Ball of Foot Pain Part II South Jersey Podiatrist

In last week’s blog I discussed how neuromas and stress fractures can cause pain in the ball of the foot. In this week’s blog I will discuss other causes of metatarsalgia. Just as a review, metatarsalgia is pain along the metatarsal bones. This is a general term and there are many different causes of this type of pain.

What is capsulitis?

A common complaint that many podiatrists hear about is pain along the 2^nd Metatarsal phalangeal joint. This is the joint where the 2^nd toe meets the 2^nd metatarsal. Pain in this area can either radiate to the toe or to the ball of the foot. It is important for the podiatrist to distinguish this with a neuroma, since there can be similar symptoms. Capsulitis is inflammation around the joint, most commonly being the 2^nd toe/metatarsal joint. Many times this can be caused by a patient’s biomechanics. Other times it can be caused by an increase in activity. The 1^st toe/metatarsal joint is programmed to take a significant amount of stress is able to accommodate for the body weight. If there is an excessive amount of activity the stress can shift to the 2^nd toe joint and therefore cause capsulitis. If there is chronic inflammation in the 2^nd toe joint that is not treated it can lead to ligament ruptures. The most common ligament that is ruptured in this joint is the plantar plate. This is the ligament on the bottom of the foot that holds the 2^nd toe and metatarsal in a straight position. If there are even microscopic tears in the tendon the 2^nd toe can begin to drift upward and/or to the side. When this begins to happen this is called pre-dislocation syndrome.  There can be swelling on the bottom of the foot near this joint, sometimes a callus may form in this area. Many patients will confuse this with a hammertoe. A hammertoe is a deformity within the toe joint, whereas pre-dislocation syndrome is a misalignment in the toe/metatarsal joint.

How is pre-dislocation syndrome treated?

This syndrome in the early stages is treated like any inflammation. An x-ray will be performed to rule out a fracture, tumor etc. Anti-inflammatory medications, ice, and rest will help with the symptoms. Orthotics will help in the long run to help support the joint and redistribute the pressure off of the inflamed area.  If conservative treatment fails surgery to repair the ligament and realign the joint may be necessary. Most of the time conservative treatment helps with decreasing the symptoms. If surgery is required your physician will order an MRI or ultrasound to assess the joint and where the damage is. Surgery typically includes repairing the rupture ligament and realigning the toe. Many times a pin or internal hardware is required to fuse the joint into a straight position.  Post operatively orthotics will be needed in order that the dislocation and the deformity do not return.

For more information, please visit our website at www.footnj.com