Pain under the ball of the big toe

Pain felt under the ball of the big toe is frequently experienced by those who have high arches or medium/high arches. Usually the person rolls out on their feet in standing and wears down the outer border of their shoes. These patients are referred to as over supinators and experience a lot of shock absorption problems.

There is frequently significant callus formation around the painful area indicating they have been taking excessive weight on this area for some time.

If the pain is very severe there is the possibility that there is a fracture of the sesamoid bones. These are two very small pea-shaped bones under the head of the first metatarsal. In most cases, this is not the case.

A thorough biomechanical assessment is required to identify the cause of the over supination and this is then addressed with an appropriate custom made orthotic. The orthotic will require forefoot balancing to reduce the excessive weight going through the head of the first metatarsal and to prevent over supination.

Regularly these patients are what is called Equinus or in other words, have very tight calf muscles and Achilles's tendons. They will require an intensive stretching programme to address this tightness and will also more than likely require a heel lift incorporated into the orthotic.

Good shock-absorbing footwear especially in the forefoot is recommended. The shoe should have a good heel and be quite flexible.

Siobhan Treacy MCSP, MISCP, FSOM
Chartered Physiotherapist
Walkwell Clinic