Ask the Doc
By Dr. Lou Pack
‘The balls of my foot hurts. I’ve been told I have arthritis and need surgery. Is there any alternative?
For our readers, the “ball” refers to the bottom of the foot just behind the toes, and it’s one of the more common areas for foot pain, especially as we age. Usually, 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 foot at the ankle, bending it 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 as well as calluses can develop on the bottom of the foot. 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.
You may have a tight calf muscle and not even realize that you are functioning this way.
But if you think about it, you may have noticed that you trip sometimes or drag your feet more than you used to. This might be especially noticeable 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 tight calf muscles and padding just behind (not on) the painful area on the bottom of the foot is often very helpful. In severe cases, injections of small amounts of cortisone into the area can be quite effective. And the use of fully custom foot inserts to redistribute the weight is often very beneficial. The combination of these therapies can often allow you to avoid the surgery you mentioned.
A former Clinical Instructor of Medicine at Emory, Dr. Pack practices at MCG Medical Associates, at Reynolds Plantation. He works with patients who have arthritis and wish to decrease joint symptoms and remain active. He also treats athletes at all levels, including Olympic gold medalists, and helps the UGA Golf Team. For further information please see his Web site at www.drloupack.com, or call (706) 454-0040.
PUBLISHED IN THE FEBRUARY 12, 2009 EDITION