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ball of foot pain from trauma

by Aintie
(Tucson, AZ.)

7 years ago I had a piece of machinery fall on me, knock me over into a downhill position and dislocated the front of my left foot. The toes were all sticking straight up, or bent upwards & back as far as they could go. By the time I made it to our local hospital and they finally pulled it to get it back in position, it was over three hours. There were no Drs. available for several hours and it was very painful for the entire time. Now I have pain in the front ball of the foot, right under the joint behind my big toe. I guess this is the area they call the ball of the foot. I've had all the xrays and had a sports medicine Dr. tell me that because it was in that position for so long, there is inflammation from the damage and possible arthritis or ligament damage but no surgery is recommended that would not have to fuse the bones and then make my foot unable to bend and flex in that area. When I walk barefooted on tile it feels like a small knot in there and causes pain, sometimes nerve-type shooting pain. The rest of the time it simply aches a lot and it is building up a callus more and more. Due to a very old serious injury to that same foot, I have to walk in heels or slides most of time. My left heel and ankle were crushed over 25 years ago. The ankle bones were pinned together, the heel bones were only pushed back together somewhat under a fluoroscope and I was put it a cast with a very high heel for over 11 months. Now when I walk all day in tennis shoes it completely stoves up. The more the ankle has to bend, the worse it is. I walk three times a week from 3-5 miles with no problems but once I get back, sit down at my desk for 20 minutes then go to get up, it is very painful and stiffened up. I simply switch to a slide or wedge shoe with about 2 3/4" heel and I'm good to go. Have adapted and been doing fine with this until this dislocated injury. For this reason, the sports Dr. who knows my history, said the surgery on this joint would not work for me since I then could not wear heels, the front half of my foot would not flex.

I need to limit the flexing of the ankle and rely on the front of the foot for that. Is there some kind on pad I can wear under the ball of my foot that would help? I see many for sale talking about alleviating metatarsal pain but I'm not sure if that's what I have and if any of them would work for me. Any tips or recommendations would be greatly appreciated.

ANSWER

Hi Aintie,

I think I got the story straight. Because of severe ankle trauma years ago, you have to walk in heels to avoid ankle pain, but the ball of your foot hurts from being overstretched from your fall seven years ago.
So, we all know that the heels are actually aggravating the ball of your foot, but it is a situation you have to live with, so we need to address what can be done to the ball of the foot.
I would suggest you have an MRI, if it has not been previously done because I am concerned about the plantar aspect of the ligaments that attach your metatarsal bones to the toes. This is known as the capsular ligaments and inflammation of them is known as capsulitis.
I would venture to guess that you probably actually tore some of them if the trauma was as bad as you state and you ended up with what is known as a plantar plate tear. Seven years down the road means any tears that have occurred probably have scarred over leaving you with residual pain.
I am not so sure the metatarsal bones would have to be fused to the toes as much as I think surgical work on the scarred ligaments might be beneficial. (I am guessing here as I cannot actually examine you).
Another area that needs to be addressed is the possibility of a Morton's neuroma as a neuroma would give you symptoms of a fullness on the bottom of your foot as well as the neurological symptoms you describe. A neuroma could have developed out of the trauma you sustained.
From a more conservative standpoint you could consider trying a metatarsal bar, not a metatarsal pad. The difference is the metatarsal bar is wider and would help all your metatarsal bones while the metatarsal pad will only help one or two of the bones.
You will have to add the bar to an orthotic so that it sits properly in your shoe and constantly hits in the right area.
I am not so sure a sports medicine doctor is your best bet with this type of injury. I would suggest you find yourself a podiatrist in your area who is probably more familiar with the biomechanics of the foot and can work with you in finding a proper treatment plan.
If you try metatarsal bars on your own, you will probably have to experiment to find one that is the right size and thickness to do the job.

Marc Mitnick DPM
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