The forefoot is the part of the foot in front of the ankle consisting of groups of bones that include the metatarsals (five long bones in the forefoot) and phalanges (the bones that make up the toes). There are many medical issues that can arise in this region due to trauma, overuse, or other factors. Forefoot pain can range from mild pain causing a slight limp to severe pain that prevents walking.
Forefoot pain can be caused by a variety of issues, including:
- Plantar fasciitis
- Tarsal tunnel syndrome
- Flat feet
Forefoot pain is pain that develops at the front of the foot. This condition usually affects the area in front of the ankle, which consists of groups of bones that include the metatarsals (the five bones between the arch and the toes), sesamoids (two tiny bones between the first metatarsal and big toe) and phalanges (toe bones). If the forefoot is injured or diseased, it may produce pain that can interfere with regular daily activities such as walking. Forefoot pain ranges in severity from very mild to debilitating.
Causes of Forefoot Pain
Most cases of forefoot pain develop gradually, because of disease, injury, infection or wearing non-supportive or ill-fitting shoes. As it progresses, patients may experience sharp pain upon standing or walking, as well as a tingling or feeling of numbness in the toes.
The most common causes of forefoot pain include bunions, hammertoes, corns, plantar fasciitis, tarsal tunnel syndrome and flat feet.
Bunions (hallux valgus) involve the formation of an abnormal bony bump at the joint of the big toe, causing the joint to swell outward and become painful. The more deformed the joint becomes, the more it can lead to difficulty walking and to the development of ingrown toenails, corns and calluses. It often occurs because of an inherited foot type or wearing shoes that do not fit properly. Early treatment can be very effective and may include taking anti-inflammatory medication, wearing roomier shoes, applications of ice or taping the foot into a normal position. For more severe cases, bunion surgery may be performed to correct this problem.
A hammertoe is an abnormally crooked, contracted toe that takes the shape of an inverted "V." This condition develops when a muscle or tendon imbalance causes the toe to buckle and eventually become stuck in a bent position. Hammertoes may occur for several reasons, including hereditary abnormalities, rheumatoid arthritis, traumatic injury or the wearing of poorly fitted shoes. Treatment generally involves wearing roomier shoes, using orthotics or taking pain relief medication.
Corns are rough, thickened layers of skin that develop on the feet because of the skin protecting itself from friction and pressure. Corns usually have hard centers and are surrounded by inflamed skin. They commonly develop on the tops of the toes or sides of the feet and toes and cause pain when pressure is applied. Treatment may involve the use of shoe inserts, trimming excess skin or surgical removal.
Plantar fasciitis is an inflammation of the plantar fascia, a ligament that runs along the bottom of the foot from the heel to the base of the toes. This ligament normally supports the arch of the foot, functioning as a shock absorber, but if, after repeated stretching, it tears, inflammation and severe heel pain result. Plantar fasciitis may be caused by having naturally tight calf muscles, wearing shoes with high heels, having flat feet or having very high arches. Treatments for plantar fasciitis may include pain medications, physical therapy, orthotics and corticosteroid injects at the site.
Tarsal tunnel syndrome
Tarsal tunnel syndrome (posterior tibial neuralgia) is a disorder characterized by abnormal pressure being exerted on the tibial nerve, which provides sensation to the bottom of the foot. This causes the nerve to be pushed against the wall of the tarsal tunnel, resulting in pain especially at the bottom of the foot. Treatment generally includes rest, wearing orthotics, taking anti-inflammatory drugs and receiving corticosteroid injections.
Flat feet are usually a congenital condition, which may become worse with time, especially if the patient is overweight. Patients with the condition tend to have feet that lean inward at an abnormal angle. Flat feet may be caused by athletic injury, arthritis or dysfunction of the tendons or ligaments. The condition may result in severe foot, knee or back pain. Treatment typically involves wearing supportive shoes and orthotic devices, performing stretching exercises and physical therapy.