Case Study

• In my family, foot pain is common. My grandmother, a farmer’s wife, had feet that always hurt and she could never afford shoes that fit well. My feet hurt and my sister’s feet hurt. We have metatarsalgia.
• In theory, neither of us should have this problem.
• Neither of us is overweight
• Neither of us has a physically demanding job, although I walk a lot at work and my sister tries to walk at least 10,000 steps a day.

Definitions useful in understanding the problem

• Metatarsalgia refers to pain on sole (plantar part) of the foot around the metatarsal heads (ball of foot)
• Tendons connect muscles to bone
• Ligaments connect bone to bone
• Fascia is the connective tissue beneath the skin that forms enveloping sheaths around muscles and organs.  It’s mostly collagen.

Metatarsalgia

• The condition can be a one-time-only problem (acute) or recur over time (chronic).
• Biomechanical conditions that increase stress at the metatarsal heads may cause it.
• Pain in forefoot that occurs when you put weight on it.
• Severe pain around the ball of the foot that comes with prolonged standing and/or walking.
• Some people say it feels like walking around with a pebble in their shoe.
• Sufferers generally can’t describe any one thing that set off the problem, but usually describe the pain as coming on gradually.

Biomechanical Factors

• Excessive foot pronation (DEFINE)
• Wearing high heels
• Wearing shoes with pointed toes
• Wearing poorly padded shoes
• Obesity
• Flat feet

Other Factors

• Gout
• Rheumatoid arthritis
• Sesmoiditis
• Trauma
• Stress fractures
• Recent foot surgery

What a Physical Examination May Show

Foot

• Weight-bearing (see picture)
• Non-weight-bearing (see picture)
• Calluses. These form in response to abnormal weight-bearing stress or pressure and often indicate abnormal biomechanics.
• Toe. It may be normal or clawed/hammered (see picture).
• Arches. The metatarsal arch which run from your big toe to your little toe, may be normal or collapsed. The medial, which runs from your big toe to your heel, may be normal or collapsed.
• Heel. Your hindfoot may be affecting the placement of your forefoot (balls and toes) when you walk. It can be straight, leaning in (valgus), or leaning out (varus).

Your Doctor Will Look at These

• The range of motion of your forefoot
• Whether your heels are straight or lean in or out.
• Whether your knees are lined up with your feet the way they should be.
• Same thing for your hips.
• Whether you have pain in the balls of your feet when pushed on.
• Whether there is any swelling or redness.

Also Ask Your Doctor to Examine Your Kinetic Chain

• It’s easy to understand the “kinetic chain” if you think about the old song that says, “The foot bone is connected to the knee bone, the knee bone is connected to the hip bone” and so on. If you have a problem in one of these, it affects all the rest.
• Ask your doctor to examine a possible discrepancy between the length of your legs. If one is shorter than the other by as much as a quarter-inch, it can make a difference.
• Ask her also to look at your legs and hips for possible rotational issues that might affecting the way that you walk.
• You’ll also have issues with your feet if your Achilles tendon is tight, so you should get advice on effective stretches.

Early Treatment

• Some drugs that you can find on pharmacy shelves can help, unless you have a treatment history that suggests you should not take them: there are • NSAIDs such as aspirin, and ibuprofen, as well as painkillers such as Tylenol.
• Shoe inserts such as orthotics can help the biomechanics of your foot as they can correct pronation and support your metatarsal arch.
• Modify your activities to avoid running and jumping. 
• Pay attention to the shoes you wear: avoid high heels, make sure your shoes are the correct size, choose shoes with extra depth and proper cushioning. A good shoe store can advise you on all these.
• Consider investing in a pair of shoes that have rocker-bottomed soles if your big toe has become immobilized or frozen (hallux rigidus).

Exercises

• Foot stretches (see picture).
• Strengthening of foot intrinsics (see picture)
• Stretches of Achilles tendon and hip muscles (see pictures).

DIY Foot Massage

(See pictures.)

Further Treatment

• For the kinetic chain
• Stretches for knees
• See picture
• Stretches for hips
• See pictures

Outcome

Between orthotics, stretches (mostly from practicing yoga or ballet), and massage, both my sister and myself have happier feet that no longer limit our weight-bearing activities, although we both have to keep an eye on the situation, espeically if we start doing a different activity or want to do a usual one for a longer time.