Forefoot Pain

Often simply dismissed as ‘metatarsalgia’ (a Greek word meaning ‘sore long bones of the foot’), forefoot pain always has specific, varying causes that arise from individual anatomical structures within the foot. These structures are often formed from different types of tissue, operate under different stresses and therefore require both a precise diagnosis and a specific treatment plan in order to resolve the pain. Below are some of the more common presentations of forefoot pain seen at Prahran Foot Clinic.

Bunions

Bunions are an often-hereditary deformation of the first toe joint in the forefoot. With severity of the condition ranging from initial rubbing discomfort from shoes, through to debilitating joint pain and an unsightly deformity, bunions are among the more unpopular genetic gifts bestowed by one’s parents.

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They most commonly develop due to poor ligament support within the foot, seeing the first metatarsal shaft (the long bone in the forefoot) rotating internally. This in turn results in a gradual, inwards movement of the great toe and eventually the deformity we come to recognize as bunions. If left untreated the deviating great toe can continue to shift under or over the neighboring lesser toes, and eventually can lead to the complete dislocation of the big toe joint.

Research has shown custom foot orthotics can be effective at halting or slowing the progression of this condition. They are also an excellent method of reducing the joint pain often accompanying more progressed cases.

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Neuroma and Bursitis

Frequently encountered in the clinical setting is a sometimes debilitating condition affecting the forefoot – neuromas. This is a thickening of the nerves after they become entrapped within the joint of the forefeet at the base of the toes. 

Whilst custom foot orthotics and footwear modification play a large role, clinical research shows that Radial Shockwave Therapy can reduce symptoms significantly within a few treatments (1,2)

1. Seok et al

2. Fridman et al

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Plantar Plate Dysfunction

Netter drawing MTPJ

A lesser known but common culprit for forefoot pain is damage to a small structure known as a plantar plate. About the same size as your fingernail, this square plate of cartilage sits underneath the joints of your toes and the long bones of your foot, the metatarsals. Specifically, the second plantar plate most commonly is affected, causing discomfort often likened to a feeling of a stone or marble within or under the joint. 

As cartilage takes a long time to heal, targeted therapies such as Radial Shockwave Therapy (3), custom foot orthotics, carbon fibre shoe inserts, footwear modification and even CAM walkers (moon boots) can be utilised to resolve symptoms faster and get you back on your feet faster than rest alone.   

3. Labbad et al

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