Musculoskeletal (MSK) Pain: Forefoot Pain (Ball of Foot)
Forefoot pain is a common issue that affects individuals of all ages and can arise from various causes. Sometimes referred to as metatarsalgia by medical professionals, this condition signifies musculoskeletal pain and inflammation in the front part of the foot (forefoot). The forefoot, which encompasses the toes and the ball, is crucial for daily activities. Discomfort in this area can significantly hinder everyday tasks, making walking, running and even wearing shoes challenging.
While forefoot pain can result from various factors, including injuries, unsuitable footwear, and underlying medical conditions, this article will focus on forefoot pain (pain in the ball of the foot, primarily on the sole), which is a common musculoskeletal pain associated with running.
Causes of Forefoot Pain in Running
Forefoot pain is usually caused by
- Footwear: Poorly fitting shoes can cause pressure and strain on the forefoot.
- Coaching Cue: an uneducated instruction like “hit the ground” in an attempt to “produce force” contributes to this type of pain.
- Running technique: specifically, the way one lands while running plays a significant role.
Gaining insight into these factors can aid in the effective and timely prevention and management of forefoot pain, provided one is willing to invest some time and effort.
Symptoms
The most common symptom of forefoot pain is discomfort or tenderness on top, the bottom or both sides of the front part of the foot. Additional symptoms may include swelling, redness, and difficulty bearing weight on the affected foot.
If you experience any tingling or loss of sensation in your foot, it’s advisable to consult a medical professional to ensure that there isn’t a more serious issue at play.
Reasons to Seek Urgent Care:
- You experience severe pain in the ball of your foot.
- You find it very difficult or impossible to walk.
- Your foot appears to have changed shape and/or color.
- You heard or felt a snap, grind, or pop at the moment of the injury.
- You may experience faintness, dizziness, or nausea as a result of the pain.
These symptoms may indicate a possible fracture and would require medical attention.
Luckily, in most cases, you can be confident that you can manage your forefoot pain independently.
Solutions for Forefoot Pain Relief
The treatment for musculoskeletal pain in forefoot will depend on the underlying cause, however, there are a couple of things you can do immediately to feel better. Regardless of the cause of forefoot pain, your feet will thank you if you:
- Do a warm/hot foot bath with epsom salt and/or calendula oil. The oil has anti-inflammatory, as well as antibacterial and antifungal properties and will make your skin feel better.
- Do a foot massage and
- Put your feet up for 10-15 minutes
Check Your Running Shoes
Let’s address the obvious: one of the most frequent causes of forefoot pain during running is wearing improperly fitting shoes. Your body relies heavily on your feet during movement, carrying your full weight with each step. When your feet make contact with the ground, the forefoot is designed to support this by allowing your toes to spread, preventing each landing from feeling like a hard brick hitting the floor. Therefore, it’s crucial that your shoes offer enough width to accommodate the natural expansion of your foot, particularly around the forefoot, with every step you take.
- Invest in better-fitting shoes that provide ample width in the toe box, which may mean sizing up, but focus specifically on the width.
- Adjusting your lacing can significantly impact comfort; try loosening the laces near the toe box and tightening them as you move toward the ankle.
- Visit local stores to try on shoes to ensure a proper fit and comfort.
- When shopping online, don’t rely solely on labels marked ‘wide,’ as they may not accommodate your feet adequately. It’s crucial to explore various brands and styles to find the best fit.
- Avoid cushioned shoes, avoid bells and whistles like carbon plates etc. Instead go for simpler designs, with more room and less fanfare.
While I always say that comfort is the most important thing about any running shoe, I do want to emphasize that too much cushioning is never a good thing. It dulls your perception on support, and makes each ground contact less balanced which makes your forefoot work more than it needs to. You might think and feel that your feet feel better with all that foam under it, but in reality, that cushioning is masking the real issue of why you developed the forefoot or foot pain in the first place, and encourages careless motion (incorrect technique/movement) so eventually another part of your body like an ankle, knee or hip, will take one for the team so to say.
All of the above advice applies equally to the shoes you wear on daily basis. Ensure that your footwear allows for proper forefoot movement and function. Wearing narrow dress shoes or regular shoes consistently will inevitably result in foot pain and possibly foot deformities.
Avoid This Coaching Cue
There is unfortunately a coaching cue in existence these days that may lead to forefoot pain. Often it also causes what is generally referred to as shin splints. This cue stems from poor understanding of physics and biomechanics.
The coaching cue in question is “to hit the ground / put more force into the ground”. Do NOT do it.
This cue shows a significant misinterpretation of established laws of physics and well known information in biomechanics. There is a wealth of research and educational information available that highlights the erroneous assumptions in the idea that by hitting the ground harder the runner will get more force returned and that it will increase speed. In science and research, excessive ground reaction force is a well known factor in lower extremity injuries. However, coaches and runners who promote the idea of striking the ground harder, chose to ignore research and available educational information. Yes, it is correct that fast runners, and sprinters specifically, register higher ground reaction force on landing, but it is because they run fast. Their speed is the cause of higher ground reaction force. Not the other way around.
