Ball of the Foot Pain
Pre-Dislocation Syndrome: [Causes, Symptoms & Best Home Treatment]
Pre-dislocation syndrome is 2nd toe pain that can lead to a #1) plantar plate injury or #2)hammer toe. It can result in crossover toes. Learn to FIX IT!
- Metatarsalgia: which means generalized foot pain without a specific cause.
- Second toe capsulitis: this is the inflammation of the second toe joint capsule.
- Capsulitis is related to hammertoe formation, and can lead to a plantar plate tear. There is some overlap between these three disorders. As they get worse tearing and ligament damage can occur.
- Morton’s neuroma: this is the damage and inflammation to the nerves between and underneath the metatarsal joints.
- Fat pad atrophy of the ball of the foot: this is the loss of cushioning in the ball the foot.
So, click on the photo gallery to see the specific causes of your ball of the foot pain!
Click on the photo gallery to see the specific causes of your ball of the foot pain!
- Pre dislocation syndrome Overview:
Pre dislocation syndrome is an isolated pain under the metatarsal phalangeal joints (MTPJs, the joints that form underneath the base of your little toes, not the actual toes themselves).
- It can happen to any little toe but it is almost always found affecting the second toe joint.
- These are usually identified as “grape-like” swellings in the ball of your foot (due to swelling and bruising), but it’s normally to have almost no visual signs at all besides the pain in the joint.
Symptoms & Diagnosis:
- The toe itself has an increased joint range of motion both up and down as well as side to side; this motion is accompanied by increased pain in the joint.
- There is usually no callus in the area but there may be some swelling (“grape-like”).
- It is also not uncommon to have a hammertoe that is non-reducible; and if it does not look like a hammertoe yet, the proximal phalange will bend back over time and the front of the toe will curve down like a claw.
- It will eventually become rigid and need surgery if left unaddressed.
Associated Risk Factors:
- Predislocation syndrome of the second toe is usually accompanied by a bunion of the big toe.
- The second toe dislocates upward as the big toe drifts underneath it over time.
- It can also be caused by a short big toe leading to increased pressure on the second MTPJ.
Mechanism of injury:
- Skip this unless you really want to know– it is not essential for understanding your condition.
- The plantar plate is a thickening of the plantar capsule consisting of fibrocartilage and attaches into the proximal phalanx and between the condyles of the metatarsal neck (it attaches more strongly at the base of the proximal phalanx & it is weakest at the base of the metatarsal neck). Unfortunately it almost always ruptures distally due to increased tension; this eventually leads to destabilization of the MTPJ collateral ligaments and allows transverse motion. So this is how we get sagittal plan instability as well as transverse plane instability.
- Basically predislocation syndrome is caused by excessive pressure on the base of that toe, a bunion under-riding the second toe, or perhaps even a short first ray.
Diagnosis of Pre-dislocation syndrome
- It is important to rule out conditions such as Morton’s Neuralgia, Capsulitis and Bursitis when considering predislocation syndrome.
- Morton’s Neuralgia is different because the pain is usually between the third and fourth metatarsal phalangeal joints (rarely between two and three- but possible), If the pain is between the second and third metatarsals it is more likely to be an intermetatarsal bursitis rather than Morton’s Neuralgia.
- Capsulitis and Bursitis are usually found in the same area and are more common, but you can differentiate predislocation syndrome by performing the Lachman test (aka the vertical drawer test) and by checking the joint range of motion.
- The Lachman test stabilizes the metatarsal and attempts to slide the base of the toe dorsally (upward) and see if it dislocates by more than two millimeters; this motion should be painful if it is predislocation syndrome. Pain with joint range of motion will differentiate this condition from other pain in the ball of the foot generally classified as metatarsalgia, but it will not differentiate it from arthritis (the 2mm dislocation will confirm that its not arthritis).
- Always compare both feet! If it is both feet then this argues against predislocation syndrome!
