FOREFOOT PAIN

NEUROMA
A neuroma is the most common cause of forefoot pain. It is an enlargement of one or more of the sensory nerves that provide innervation to the central three toes and to a portion of the bottom of the forefoot.

A neuroma often causes a "clicking" feeling in the foot as if the toe is dislocating while walking. It may cause an area of numbness which causes a feeling of swelling. Often an individual will remove his or her shoe to remove a sock wrinkle from under the forefoot but will find no wrinkle in the sock.

Neuroma pain can usually be successfully treated conservatively. If conservative treatment does not provide enough relief the condition can be treated surgically.

STRESS FRACTURE
A stress fracture is a tiny crack that usually occurs in one of the central three bones in forefoot. It is usually associated with an increase in activity level. It is also known as a "march fracture" because it is frequently seen in military recruits and occurs because their activity level is dramatically increased during the rigors of boot camp.

This condition usually begins with rather mild pain in the forefoot which increases to quite severe pain within a few days. There is usually mild redness and swelling noticeable on the top of the forefoot. This condition will resolve spontaneously in most cases but is usually painful for two to three months.

This condition is not surgically treated and a cast is usually not necessary. X-rays can be normal if they are taken near the time the pain begins. This is a tiny crack in the bone that is usually not detectable on x-ray. X-rays taken 6 to 8 weeks after the injury occurs will show a thickened area of the cracked bone. This is the bone callus and is visual evidence that the bone was cracked and is now healing.

FAT PAD ATROPHY
This is a thinning of the normal fat pad that provides cushion between the bones in the forefoot and the weightbearing surface. In this condition calluses often form across the forefoot behind the toes. This condition is most painful during weightbearing barefoot on a hard surface such as the kitchen floor. The pain is relieved by a cushioned surface or putting your feet up.

The most effective treatment for this condition is a pair of good quality cushioning insoles and the most cushiony shoes you can find. Get as much cushion as you can between your foot and the ground. There is no surgical treatment for this condition.

BUNIONS
A bunion is a prominent bump on the inside of the foot behind the great toe. This prominence pushes on the shoe and can cause pain. The great toe usually seems to veer off toward the lesser toes and can cause pain by pressing upon the 2nd toe. Sometimes the great toe underlies the 2nd toe causing pain.

There is little that can be done for this condition conservatively. Shoe modifications can help. Surgical intervention is the most effective means of treatment for this problem.

TAILORS BUNION
A tailors bunion is a prominent bump on the outside of the foot behind the little toe. This prominence pushes on the shoe and can cause pain.

The most effective conservative treatment is spot stretching of the shoe. Most shoes can be stretched specifically at the area of prominence of the tailors bunion. This helps reduce pressure on the prominent area of the foot but does not make the shoe too wide for your foot.

If conservative treatment does not provide adequate relief this problem can be corrected surgically.