Why do I feel like Im walking on pebbles?

That is a lot of time spent on something that may not be your problem. One of my favorite idioms from my Dad: If it looks like a horse, and smells like a horse, and sounds like a horse…. it probably is a horse and NOT a Zebra. 

On to the horse!  

Capsulitis

Capsulitis is the inflammation of ligament-like tissue that surrounds a joint. This problem involves the metatarsal joint or “table leg” of the foot. So think of the foot as a table with 5 legs. When one table leg is forced to bear more weight, it gets angry. 

Symptoms to look for:

• Tenderness directly under the toe joint or metatarsal head
• Pain in the ball of the foot, especially while walking barefoot on a hard surface
• Swelling at the base of the toe
• Tenderness that can extend to the top of the joint in severe cases
• A callus or thickened skin in the area in chronic cases

This condition favors the second toe, although it occasionally occurs in the third or fourth toes as well. Capsulitis of the second toe is often associated with having a long toe (AKA Morton’s toe) or having a bunion. 

Pandemic Problems and “More”

We noticed a spike in capsulitis right after the pandemic made much of the work force migrate home. People stopped wearing shoes and spent more time on hard floors. It’s easy to underestimate just how many steps you take at home. You may forget how much pressure your foot takes but the foot won’t!

“The More” happens when the metatarsal continues to get beat up. The body starts with a warning of escalating pain. If the extra stress continues, the bone will try move out of the way to escape the repetitive trauma. This evolves to a stress fracture. It is very much like bending a metal coat hanger until it weakens and breaks. There will be a significant increase in swelling and pain at this stage. This is the proverbial jumping from the frying pan into the fire.

Sesamoiditis

Sesamoiditis is a capsulitis of the big toe. The sesamoids are 2 gliding bones under the 1st metatarsal that act as a floating pedestal. They look like round headlights on an x-ray. The sesamoids’ function is amazing. I will save this for a future blog.

Excessive pressure is the main cause for problems. The sesamoids can fracture from direct impact. This injury occurs when the hallux is bent upward with a heavy ground impact. Coming down with a rebound or walking down a large step in high heels will do the damage. And once the sesamoids are fractured, they will always look fractured. 

You seldom see swelling or bruising with sesamoiditis. You are more likely have difficulty bending and straightening the big toe.

Actual Lumps 

We have discussed joint and nerve pain, but the lumps you feel may be an actual bumps. A few conditions may be responsible for this. 

Rheumatoid nodules are marble-sized lumps that form in the forefoot. There is usually a history of rheumatoid arthritis associated with this. Rheumatologist do such a good job managing this disease that I rarely see this type of nodules. They also can occur in the hand.

Plantar fibromatosis is a lumpy growth in the fascia. It appears right between the big toe joint to the mid arch area. It will feel like a bunch of small peas or grapes under the skin

Porokeratomas are sealed sweat glands that become clogged. They can feel like small ball bearings. They can appear in both the palms of the hands and the bottom of the feet. These can be very painful if located in a weight-bearing area.  

Finding Relief from Pain at the Base of the Toes

Consistent pain in the ball of the foot will definitely get your attention. Ignoring the problem may extend the duration to resolve the problem. If you are avoiding activity because of the pain, you should seek professional care.

The first step is correctly identifying the condition and its underlying causes. If you have capsulitis, for example, what is contributing to it? Is it your shoe choices? Your activities? An abnormality in your foot structure? Some mix of the three? Something else entirely? Did you think there’d be so many questions? But it’s OK, because we’ll find the answers.

Once we have a firm understanding of what’s going on, we can make our best recommendations for treatment. The keys to recovery often lie in protection, offloading, and/or correction.

In some cases, the use of accommodative orthotics can protect vulnerable areas. We may also recommend changes to your footwear and workout schedule. A specific stretching program might be recommended to further reduce stress and impact 

A cortisone injection may be selected for short term relief. This may be helpful as we work toward longer-lasting goals. We may sound like a scratched DVD but this is why early treatment is important – to avoid this.

Only in very rare cases will surgical intervention be needed. The goal is to shorten a metatarsal bone to offload excess pressure. This would be like shortening a long table leg. In most cases, conservative treatments provide the best results. 

If the problem is plantar fibromatosis, we can take different actions to address them. These lumps can be shrunk via injection therapy and rarely need to be removed. A physical therapy technique called crass fiber massage is very effective. Large rheumatoid nodules may need to be removed. Porokeratomas can often be addressed conservatively if found early.

Start Walkin’ on Sunshine Again

Every path has its bumps and rough patches, but you should never feel like you’re always walking on them. Please never delay in contacting us anytime of persistent foot or ankle trouble is interfering with your life.

Call us at (317) 545-0505 or fill out our online contact form to schedule an appointment.

If these symptoms sound like the ones you’re experiencing, you might find that you’re suffering from Metatarsalgia.

What is Metatarsalgia?

Metatarsalgia is a general term, relating to any pain that is experienced in the ball of the foot. There are a number of factors that cause metatarsalgia:

1. Sport. Sadly, one of the number one causes of metatarsalgia is running, or high-impact athletics. Continued stress on the ball of the foot can cause inflammation, which leads to pain. Sports that involve jumping, such as tennis or squash, can also contribute to the problem.
2. Stilettos. Whilst undeniably lovely looking, high-heeled shoes are a major problem when it comes to foot pain. Continually wearing towering stilettos, or squeezing feet into shoes that are too narrow, can cause real issues with your feet; especially around the area below the toes (which takes the most pressure, whilst teetering in heels!)
3. Foot deformities; such as bunions or hammer toe. If you suffer from a foot deformity, such as hammer toe, or bunions, this can lead to significant pain in the ball of your foot.

What to Do if You Think You Have Metatarsalgia.

The first thing to do if you suspect you might be suffering with metatarsalgia is to speak to an expert. A doctor will be able to examine your foot, or alternatively, you can book an appointment with Foot Solutions, who can provide a complete foot assessment and identify all problem areas.

Recovery: What Treatment to Expect

It is likely that you’ll be recommended the following courses of action:

1.  Wearing the correct shoes. Chances are that you’ll be advised on what suitable footwear to invest in, to help ease the pressure on the affected area. If you’re concerned about losing out on the glamour of fashionable shoes, then be reassured; many comfortable shoes are extremely fashion-forward!
2. Orthotics. You may also find that your expert recommends some orthotics for you to use. Orthotics, quite simply, insert into your existing shoes, repositioning the foot into the correct position and easing pressure on the ball of the foot.
3. Lifestyle. Your expert may also recommend some lifestyle changes, to help you to recover as quickly as possible. This could include; elevating the foot more often or taking a short break from running. These slight changes will help you to cope whilst the comfortable shoes and orthotics help reduce stress on the foot.

 Don’t suffer in silence if you think you may have metatarsalgia. It is one of the most easily treated foot complaints, and a few simple adjustments to your lifestyle could help reduce the symptoms significantly.

 Speak to one of the team at Foot Solutions to book your FREE foot assessment and receive some excellent advice on how to ease the pain of  metatarsalgia.