from wearing high heels for extended periods; or even from previous steroid injections in the area. Whatever the cause, when your fat pad thins out, you lose your natural shock absorption; suddenly, you’re walking more directly on the bones in the ball of your foot. The pain feels deep and achy, and is often worse on hard surfaces. Luckily, this condition can now be addressed with innovative procedures such as fat grafting that can actually restore the natural cushioning in your foot. We can also use regenerative therapies to improve the health of the remaining fat pad tissue.
   
   

4. Morton’s Neuroma

This is a condition where the nerve tissue between your metatarsal bones becomes thickened and inflamed—most commonly, this occurs between your third and fourth toes. The pain is usually described as burning, tingling or numbness that can shoot into your toes. For this condition, we’ve seen excellent results with non-invasive treatments like Shockwave Therapy, using acoustic waves to stimulate healing and reduce inflammation in the affected nerve tissue.

Playing Detective with Ball of Foot Pain

How can you determine which of these causes is the source of pain in the ball of your foot? Your body gives you clues through the type of pain you’re experiencing, along with when that pain occurs. Location is a huge clue: if your pain is localized to one specific spot, particularly behind your second toe, capsulitis is a strong possibility. If the pain is more generalized, across the entire ball of your foot, metatarsalgia is more likely to blame. Are you experiencing burning or tingling that shoots into your toes? Morton’s neuroma should be considered.

The timing of your pain also tells a story. If your pain is worse when you’re walking barefoot or on hard floors, that often indicates fat pad problems or metatarsalgia. But if your pain is worse in tight shoes, and improves when you’re barefoot, Morton’s neuroma is more likely to be the cause. Got pain that’s constant, regardless of your activity? Capsulitis or a serious structural problem is likely to be the source of discomfort.

You should also pay attention to what makes your pain better or worse. Does it hurt more in certain shoes? Is the pain worse after you’ve been on your feet all day? All these details will help us paint a picture of what’s really going on.

If all of this sounds overwhelming, don’t worry: you don’t have to play detective alone. Houston podiatrist Dr. Andrew Schneider is here to help! If you’re struggling to determine what’s causing pain in the ball of your foot, take note of your symptoms and request an appointment to come into the office. Together, we’ll get you to the right diagnosis—and your ideal treatment plan for recovery!