Many people at some point in their life experience pain on the ball of the foot, commonly known as the forefoot. Some patients describe the pain as feeling like they are walking on a pebble or sometimes like they are walking on a hot coal. At times the pain can prevent people from doing the things they like to do such as jogging, hiking, or even taking a leisurely walk with the dog.

Fortunately there is much that can be done to resolve this type of pain. Because of the many structures in this area, the proper diagnosis of the pain is paramount. Proper diagnosis begins with a careful exam of the foot and usually plain X-rays.

The long skinny bones in the foot called metatarsals can sometimes be abnormally long, leading to excessive pressure on the ball of the foot. This abnormal anatomy can cause the fat pad to wear down and eventually pain develops. In this situation a custom made foot orthotic or insert is usually prescribed and fitted to the patient. Extra padding in the orthotic is added to allow for cushioning in the painful area.

In some conditions, patients can develop a painful tear in the ligaments under the ball of the foot. This tear is called a plantar plate tear. If the tear is severe, it usually results in a hammertoe deformity and often requires surgical intervention to resolve the pain. MRIs are utilized to make a proper diagnosis of this condition.

Another common cause of forefoot pain is called a Morton’s neuroma. This is a painful swelling or enlargement of nerves between the metatarsal bones on the bottom of the foot. This results in a burning sensation or even sometimes numbness in the toes. A careful physical exam and taking a proper history from the patient will help to diagnose a Morton’s neuroma. Corticosteroid injections and sometimes even surgical intervention are often needed to resolve this type of pain.

In conclusion, there are things that go wrong in the complex structure we call the foot. Your local foot and ankle expert can help to diagnose and properly treat these common conditions and get you “back on your feet” again.

Dr. Bean is a podiatrist with West Coast Foot and Ankle Center and can be reached at (760) 565.5545. For more information visit

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