Sesamoids are small bones that are connected only to tendons or are embedded in muscle. This structure appears in only a few places in the human body, one of which is the foot. Two very small sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the big toe—one on the outer side of the foot and the other closer to the middle of the foot. Sesamoids provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. In the foot, sesamoids assist with weight-bearing and help elevate the bones of the big toe.
Like other bones, sesamoids can fracture. Additionally, the tendons surrounding the sesamoids can become irritated or inflamed, which is called sesamoiditis and is a form of tendonitis. Sesamoiditis is a common condition among ballet dancers, runners, and baseball catchers because of the pressures placed on their feet.
- Pain under the big toe or on the ball of the foot.
- Swelling and bruising.
- Difficulty and pain in bending and straightening the big toe.
Surgery is usually not required to treat sesamoiditis. Treatments generally include:
- Discontinuation of the activity causing the pain and inflammation.
- Over-the-counter pain medications and anti-inflammatories, such as ibuprofen and aspirin. Note: Please consult your physician before taking any medications.
- Icing the sole of the foot.
- Wearing shoes that are soft-soled and low-heeled.
- Using cushioning in shoes to relieve stress.
- Injection of a steroidal medication to reduce swelling.
If symptoms persist, you may need to wear a removable brace on the leg for 4-6 weeks to give the inflammation time to subside and the bones to heal.
Plantar fibromas are benign tissue tumors or growths on the plantar, or bottom surface of the foot. Unlike plantar warts, which grow on the skin, these grow deep inside on a thick fibrous band of ligaments called the plantar fascia. The presence of the tumor can cause pain or pressure on other parts of the foot structure that can lead to other foot problems.
Nonsurgical measures used in treating plantar fibromas often fail to provide adequate relief of symptoms. At the same time, surgical correction can lead to further complications, such as plantar nerve entrapment or larger and recurrent fibromas that may be worse than the original problem.
A relatively new procedure applies cryosurgery to freeze and shrink the tumors and is gaining in popularity. This short, outpatient treatment causes minimal to no postoperative pain or disability. Patients return to wearing regular shoes within 24 to 48 hours after cryosurgery.
Metatarsalgia (foot pain in ball)
Pain in the area between the arch and toes, or ball of the foot, is generally called metatarsalgia. The pain usually centers on one or more of the five bones (metatarsals) in this mid-portion of the foot. Also known as dropped metatarsal heads, metatarsalgia can cause abnormal weight distribution due to overpronation.
Metatarsalgia occurs when one of the metatarsal joints becomes painful or inflamed. People often develop a callus under the affected joint. Metatarsalgia also can be caused by arthritis, foot injury (from sports, a car accident, or repeated stress), hard surfaces (cement or tile floors), and specific footwear (rigid-soled work boots).
A simple change of shoes may solve the problem. In more severe cases, custom orthotics may be prescribed to alleviate the pain and prevent overpronation.
Flat Feet (over pronation)
Flat feet are a common condition of the foot structure. In infants and toddlers, prior to walking, the longitudinal arch is not developed and flat feet are normal. Most feet are flexible and an arch appears when children begin standing on their toes. The arch continues to develop throughout childhood, and by adulthood most people have developed normal arches.
Flat feet are generally associated with pronation, a leaning inward of the ankle bones toward the center line. Shoes of children who pronate, when placed side by side, will lean toward each other (after they have been worn long enough for the foot position to remodel their shape).
Many people with flat feet do not experience pain or other problems. When pain in the foot, ankle, or lower leg does occur, especially in children, the feet should be evaluated.
Painful progressive flatfoot, otherwise known as tibialis posterior tendonitis or adult-acquired flatfoot, refers to inflammation of the tendon of the tibialis posterior. This condition arises when the tendon becomes inflamed, stretched, or torn. Left untreated, it may lead to severe disability and chronic pain. People are predisposed to tibialis posterior tendonitis if they have flat feet or an abnormal attachment of the tendon to the bones in the midfoot.
Nonsteroidal anti-inflammatory medications, icing, physical therapy, supportive taping, bracing, and orthotics are common treatments for painful progressive flatfoot. Note: Please consult your physician before taking any medications. In some cases, a surgery may need to be performed to repair a torn or damaged tendon and restore normal function. In the most severe cases, surgery on the midfoot bones may be necessary to treat the associated flatfoot condition.
Capsulitis is an inflammation of the ligament on the bottom of the foot. It is usually caused by trauma or abnormal structural functioning, which overstretches the ligament that attaches one of the toe bones to a metatarsal bone. Wearing high heels or other poorly fitting footwear and performing repetitive activities that bend the toes, such as ladder climbing, are also known causes.
Pain in the forefront of the foot is the most common symptom of capsulitis. Capsulitis is often misdiagnosed as Morton’s neuroma because of similar symptoms.
Noninvasive treatments are used to resolve capsulitis, including:
- Wearing low-heeled shoes with firm soles that fit properly.
- Decreasing or temporarily discontinuing the activity responsible for the onset of the inflammation.
- A short course of oral anti-inflammatory medication. Note: Please consult your physician before taking any medications.
- Cortisone injections.