Any ideas for treating persistent ball of foot pain?

February 23, 2021 7:08 PM

I have had persistent ball of foot pain in the joint of my second toe for the past two months. After trying almost all the more conservative treatments, I'm wondering if there's anything else I can try that isn't surgery. Any ideas?

Since December, I have had ball of foot pain in my left foot and I have tried the following things:

-An oral anti-inflammatory
-Rest
-Ice
-Supportive shoes
-Buying shoes with a wider toebox
-Wearing a CAM boot (still wearing it)
-X-ray, which showed no fractures
-MRI, which indicated inflammation in the area causing me pain
-Cutting down all unnecessary activity and Instacart-ing like a champ

I have seen two podiatrists at this point. My first doctor was nice, but after she suggested a metatarsalgia pad on Amazon which I had tried even before I went in to see her, I figured it might be better to move onto another doctor who had a wider variety of pain treatment services to offer.

I am now working with my second doctor who also gave me a splint to help support my problem area (to wear with the CAM boot), which is helping at the moment, but ultimately I am trying to find a long-term solution to my pain. He recommended MLS Laser therapy, which has supposedly had good results for others but I am two sessions in, and I am becoming increasingly pessimistic about this treatment, just because nothing so far has worked and I would not be surprised if the laser treatment does not work either. The doctor mentioned that if the laser treatment doesn't take, I may need to consider surgery. I really, really, really do not want to have surgery. Has anyone experienced a similar issue and have ideas about what I could try?

If it's relevant, I am a 31-year-old female and otherwise healthy and at a healthy weight. I am not sure exactly what caused this problem, but I was on my feet a lot on the day that the pain started, and for several months prior to that I had been dancing for exercise for several months, sans shoes (stupid mistake, I now realize), which never caused me pain before, but I figure maybe this current pain is a cumulative effect of my exercise?

My insurance actually does cover orthotics, which my first doctor looked into and confirmed, but we both decided (early on, when it seemed like this would not be such an ongoing problem) that I didn't want to go that route. I will take the damn orthotics if it means I can stop wearing this boot!

Also, I am not interested in getting a cortisone shot, as I'm afraid it may do more damage than good over the long-term.

Given all that, should I seek physical therapy as alternative? I have committed to a series of these laser treatments, but after that's done, and if they don't work out, should I seek out yet another foot doctor for a second opinion to see if anything else could be done?

posted by dean_deen to Health & Fitness (13 answers total)

Probably Morton’s Neuroma; link goes to Mayo Clinic site on symptoms, diagnosis and treatment.

You’ve tried some conservative treatments without help. Steroid injection, in my experience, is about 70% effective. No reason to suffer - try it once. That is unlikely to cause any complications. Repeated injections can cause problems, however.
posted by sudogeek at 7:27 PM on February 23, 2021 [3 favorites]

these insoles have helped me a lot; you can remove the bit right under where your foot hurts, so that part doesn't strike the ground.
posted by fingersandtoes at 7:38 PM on February 23, 2021

I had Morton's Neuroma and tried for months to tough it out. Nothing helped. It cleared up completely after two steroid injections. If that's what you have I would consider taking the shot.
posted by Mender at 8:05 PM on February 23, 2021 [1 favorite]

I have Morton's neuroma and steroid shots made it way worse. What improved it was working with a good pedorthist to make and tweak (multiple times, over months) an excellent pair of orthotics that took pressure off the neuroma.

