Forefoot pain can be very disabling. There are many conditions that can cause pain.
FOREFOOT PAIN //
HALLUX VALGUS OR BUNIONS
The “bunion” is formed by a bone in the big toe moving out of place. The big toe or hallux then pushes towards the little toes or into valgus hence the medical name hallux valgus.
Many patients who have hallux valgus have no symptoms. There is no need to do anything about hallux valgus until it causes symptoms.
To correct hallux valgus, the bone that has rolled out of place must be moved back into the right place and held in position with special screws until the bone heals.
STIFFNESS IN THE BIG TOE OR HALLUX RIGIDUS
A painful and stiff big toe is very disabling. Patients complain of inability to wear many shoe types and pain in the big toe especially when walking.
In the early stages, insoles and injections and perhaps physiotherapy to address the amount of weight you put through the big toe are very helpful treatment.
Patients with moderate to severe arthritis who cannot manage anymore with insoles and shoe modifications may come to surgery. The most common surgery performed is a 'cheilectomy' or clean up of the joint. The major advance is that many patients opt to have a little spacer inserted into the joint to stop the joint surfaces from grinding against each other.
Some Patients with very severe deformity and arthritis have very little function from their hallux and these patients make require a joint fusion.
CROSS OVER OR DISLOCATED 2nd TOE
The 2nd toe can dislocate. The toe sits on top of the foot and often crosses over the hallux. Most patients have a very painful lump in the ball of the foot and feel like they are standing on a pebble every time they stand.
There are many conservative options and there is a surgery to rebuild the front of the foot and it is normally referred to as a fore foot reconstruction.
PLANTAR PLATE TEARS
Some patients have forefoot pain under the ball of the foot and feel as though they are walking on a stone with every step (even though they don't have a bunion or toe deformity). The plantar plate can tear and when walking the metatarsal head can push through the hole in the plantar plate and produce pain with every step. The plantar can also degenerate and split as well as tearing.
Insoles, physiotherapy to address biomechanics and perhaps a one injection of steroid to help the insoles settle your pain faster are the main treatments.
In the old days, the surgical treatment was a forefoot reconstruction but it is possible to reattach the plantar plate. It is rare to recommend this treatment.
A Mortan's Neuroma is a painful thickened nerve in the forefoot. Often the nerve is being crowded by a bursa (little soft tissue collection of fluid). Neuroma's can range from small to large. Small Neuroma's often resolve with an ultrasound guided injection of steroid.
Insoles and physiotherapy to address your biomechanical abnormalities can be incredibly helpful.
Ingrowing toenails can cause patients significant pain and problems. If a patient has been on several courses of antibiotics it may be necessary to do a small procedure on the toenail.