Lake Oconee Breeze

Ask the Doc

March 10, 2010

The ball of the foot is a common area for pain

By Dr. Lou Pack Lake Oconee Breeze

LAKE OCONEE — “The ball of my foot hurts. I’ve been told I have arthritis and need surgery. Is there any alternative?”



The “ball” refers to the bottom of the foot just behind the toes.  It’s one of the more common areas of foot pain, especially as we age.  And in most instances, surgery can be avoided.

The most common cause of pain in this area is a tight calf muscle.  This might seem like a “stretch” (no pun intended) but when the calf muscle is tight (and most people have this to some extent) it becomes difficult to bend or flex your ankle upward when walking. So with each stride, instead of flexing at your ankle, you contract your toes bending them upward.  When this happens, the bones just behind the toes (metatarsals) are pushed downward.  At the same time the natural fat pad is moved forward leaving those bones unprotected.

As the toes become more contracted and pressure continues, a painful bursitis can develop on the bottom of the foot.  Painful calluses can also be seen in this area.  And in the final stages, if left untreated and unprotected, ulcerations or sores may occur in those with compromised circulation (like Diabetes).

In addition, as the toes become rigid and fixed in this contracted state, painful corns (areas of hardened thick skin) may occur on tops of the toes.  These can be as problematic as the symptoms on the balls of the feet.

Tight calf muscles can cause you to trip or drag your feet especially when wearing rubber soled shoes and walking on carpet.  So this isn’t always simply due to old age or being clumsy, but again, to an inability to flex or bend at your ankle.

You may also notice that the ends of your shoes sit up off the ground and that the very ends of your shoes (on the bottoms near the toes) are worn excessively.

Stretching and padding just behind the painful area on the bottom of the foot is often helpful as is fully custom foot inserts to redistribute weight.  In severe cases, injecting cortisone can be effective.  These therapies can often help you avoid surgery.



— A former reconstructive foot and ankle surgeon and past clinical instructor of Medicine at Emory, Dr. Pack practices at MCG in Greensboro. He works with patients who have arthritis and wish to decrease joint symptoms and remain active without medication or surgery. Dr. Pack also treats athletes at all levels. In the 2004 Olympics he had a silver and gold medalist, and helped the UGA Golf Team (2005 NCAA national champions). For further information please see www.drloupack.com, drloupack.blogspot.com or contact him directly at (706) 454-0040.

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