Toe / Ball of Foot Pain

Greetings,

For about 1 year I’ve had pain in the ball of my right foot. The pain originates on the forward edge of the foot, just below my third and fourth toes. It also tends to correspond with tingling / aching pain in the third and fourth toes(no burning and definitely no numbness though). I’ll also occasionally feel pain on the top of the foot, again just before the third and fourth toes.

It’s definitely worse when wearing shoes, particularly tighter, flat shoes without a lot of support. Walking and standing for long periods aggravates it. My third and fourth toes also seem particularly sensitive to the cold (more so than previously and more so than my left foot).

Hot water makes it feel better, as does exercise and massage (though it hurts initially during exercise, but after playing for 20-30 minutes the pain goes away — though this may just be endorphins masking the pain).

I’m an otherwise healthy 28 year old male. I’m in fantastic shape, play soccer twice a week and assorted weight training / cardio exercise 6 days a week.

I’ve seen a Podiatrist about this for the last 4 months. His diagnosis is that I’ve overloaded my third / fourth metatarsals, but he doesn’t believe it’s a neuroma due to his inability to replicate symptoms via palpitation / manipulation of the foot. I’ve been doing physical therapy and wearing supportive shoes with a wide toe box. I’ve noticed a very slight improvement in symptoms, but I still definitely struggle with the pain.

The pain originated after significant trauma to both feet. In January of last year a man broke into my house. I fought him out of my house, but I wasn’t wearing shoes (I was in my pajamas) and the fight proceeded onto the street in front of my house. He was also a large individual and stepped on my feet a number of times. Needless to say my feet were extremely bruised, cut and I had a displaced fracture of my pinky toe on my left foot.

1) Any ideas as to what you think this could be? Would you agree that an overloaded 3rd / 4th metatarsal is likely the issue?

2) Would you suggest an MRI to confirm diagnosis / investigate further? I’d personally love to know exactly what it is as to attack the problem head on.

3) Do you think I’m likely to ever recover from this? At a year out it’s feeling pretty dismal / like this might be something I’ll suffer from for the rest of my life.

4) How do you distinguish structural / neurological injury from say, neuropathy caused by systemic issues (infection, diabetes)? Do infectious causes usually involve more of the foot, advance to other areas and product symmetrical symptoms?

Any other suggestions / comments?

I really appreciate your input. Here’s hoping I can fix this!

2 Responses

  1. Foot-com

    Thank you so much for getting back to me!

    I have not had any kind of diagnostic imaging despite an x-ray to check for stress fractures. The x-ray showed no evidence, but did show some bone “deformation” that the doctor thought may have indicated fractures in toes other than the pinky toe that have since then healed.

    I’ll go ahead and request that we try some imaging at my next appointment and hope that it gets me closer to a diagnosis, treatment and eventual relief!

    Thanks again!

  2. Foot-com

    Hello and thank you for your question. First off, I am so sorry to hear that you had to experience someone breaking into your home – and then having to fend him off, nonetheless.

    Based off of your description and not on an actual examination of your foot, it sounds more like a neuroma than a stressed 3rd and 4th joint. Have you had any injections to either the joint or the space between the 3rd and 4th digits? Have you had any diagnostic tests such as MRI or Ultrasound? Those would be my first recommendations. If a neuroma is observed on MRI or Ultrasound then discussing treatment options such as steroid injections, alcohol injections or radiofrequency ablation would be your next step.

    And as far as ruling out neuropathy, that is typically all digits or the entire bottom of foot, and the symptoms are greater at night. I hope this helps – Good luck!

    ==============
    Dr. Emily Splichal
    Please be advised: we do not provide medical advice, diagnosis or treatment.
    By law, we cannot give specific medical advice over the Internet.

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