Pain in the Ball of Your Foot

Do you sometimes develop pain in the ball of your foot? What if you have recently developed this pain and it has not improved? There can be many contributing factors to forefoot pain, but the most apparent is ill-fitting shoe gear or no shoe gear at all. It's important to first determine the exact point of pain. In medicine we refer to this as the point of maximum tenderness. Let's review some steps to determining the most likely cause of the pain based on the location.

Pain in the ball of the foot at the base of the second toe

This is one of the most common areas for pain in the ball of the foot. Patient's with this pain will many times describe the recent use of shoe gear with a heel or walking barefoot. The source of pain usually presents from inflammation of the capsule surrounding the 2nd metatarsal phalangeal joint and specifically a thickening of the bottom of the capsule called the plantar plate. Individuals suffering from this type of pain should see a foot and ankle specialist to rule out the presence of a tear in the plantar plate. Delayed treatment of this condition, many times referred to as Predislocation Syndrome, can result in a complete tear of the plantar plate, followed by subluxation of the joint and the second toe overlapping the big toe.

Pain in the ball of the foot and at the base of the big toe

Do you feel pain when pressing the ball of the foot at the base of the big toe? If so, this could be indicative of sesamoiditis, or the two small bones that are present under the end of the first metatarsal. It is important to recall any point of trauma to this area. Although not as common, individuals with pain in this area after landing forcefully on the forefoot can have a sesamoid fracture. It is very important, especially with a history of trauma, to seek medical attention immediately. Fractures of the sesamoids can result in avascular necrosis (the bone dying due to lack of blood supply).

Pain across the entire ball of the foot

As we age, the elasticity of ligaments is compromised along with the integrity of collagen. The ball of the foot requires these structures to secure the fat pad on the plantar forefoot. When there is migration or movement of the fat pad towards the toes, the bones of the forefoot, mostly the metatarsal heads, rest on non-supportive tissue. This will quickly lead to pain in the forefoot when standing on any hard surface. The most simple solution is to wear shoe gear whenever walking or standing. Accommodative orthotics can also be used for the management of this condition.

All Color Changes to Nails Are Not Fungal

Do you have a nail that started to change shape or color? Did you notice that no matter what you do, the nail continues to grow back irregular? These could be signs of a fungal infection, or they could be signs of something far more serious.

Changes to our nails can be the first indicator of a deeper issue or problem. Whereas all nail changes do not suggest a severe medical condition, there are some nail changes that require seeing a doctor as soon as possible. It is important to know what to look for and when to seek medical attention. The first key finding requiring medical attention would be a color change to the nail, especially if that color change involves the skin surrounding the nail. Sometimes melanoma (a form of skin cancer) can occur at the base of the nail or involve the skin under the nails. This can only be definitively diagnosed with a nail biopsy by a doctor. If you have noticed color changes to the nail resulting in the presence of a dark brown or black pigment, you should schedule an appointment to see a doctor. Other color changes such as the presence of a thickened yellow nail may suggest a fungal infection. If you notice that the nails have changed to a yellow color, then check under the end of the nail. Do you notice any yellow or white debris coming from under the nail? If so this could be signs of a fungal infection.

It is very important to note when the nail change occurred and what was happening, if anything, at the time of the change. It is well-documented in the clinical literature that acute trauma to the nail bed or base of the nail called the eponychium, can result in nail changes. If you have noticed that the nail has become painful and black / blue after trauma to the nail, this could be signs of bleeding under the nail as well as a possible nail bed laceration. Nail bed lacerations, or tears in the skin under the nail, should be repaired as soon as possible. The blood that is pooling under the nail from the injury must also be removed. This condition, a subungual hematoma, can suggest a fracture of the distal phalanx (the bone at the end of the toe) requiring immediate medical attention.

Sometimes individuals do not recall a specific moment of trauma to the nail, but do note the presence of black and blue nail changes consistent with that of a bruise. This is notably common in patients with microtrauma from ill fitting shoe gear. Although these patients do not readily recall a moment of acute trauma, the repetitive insult to the nail complex leads to bleeding under the nail. It is best that any form of dark color change to a nail be thoroughly investigated by a medical professional.

Are you worried you may have fungal nails?

Fungal nail infections are a common condition that affects about 10% of the population. Onychomycosis, the medical term for a fungal nail infection, may begin as a white or yellow spot under the end of the nail and then spread to the entire nail if not treated appropriately. Many cases of toenail fungus are benign, but that doesn’t mean getting a fungal infection on your toenail isn’t bothersome. No one wants toenail fungus, so understanding some of the common signs, causes, and ways to prevent toenail fungus is imperative for maintaining good hygiene.

Common signs of fungal toenails include:

· Discolored toenails or nails that are yellow, brown, or white

· Thick nails

· Brittle nails

Dermatophytes, a type of fungus, are the most common cause of fungal nail infections, but they don't always initiate the infection. They can also develop in the setting of recent nail trauma.

Some of the most common causes of toenail fungal infections are:

· Yeast and mold infections, however these are usually opportunistic and not necessarily the causative agent when present.

· Toenail injuries or toenail surgeries

· Reduced blood circulation to the feet

· Foot fungus (Athlete’s foot) that starts in the feet and spreads to the toenails

· Excessive foot sweat

· Walking around barefoot in communal areas like gym locker rooms, showers, and swimming pools

While anyone can get toenail fungus, it is important to note that some people are at greater risk for developing fungal toenail infections. Older adults, individuals with a history of Athlete’s foot, people who visit locker rooms on a regular basis (i.e., gymgoers), and runners may have a higher chance of developing toenail fungus.

How to Prevent Toenail Fungus from Developing

Age, genetics, and lifestyle all play a role in why people may develop toenail fungus. That said, there are things you can do to prevent toenail fungus from developing. Some tips to avoid toenail fungus include:

· Keep feet clean, dry, and moisturized with a natural daily foot cream.

· Do not share nail clippers with other people.

· When trimming your own nails or getting a pedicure at a nail salon, make sure to trim nails. straight across and smooth down edges with a file.

· Wear sweat-absorbent socks made from breathable materials. This is especially important for long-distance runners, who tend to be prone to toenail fungal infections.

· Wear shoes or flip flops in common areas like pools and locker rooms to avoid bacterial infections.

· When getting a pedicure, make sure you go to a nail salon that uses new or sterilized tools for each customer.

If you are concerned about nail fungus, schedule a consult with us today at Quantum Foot and Ankle Group 201-571-0900