Forefoot Pain

Forefoot and toe pain occurs from the long metatarsal bones in the foot down towards the toes.

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Below we outline the more common causes of forefoot and toe pain as well as some of the less common causes.

Common causes of forefoot pain

Corns and calluses occur with a thickening of the skin which is usually do to repeated pressure or friction. A callus usually develops on the weight bearing sole of the foot especially the heel and ball of the foot. Corns are smaller than calluses and develop on parts of the foot which aren't weight bearing, for example the tops or sides of the toes and occur due to friction.

Turf toe is a sprain of the joint at the base of the big or great toe. It is usually caused by stubbing the toe or anything force that bends the toe upwards more than it natural range. Players with flexible ankles and shoes which are also very flexible are most at risk. Turf toe is also known as a first metatarsophalangeal joint or MTP joint sprain.

Black toenail or subangual hematoma as it is known is blood under the toenail giving it the impression of being black. It is caused by a trauma or impact to the toe and is often throbbing and painful. If a large part of the nail is black then it may require medical treatment to remove the pressure from the blood under the nail.

Bunion or hallux valgus is a painful swelling and enlargement of the bone on the inside of the big toe. The big toe will look like it is pointing inwards and sometimes will actually lie across the other toes. Conservative treatment includes bunion taping and padding the toes but often surgery is required to correct a bunion.

Mortons Neuroma or Morton's syndrome is a compression of the nerve between the third and forth toes in the foot which results in pain on the side of the toes next to the nerve. Pain is made worse by squeezing the foot as the nerve is compressed more.

Metatarsal stress fracture of the foot is a hairline fracture in one of the long metatarsal bones. A stress fracture is caused from overuse but athletes with poor foot biomechanics are more susceptible. Symptoms include pain in the middle or front of the foot which comes on gradually and is made worse by running. There will often be a specific tender spot at the site of the fracture. Stress fracture at base of 2nd metatarsal affects ballet dancers and is caused from over use. It should be treated by non weight bearing rest for at least 4 weeks.

Jones fracture is specifically a fracture of the 5th metatarsal on the outside of the foot at the very end of the foot nearest to the ankle. Symptoms include pain at the time of fracture. It will be very tender and the athlete will be unable to walk on the foot. Sometimes a deformity in the foot can be seen.

Metatarsalgia is the common name given to synovitis of the MTP joint. It is inflammation of the joints where the long metatarsal bones meet the toes. The synovium is a sheath surrounding the joint which contains the lubricating synovial fluid and it is this sheath which becomes inflamed.

Hallux rigidus or hallux limitus is the latin name for a stiff big toe. Symptoms of hallux rigidus include pain at the base of the big toe when walking and stiffness in the joint at the base of the big toe which is known as the MTP joint. Swelling and inflammation may also be present. As the condition gets worse the patient may limp when walking.

Sesamoiditis is inflammation affecting the sesamoid bones which are two tiny bones embedded within tendons under the base of the big toe. There will be a gradual onset of pain during weight bearing activities with tenderness over the under surface of the joint. The sesamoid bones can also be injured through a fracture or stress fracture.

Ingrown toenail or onychocryptis is where the sides of a toe nail grow downwards into the skin. Depending on how bad it is it can be very painful and disabling. It can be caused by poor footwear choices or failing to cut the toenail properly.

Less common causes of midfoot pain

Verrucas also known as a plantar wart is a wart caused by the papovavirus when it enters the skin. It is often found on the sole of the foot and can be differentiated from a corn because it is painful when squeezing from the sides whereas corns are more painful when pressing down onto them. Treatment with products containing salicylic acid are usually successful.

Hammer toe or claw toe occurs when the flexor tendons of the toes are too tight causing the toes to curl. If the foot is unstable the toes will attempt to grip the ground more as they attempt to maintain stability.

Joplin's neuritis is compression or irritation of a nerve over first metatarsal and first MTP joint at the base of the big toe. Symptoms include pain which radiates into the big toe. It is often caused by poor fitting footwear and orthotic inserts to correct poor foot biomechanics may help.

Freibergs osteochondritis or Friebergs disease affects children between the ages of 14 and 18 years old. it involves the crumbling or fragmenting of the bone around the end of the metatarsals or long bones in the foot.

Stress fracture of the sesamoid is a hairline fracture of one of the sesamoid bones which are two tiny bones in tendons under the base of the big toe. They are more common in basketball players and dancers who are on the balls of their feet more.

Subangual exostosis are bony projections on the under surface of the toes, usually the big toe.