The ball of your foot endures repeated loading  and stress as you stand, walk and run. Standing on tip toes throws your entire body weight onto this area.

Repetitive injury here can damage the supporting structures, creating ache, burning or sharp pain. Sometimes you may sense of walking on a pebble or the feeling of something hard in your shoe. This is often aggravated by thin-soled flexible footwear or high heels. Hard thickened skin(corns or calluses) are often associated with localized pain. A frequent focus is under or in line with the second and or third metatarsals/toes.

This occasionally can be associated with the development of a hammer toe. Numbness of the second, third and or fourth toes may develop from irritation of the small nerves (Morton’s neuritis).

What to do if you have pain in the ball of your foot

There are a number of things you can do to address ball of foot pain and often you must combine a few treatment options. Sometimes all you need to do is rest and choose your shoes with care, stiffer, cushioned options being preferable.  If your muscles are tight or weak, physiotherapy can help.

Orthotics or insoles can help cushion and offload painful areas. Carefully positioned metatarsal cushions or pads can also protect the damaged areas and help healing. In more severe cases, you may need injections or surgery as a last resort.

How can Doctor Greene’s help you

Our specialist products can help you address ball of foot pain, corns and calluses and irritation associated with hammertoes.

• Toe Gel Sleeve
• Ball of Foot Cushion

Stress overuse injuries, bone bruising or fractures all occur due to repetitive loading. They can involve any bone in the foot or ankle. They are an extremely common cause of foot pain, often underappreciated, with delays in diagnosis, timely management, and therefore associated with prolonged recovery.

Causes can include increased activity, a change in footwear or a change in the terrain on which you walk or run, but often there is no discernible cause.

If you notice a gradual onset of pain without any obvious injury and it gets worse when you walk or engage in other weightbearing activity, suspect that it may be a stress injury. Any bone (of the 26) in the foot can be affected.

Diagnosing the problem

X-rays may reveal obvious fractures, but don’t detect bone bruising, which is best visualised on MRI.

What to do if you have a stress fracture or overuse injury

Treatment essentially involves reducing your activity so your bone can heal. You may need to choose specific footwear to cushion and protect your foot, or to use a surgical boot or shoe. Physiotherapy can help to maintain flexibility and address muscle imbalance.

Contributory factors can include suboptimal bone density, or deficiencies in calcium, vitamin D or vitamin C, so consult your GP if you are concerned.

How can Doctor Greene’s help you

Our specialist products can help you address the pain associated with stress injuries to your foot.

• Ball of Foot Cushion
• Gel Heel Cushion

A dorsal boss is a bony prominence or spur typically found on the instep. It develops over one of the small joints of the midfoot. It cause a visible lump or swelling over the instep. It is generally painless but can cause irritation or pain when in rubs against a closed shoe or the strapping of a sandal.

Sometimes there may be pins and needles or numbness where the small nerves are compressed over the bump.

What to do if you have a dorsal boss

Choose your footwear with care so you can avoid aggravating the pain. Occasionally, this type of bump needs to be surgically shaved to alleviate pain.

Dorsal boss and midfoot arthritis

A bony boss occasionally develops due to midfoot arthritis. Pain in this situation may not just come from direct contact but also arise from joint inflammation, aggravated by walking. Managing midfoot arthritis involves footwear and activity modification, pain relieving medication or injections and finally surgery.

How can Doctor Greene’s help you

Our specialist products can help you address the pain and irritation associated with having a dorsal boss.

• Foot Cushions Multipack

This is a slow growing nodule or swelling that appears under the skin on the sole of the foot. It develops from the tissue that supports the arch of the foot.

Typically painless, it can cause discomfort if large in size or in an area that’s under direct pressure when you’re standing. Some shoes can cause irritation, as can walking barefoot. Multiple swellings can arise and both feet may be affected.

What to do if you have a lump on the sole of your foot

All lumps, no matter what their size, shape or location, whether they or painless or otherwise, should be taken seriously. If you find a lump, make sure you discuss it with your GP or specialist.

Diagnosing and treating a plantar nodule or fibroma

This diagnosis can be confirmed by ultrasound or MRI. Your GP or specialist may decide to keep the lump under observation if there are no related symptoms. If it’s causing discomfort, you may use cushioned orthotics or pads. Occasionally, steroids or other chemicals that dissolve collagen can also be used. Painful or large nodules can be surgically removed, but recurrence rates can be high.

How can Doctor Greene’s help you

Our specialist products can help you address the pain associated with a plantar nodule or fibroma.

• Gel Heel Cushion

The arch of the foot refers to that part of the foot extending between the ball of the foot and the heel. As a structure, it must be supple to accept weight and shock absorb, but it must also be rigid when the body is moving forward during normal walking and running. This means that the configuration changes during each step.

Each person’s arch configuration is different and there is a broad spectrum of normality. A ‘flat foot’ or pronated foot is one with a depressed or dropped arch. Most flat feet or high arched feet are pain-free and function normally, but at the extremes, they can be problematic and cause symptoms.

