Are your sandals causing the pain in the balls of your feet?

In southern Ontario many people can’t wait to start wearing their sandals after a long winter.  Unfortunately wearing sandals over many years can result in pain in the balls of your feet.  Metatarsalagia is a general term for pain in the ball of the foot but does not specify the exact cause of the pain.  The many causes of metatarsalagia are outlined below.

• Sports that place tremendous pounding on the ball of the foot, like jogging.
• Flat feet and bunions
• An enlarged metatarsal head.
• Calluses or corns that cause the weight on the foot to be unevenly distributed.
• Ill-fitting shoes that put pressure on the bones of the feet.
• Shoes with small toe boxes that cramp your toes.
• The thinning or shifting of the fatty tissue of the foot pad due to aging. 
• Arthritis or any degenerative disease of the joints.
• Systemic conditions such as diabetes, which can cause nerve-type pain in the foot.

Most of the causes listed above are the result of mechanical stresses applied the foot over a long period of time.

Many people love to wear their sandals during the summer.  Sandals that cause the most problems are flip flop sandals or sandals with one to three straps over the front of the sandal.  If you wear these types of sandals you may have to compensate by clawing your toes to prevent the sandals from not falling off your feet. Unfortunately, this places a lot of stress underneath the ball of the foot as shown in the diagram. 

People will often complain of pain in the balls of the feet when it is time to switch back to regular shoes at the end of summer. The toes may continue to claw since they may be confined in a shoe with a shallow toe box.

I usually recommend that my patients switch to sandals with a back strap that firmly holds the foot in the sandal. Regular shoes should have deep to box to prevent back pressure from claw toes on the metatarsal heads.  If the fat pad under the ball of the foot has thinned out, there are many over the counter cushion insoles or gel cushion pads that can be used to cushion the foot. Osteopathic foot manipulations can be performed to increase the range of motions in the foot.  Exercises can be prescribed to strengthen the small muscles of the forefoot that help to prevent the toes from clawing.  If the pain in the ball of the foot is due to a bunion deformity a custom foot orthotics can be prescribed to help stabilize the foot and take pressure off the bunion and the ball of the foot.  Custom foot orthotics can be used inside of sandals. Many sandal styles come with a removable foot bed. The foot bed can be removed and the custom foot orthotic can be replaced inside the sandal. 

I hope you can avoid pain in the balls of your feet while wearing your sandals. Enjoy next summer.