Pain under the ball of the foot

What is it

Pain is felt under the "ball" of the foot. This is a common condition with both conservative and surgical options available to treat it.

Non-surgical options

Offloading dome or shelf insole for shoe. It is often the case that the symptoms can be fully cured with a special insole that spreads out the weight going through the front of your foot. This is almost always the first treatment for isolated metatarsalgia. 

Sometimes the metatarsalgia can be caused by another problem in the foot like a bunion. It this is the case and the insole fails to work then operative treatment of the other problem may be considered.

Surgical options

The metatarsal bones themselves can be overlong and occasionally an operation to shorten them can be performed. A Weils osteoteotomy is performed through a cut made in the top of the foot. The cut bone is held with a small screw which usually does not need removal.

Risks of surgery

All surgical procedures carry some risk. These risks are usually rare, but can include infection, bleeding, damage to surrounding structures such as tendons or nerves, numbness, dysfunction of foot, ongoing pain, unsightly scar, painful scar, wound healing problems, swelling. There is also a risk that the procedure does not work fully and that the patient is left with some ongoing symptoms.

There are also some medical risks to surgery such as a clot in the leg (DVT), clot in the lung (pulmonary embolus or PE). The general anaesthetic has rare risks of problems such as heart attack, stroke, chest infection and in extremely rare circumstances, death.

With a Weil's osteotomy there is a small chance of the bones not fusing together and this is called "non-union". Smoking and diabetes increase this risk. If this happens you may need further operations to deal with the problem. Rarely the screw needs removing through the same incision at a second operation.

What to expect after surgery

  • This will be done as a day case procedure under a general anaesthetic.
  • A local anaesthetic block is used around the ankle to decrease post-operative discomfort.
  • The patient is discharged home from hospital on the day of the operation with painkillers to use as necessary.
  • The patient must keep their foot up above the level of the groin for 23 hours every day for two weeks. This minimises swelling, decreases discomfort and reduces the risk of wound complications and infection.
  • The patient is able to weight bear in a special shoe from day one to move around the house.

Expected recovery milestones

  • At two weeks you will be seen for a wound check; if the wound is healed you will be able to do more walking around but will be quite uncomfortable until six weeks post-operatively when you will be seen again.
  • At the six week appointment an x-ray will be taken to check on the healing of the bone.
  • Between six weeks and three months you should expect to return to work and normal activities. I would expect to discharge you from further follow-up after three months.
  • Between three months and one year there will still be some swelling and minor discomfort.