Typical symptoms of an excessively flat foot includes, aching discomfort or pain along the inner arch structures. The pain can extend to the level of the inner ankle. Sometimes pain only occurs during or after sports or other physical activity. Sometimes walking or even standing can make the foot hurt or fee tired and you just feel the need to sit down.

In addition to a flattening of the arch, calluses can develop at pressure points and uneven cause wear in shoes. In severe cases the foot may over a short period, change shape or become flatter and the pain can move from the inner arch to the outer foot and ankle.

Diagnosing flat feet

The diagnosis is usually based on the symptoms and findings described above. Occasionally x-rays, ultrasounds or MRI are required.

How to treat flat feet

Treatment depends on how severe symptoms and malalignment are. Approaches that may help include:

• weight reduction
• physiotherapy to stretch tight muscles like the calf and strengthen those that support the arch
• shoes with lace-up extensions, boots or braces that clasp and encapsulate the foot and ankle
• shoe inserts, arch supports or orthotics (which can be off-the-shelf or custom).

If symptoms persist, your specialist may arrange further investigations. In severe cases, surgery is an option, but it will be followed by a lengthy period of immobilisation and rehabilitation.

The tibial nerve (the major nerve to the foot) or its branches can become compressed and irritated as it passes from ankle into the foot. This can cause numbness, pins and needles, and burning along the inside and sole of the foot and as far as the inner ankle.

This condition is equivalent to the more common carpal tunnel syndrome in the hand. Similarly, tarsal tunnel symptoms can fluctuate and may disappear between episodes.

Diagnosing tarsal tunnel syndrome

Gently tapping with a finger along the inner ankle and foot can regenerate the nerve irritation symptoms. Ultrasound, MRI and nerve conduction tests can help clarify the situation.

Treating and managing tarsal tunnel syndrome

You may find an arch supporting orthotic helps to treat a collapsing arch, which can be associated with tarsal tunnel syndrome. Steroid injections can help alleviate symptoms. If there is a clear narrowing of the tunnel through which the nerve negotiates, you may need surgery, but this is a last resort.

How can Doctor Greene’s help you

Our specialist products can help you address the pain associated with tarsal tunnel syndrome.

This is a benign, painless, fluid-filled lump or swelling that can occur under the skin in any part of the foot or ankle, usually in connection with a named tendon or joint.

Ganglions may fluctuate, increasing or decreasing in size and sometimes disappear completely. They can become uncomfortable, if they grow large enough or can be irritated by footwear.

Not all lumps are ganglions. All lumps, no matter what their size, shape or location, whether they or painless or otherwise, should be taken seriously. If you find a lump, make sure you discuss it with your GP or specialist.

Treating a ganglion

Ultrasound or MRI scanning can help confirm the diagnosis. If the lump is large, painful, or causing irritation then the ganglion can be drained or removed. Ganglions can unfortunately recur after both drainage or surgery.

Calluses (also known as callosities) can develop on the undersurface or ball of the foot or between the toes. Some calluses develop a hard centre called a seed corn, which can be extremely sensitive.

Calluses can sometimes be confused with verrucae or wart and many are treated as such. If in doubt, you should talk to your chiropodist or podiatrist.

What to do if you have a corn or callus

To relieve the symptoms, you can carefully trim, shave or pumice the thickened skin. Careful footwear selection can relieve the pressure on the area and prevent the corn or callus from recurring.

You can also moisturise the area to help alleviate symptoms and reduce the risk of a skin ulcer.

If your corns prove resistant, it is possible to have surgery aimed at addressing the underlying bony prominences, but this option is considered a last resort.

How can Doctor Greene’s help you

Our specialist products can help you address the pain and irritation associated with corns and calluses.

• Ball of Foot Cushion
• Foot Cushions Multipack

Verrucae are plantar warts, which are usually found on the soles of the feet. They’re caused by infection with human papilloma virus (HPV). Up to a third of primary school children get verrucae, of which two thirds resolve within two years. They are often confused with calluses.

Verrucae develop at sites of increased pressure, such as the heel or the ball of the foot, where the skin is damaged and acts as an entry point for the virus. The virus can then penetrate the skin cells and replicate.

Verrucae appear as single areas or clusters of thickened skin. They may have no symptoms or can cause pain. Sometimes, they create the sensation of walking on a pebble.

A key feature of verrucae is the presence of small black dots, which you can see after the hard skin is removed. These are small veins and distinguish verrucae from true calluses or corns.

Verrucae can be very hard to get rid of, as the thick skin on the sole of the foot allows deep penetration and can prevent topical medications reaching the virus.

What to do if you have a verruca

There are numerous treatment options, but they all require patience, persistence and the understanding that verrucae often recur. There is no single guaranteed solution

If you have no symptoms from your verruca, you can adopt a ‘wait and see’ approach as most resolve within two years.

The two most common treatments are

• topical salicylic acid (burning the wart)
• cryotherapy with liquid nitrogen (freezing the wart).

Those with diabetes or poor circulation should be careful when trying these.

More serious cases may require surgical removal, chemical cautery, phototherapy, laser treatment, immunotherapy or antiviral medications.