This article will not explore this topic in depth, because it requires more than a few words to adequately lay it out. My simple and straightforward recommendation is to avoid following or using this cue.
Clean Up Your Running Technique
Focusing on the central theme of this article, let’s explore the changes that can be made if you experience musculoskeletal pain in the forefoot part of your feet during or after running.
The goal of running is to go from point A to point B. To achieve that we need to displace our entire body in a given direction. So as we fall forward, we change our support from one foot to the other so we don’t fall down as our center of mass is relocated. Ultimately, how we change support plays an important role in how well we run.
A) Ironically, focusing on how you land or how your feet strike the ground, has a negative effect that produces a forceful landing which eventually leads to musculoskeletal pain in your feet among other things.
The physical reality is that
- your feet will drop down on their own
- on top of that, it will happen with better timing if you stop trying to control it.
Pain in forefoot comes from heavy landing whether it is done on purpose (as by following erroneous coaching cue described above) or while trying to land correctly. Either way, focus on landing is the culprit.
- Do NOT focus on landing
- Do NOT try to land on forefoot or flatfoot (sometimes erroneously referred to as midfoot, which is the arch of the foot)
Correct landing is simply one of the parts of correct running technique. Running involves our entire body, not just legs or feet so you should not separate how you land from how you run. Practice correct running technique, and correct landing will happen.
B) Another technique error that leads to musculoskeletal pain in forefoot or ball of foot is attempting to land on just the forefoot, or the toes, and preventing your heel from touching the ground. This tactic actually results in more problems than just musculoskeletal pain in the forefoot. It usually strains the achilles tendon, as well as your calves. So all the more reasons to not do it.
Instead
- DO maintain your weight on your forefoot
- DO allow your ankle and heel to perform their own part of this equation – maintain balance and accommodate overall movement.
In sprinting, it only looks like runners run on their toes or their forefoot, but that is simply the result of speed that comes with short ground contact time. So there is no time for the ankle and heel to drop lower. Sprinters do not actually make any effort to prevent their heels from touching the ground.
C) Another distinctive feature of elite runners – regardless of their chosen distance – is lack of pounding noise when they run. This directly contradicts the common description of running among recreational runners – they talk about running as ‘pounding the pavement’ or ground.
Running is not pounding. Running is a skill based sport. This choice of words points to one of the most important differences between recreational runners and elite level runners – level of skill. But I would even say presence or absence of it, rather than differences in level.
- Do NOT pound the pavement
Instead
- DO stay light on your feet
How? What aspect of running skill enables a lighter, quieter footfall? How can we avoid pounding the pavement if we should not focus on landing? In essence, it’s about learning how to run properly. To be specific, in order to minimize ground impact and noise, the part of running technique that you should focus on is pulling your support foot off the ground. This simple adjustment will significantly reduce the sound of your landing, as well as impact.
D) And here’s one more common cause of musculoskeletal pain in the ball of your foot. It is very poorly understood and nobody talks about it – resisting falling forward. Watch this video to see the mechanism in action.
To learn to fall forward a runner must get comfortable with the idea of free falling. Majority of people will lean back to resist falling. It is a deeply ingrained instinct to protect oneself stemming from the days of childhood when parents would yell – don’t run you’ll fall! Kids are absolutely ok with falling, it is parents who are not. It is a learned behaviour. However, movement is change of support as we allow our body mass to fall in the desired direction. So, in running we fall (not lean) forward and have to change support to keep falling and keep moving.
When a runner resists falling, the resistance has to have support, some part of your body must provide it – so that role goes to the forefoot. To run a few miles is to make a few thousand steps with that repetitive pressure on the forefoot with each step. Voila – musculoskeletal pain incoming.
When it comes to cleaning up your running technique, it should be done in training sessions, so that when you actually run, you focus on just one thing – pulling. In order to effectively and efficiently change support to keep running all the while staying light on your feet and avoiding any musculoskeletal pain:
- Pull your feet from the ground
This key element is integral to your running skill and should be approached accordingly. There are various drills and exercises designed to help you master this element. Improvement won’t happen on its own, especially since many people today are significantly impacted by a sedentary lifestyle.
Conclusion
Forefoot pain is a manageable issue that can usually be addressed by everything written above, but more often than not, by specifically improving your running technique.
General Recommendation For Foot Health
One of the best habits you can adopt is to spend more time barefoot or in socks (to keep your feet warm). This simple practice is an effective way to build some foot strength and promote better foot health. Simply remove your shoes while sitting at the office or working from home, and embrace being barefoot at home as much as possible.