FOREFOOT & TOES
Conditions
Hallux Rigidus (Stiff Big Toe)
Your big toe is designed to bear up to 1/3 of your body weight during propulsion or push off. It provides stability when standing ang generates force during walking. Various types of injury cause the joint surfaces to break down over time. Hallux rigidus or “stiff big toe” is a degenerative change to the big toe joint, where the toe attaches to the foot. It gets worse over time, causing the motion in the joint to decrease and ultimately, walking, running or even standing becomes painful.
Common Issues
- It is the second most common disorder, behind bunions (hallux valgus).
- Develops because of overuse (like squatting at work), repeated trauma (like kicking the ball in soccer) or inheriting a foot type or gait abnormality
- Rheumatoid arthritis and gout are also causes
- Occurs in adolescents and adults and is most common in people between the ages of 30 and 60.
Symptoms & Signs
- Pain is localized to the big toe joint
- Gradual loss of motion occurs, especially in extension (raising the toe)
- Cold damp weather can make it feel worse
- Swelling and inflammation when it is irritated
- A bump (osteophyte), like a bunion or spur, forms on the top of the joint
- Fitting your foot into cowboy boots or shallow footwear becomes difficult
Treatment
- Custom foot orthotics with a rigid extension under the big toe joint helps limit motion
- Rockered soled footwear also help limit extension of the joint
- A rigid toe plate (turftoe insert) can help limit motion
- Avoiding activities that exacerbate the condition, like soccer
- Anti-inflammatories
- Surgical fusion or removal of the spur on the top of the foot
Metatarsalgia
The metatarsal bones are the 5 long thin bones that connect your foot to your toes. Metatarsalgia is likely the second most common reason people call our clinic, seeking an appointment with Brad. It is a general term and not a diagnosis. It refers to pain and/or burning across the ball of your foot, usually involving your metatarsal bones.
Common Issues
- Intense activity(sudden increase in standing, walking or running), trauma(high heeled shoes, crush injuries) or foot structure(callused metatarsal heads, high arches, bunions) are the typical causes
- May involve the joint capsule(encompassing the weight bearing surface of the metatarsal head – capsulitis), or the joint lining between the metatarsal and the toe(synovitis) or the midshaft of the metatarsal(stress fractures)
- Most commonly involves the 2nd metatarsal or 2nd metatarsal joint
Symptoms & Signs
- Pain and/or burning sensation across the ball of your foot (forefoot)
- Sharp or shooting pain into your toes
- Tingling or numbness in your toes
- Swelling or redness over the top of your forefoot (may indicate a metatarsal stress fracture) in your toes
Treatment
- Changing or avoiding the activity
- Changing to lower heeled footwear or thicker midsole for added cushioning
- Custom foot orthotics that redistribute weight off the affected structure
- Footwear modifications that include a rockered sole modification to mitigate weight transfer
Morton’s Neuroma (interdigital neuroma)
An interdigital neuroma is a mechanically induced compression injury to one of the nerves that feed sensation to the toes. It is a development of fibrous tissue surrounding the nerve. Although it can occur between any 2 toes, it is typically seen between the 3rd and 4th toes.
Common Issues
- Develops in response to repetitive irritation, pressure or trauma (possibly from wearing poor fitting footwear or high heels)
- Common condition affecting women more than men
- More likely to occur in adults over the age of 30
- Can occur in more than one area of the foot and can occur in both feet
- Ultrasound is an accurate diagnostic test
Symptoms & Signs
- Sharp, dull, or throbbing pain at the ball of the foot
- Tingling or numbness beginning at the ball of the foot
- Symptoms may radiate into the adjacent toes, described as shooting pain
- A perceived “lump” or the feeling of walking on a rolled-up or wrinkled sock
- Immediate relief with walking barefoot or massaging the area
- A widening between the 2 adjacent toes
Treatment
- Reducing the pressure on the area is the goal of treatment
- A metatarsal pad placed strategically is effective
- Greater effectiveness is achieved with custom foot orthotics
- Wider footwear with a deeper toe box
- Radiofrequency ablation, ultrasound guided injection of steroid and anaesthetic, and surgery are alternative, invasive options
Toe Deformities (Claw Toes / Hammer Toes)
Your lesser toes are all the toes except the big toe. Lesser toe deformities can be caused by internal or external factors. The two main types of lesser toe deformities are claw toe and hammer toe.
Claw toes: a deformity involving both joints of the toe, where they are permanently flexed.
Hammer toes: a deformity involving only the 1st joint being flexed.
Mallet toes: much less common, only the 2nd joint is flexed
Common Issues
- Poorly fitting shoes, mainly too small, is one of the most common causes
- Other causes include muscle imbalances, tight tendons, arthritic conditions and neuromuscular factors
- Often occur with bunions and hallux valgus deformity
- 2nd toe may cross over the great toe in the case of hallux valgus
Symptoms & Signs
- Pain in the ball of the foot
- Painful corns on the top of the toe at the flexed joint where the toe rubs against the shoe
- Painful callus or corn at the tip of the toe
- Thickened or damaged nails
Treatment
- Custom orthotics with metatarsal support and accommodation for the toes
- Extra deep orthopaedic footwear with seamless and supple uppers and rockered forefoot
- Toe crests, separators and padding
- Shoe modifications including adding toe box material or spot stretching or rockered sole modification to mitigate pressure on the ball of the foot
- Custom footwear
- Stretching the involved and contributing tendons
The Ball of Your Foot
How does it work?
Hallux rigidus and Morton’s Neuroma are often progressive disorders and the pain can be quite limiting. Metatarsalgia is a term that encompasses many forefoot conditions. In general, forefoot disorders that fall under the term metatarsalgia, all have pedorthic treatment options.
Step 1
Book an Assessment
- Call us or book a pedorthic assessment online
- An assessment to examine your forefoot condition typically takes 30 to 45 minutes
- Bring or wear shorts (we also have shorts at the clinic)
- Bring 2 or 3 pairs of shoes that you wear most often, for work and play
- Bring your prescription, an x-ray report or CD
step 2
During Your Assessment
- Review the range of motion of your big toe joint, discuss your x-ray or MRI results
- Examine your muscle strength, structural alignment, joint ranges of motion and how you walk
- Answer any questions you may have
- Discuss the various options, including orthotics and footwear
- Perform physical tests to inform and rule out stress fractures or verify the neuroma
step 3
Enjoy a Better Quality of Life
- You’ll receive your orthotics in approximately 2 weeks
- Within a few weeks of wearing them, you should be feeling less discomfort in your big toe joint(s)
- We may have you come back for a follow up
- At any point in the future, we encourage you to return for any necessary adjustments and service the orthotics from time to time.
Frequently Asked Questions
Yes. There are options that include fusing the joint or removing the spur on the top of the joint to improve motion and reduce pain
Neuromas are permanent structural changes to the tissue around the nerve. Orthotics can help to manage or reduce the pain.
Dress shoes are often a contributor to forefoot pain. Ideally, wearing well designed orthotics in thicker soled shoes with a lower heel is best. We can provide orthotics that fit into dress shoes and help to improve comfort.
Ready to Get Started
Request An appointment
Assessments are typically 30 to 60 minutes depending on your ailment and your needs. Bring shorts to change into if necessary. Bring the footwear that you work in, and the footwear that you wear after work. If you have the prescription or referral from your referring medical professional, and the x-ray or MRI report, please bring them as well.