As you can see from Mender's comment YMMV, but personally there's no way I would have foot surgery before working with a pedorthist for at least a year (foot stuff can be slow to heal).
posted by medusa at 8:24 PM on February 23, 2021 [2 favorites]

For my Morton's neuroma, orthotics + acupuncture was what worked. The steroid shot didn't.
posted by kbuxton at 10:16 PM on February 23, 2021 [1 favorite]

Did either podiatrist give you a diagnosis? From your activity it sounds more like a torn plantar plate than Morton's neuroma. My DPM recommended Hoka One Ones with orthotics for me when I damaged my plantar plate on a backpacking trip. The rocking sole of the Hokas made a huge difference, so much so that I don't bother with the inserts anymore. I wear them at home in order to work at a standing desk - my left foot protests if I go barefoot too long. I wear them hiking too, no pain for miles. This was several years ago and I will buy new Hokas every year from here on out if it means no foot surgery. Don't buy off the shelf - if you decide to try Hokas, get properly fitted at a running store where they know what you are dealing with and will let you exchange them until you find the model that works for you.
posted by headnsouth at 11:32 PM on February 23, 2021

I really dig the work of gait, foot function and biomechanics people. Not sure where you are but hopefully you can find someone in network. They tend to work as PTs.
posted by lokta at 1:33 AM on February 24, 2021

Definitely try PT!

I was afraid I had Morton’s Neuroma when I got ball-of-foot pain this summer (after doing a bunch of standing around barefoot on hard surfaces and trail running on rocky surfaces). I had one telehealth visit with some random person at my PCP’s practice (because health services in the pandemic, ugh), and she didn’t think it was MN because I didn’t have any pain if I squeezed my foot sideways (this is apparently a significant feature of Morton’s neuroma). She sent me for an X-Ray to check for a stress factor - this was negative. She also recommended metatarsal pads - I ordered a bunch of different ones because I had lots of FSA money, and some of them helped me feel better (I liked the ones that stick to your foot or that you tape to your foot - I can’t get the in-shoe kind to stay put).

No one recommended PT to me (though I’m sure I could have gotten a referral if I’d asked) but I also started doing a bunch of PT exercises for metatarsalgia on my own and I think that helped a lot (mostly calf stretches - I have tight calves anyway, so the stretches were familiar to me). I kept this printout in my bedroom.

The pain lasted for months (sometimes intense, sometimes just uncomfortable, and this was happening at a really difficult time in my life, too, yay) but it did go away. I try to wear slippers around the house now and I’ve switched from super-thin running shoes to regular light trail shoes, but otherwise I didn’t have to do anything drastic. I do try to keep up with the stretches but I don’t do them daily anymore.
posted by mskyle at 3:03 AM on February 24, 2021 [1 favorite]

I had terrible pain in the balls of both feet -- it felt like golf balls were in there! A good podiatrist helped by diagnosing as not MN but inflamed tendons. Custom orthotics and never ever again wearing heels higher than an inch (sob!) were the answer for me.
posted by Dolley at 5:51 AM on February 24, 2021

Response by poster: Thanks for your responses so far, everyone-you're giving me new ideas to consider. Please keep 'em coming! Morton's Neuroma has not been brought up by either doctor, but based on what I've read about it, I am fairly certain I don't have MN. It's more an inflamed tendon issue.
posted by dean_deen at 5:55 AM on February 24, 2021

One upon a time I had severe pain in the ball of my foot below my big toe. X ray showed I had a split sesamoid bone, but inconclusive on whether that was recent or old or ideopathic. At any rate, it was quite inflamed. I spent 6 mouths trying a lot of things, pads, the boot, etc. Then at some point a steroid shot, which fairly miraculously just ... worked. Pain gone, and it's stayed gone (with the caveat that I fell and broke my back a few weeks later, so the foot had a while to heal while I was in hospital). Seems like it just needed the shot to take down the inflammation, then my body did the rest from there, and now doesn't care whether that little bone is split or not. So give the shot a try - at any rate, the lidocaine that's also in it will be diagnostic.
posted by Dashy at 6:21 AM on February 24, 2021

If you don't want a cortizone shot, would you be open to oral steroids? They can work well for gout flares, so I don't think a shot is required to work on your feet.
posted by soelo at 7:34 AM on February 24, 2021

Look into trigger point self-massage therapy - you may have a sample interosseous trigger point or maybe a flexor digitorum longus trigger point (which is actually coming from a muscle in the calf). I'd look into a good orthopedic acupuncturist as well.
posted by Jaclyn at 8:56 PM on March 15, 2021