- X-rays are also needed to rule out arthritis, malalignment, Freiberg’s infraction, fractures or neoplasms.
- A podiatrist can help diagnose this further through a history and physical, as well as an injection to the ball of the foot to see if the pain goes away.
- An injection is generally not a first line treatment for this problem.
- It can make the dislocation worse.
- Orthotics to relieve pressure from the bulb foot.
- The choose to relieve pressure from the bulb foot.
- Stretching and flexibility decreasing pressure from the bulb foot.
- Weight loss.
- Physical therapy to increase flexibility and remove pressure from the bulb foot.
- Massage therapy to leave pressure and swelling to the ball foot.
- The most successful therapies include wearing good shoes and good orthotics.
- Good supportive slippers at home rather than walking barefoot.
Ball of the Foot Pain Treatment Infographic:
Ball of the Foot Home Treatment:
- Consider taping, orthotics and great shoes as a combination to fix your foot problem.
- Products are not always necessary to fix your problem.
- The key is correcting the biomechanics that are leading to forefoot overload. Foot overload means too much pressure in the ball of the foot.
- Generally something called ankle joint equinus can lead to a too much pressure in the ball of your foot. This means your ankle is not flexible enough to move up and down.
- Ball of the foot pain treatment consists of two phases, first is control inflammation, next is to control bio-mechanics.
Remove Control Inflammation:
Massage & Ice Products:
- The metal ball is one of my personal favorites.
- This works great for your arch, less for the ball of the foot.
- These can help relax the arch or heel ligaments, leading to less pressure in the ball of the foot.
- Pills, creams and ice will never completely fix your problem alone. What they will do is reduce the pressure on the area.
Menthol Based Gels:
- Biofreeze is one of our favorites.
- These gels have been studied to work 2x as long as ice.
- This works great for the ball of the foot.
- Consider using these as options when resting on the couch or going to sleep at night.
- These can work great for loosening your muscles.
- This is means for your hamstring and calf muscles. This can loosen the ankle tightness putting pressure on the ball of your foot.
- This allows less tightness and pressure on the ball of your foot.
Ball of the Foot Stress Relief.
- The key is to prevent future pain.
- If you can get rid of the pain and swelling, this will let you start walking normally.
- If you can walk normally, the vast majority of your pain should gradually start to go away.
- This means proper cushion, proper stability and pressure relief from the front of your foot.
- This will relieve pressure from your big toe, your 2nd toe, your Morton’s neuroma, your plantar plate, hammer toes and joint capsules.
Best Metatarsalgia Shoes:
- Getting a great supportive pair of shoes will make sure that there is pressure removed from the ball of your foot.
- This is especially important if you have a metatarsalgia, a Morton’s neuroma, 2nd metatarsal overload syndrome and capsulitis!
- Consider shoes combined with a good supportive orthotic for best pain relief!
- The following link will show you what our favorites are.
Best Ball of the Foot Insoles:
- These are our recommended orthotics & insoles.
- There are different types for different shoes.
- Women’s shoes usually need a less bulky orthotic, but allow for less correction.
- A full length orthotic requires a running shoe, boot or comfortable walking/dress shoe.
Best Full Length Orthotics:
- Full length orthotics are the most recommended type for ball of the foot pain.
- Be aware that if they are too uncomfortable, it might be worth starting with a less corrective pair.
- Eventually you can then work your way up to these.
Best Dress Shoe Orthotics:
- These are a stronger option for shoes with tight dress shoes.
- Just be aware that less corrective orthotics & tight shoes are usually not a good combination.
Best 3/4 Length Orthotics:
- These may be a good option for ball of the foot if the full length orthotics are too tight or too uncomfortable.
Get A Great Dynamic Stretch:
- It is possible to stretch on your own, but these products can also really help!
- Personally I have the stationary block set up in my kitchen to stretch every day multiple times while getting my coffee!
- This will take pressure off of the ball of your foot.
Ball of the Foot Pain