Ball of Foot Pain – Metatarsalgia


FFlat feet, dropped arches, ankles that roll in; all of these are terms to describe what podiatrists and health professionals often term over pronation. In simple terms, when standing or walking, the arch of a person’s foot appears to flatten out more than it should. This condition is often attributed as the cause of a variety of foot and leg problems including:

  • Heel pain
  • Plantar Fasciitis
  • Morton’s Neuroma
  • Metatarsalgia
  • Bunion formation
  • Shin splints
  • Knee pain
  • Lower back pain
  • Weak ankles

What is over pronation?

The joint just below the ankle joint is called the sub-talar joint. This position of the bones in this joint largely determine how high your arch is and how it moves. When the sub-talar joint moves the arch up it is termed supination, and when it moves the arch downwards it is termed pronation. The arch of your foot needs to be able to move up and down to adapt to the ground beneath it, but in some cases the sub-talar joint moves in a way that makes the arch drop lower than it should, and this is termed ‘over-pronation’.

What causes flat-feet or over pronation?

Your foot shape is firstly determined by your genes – you can inherit flat feet if your arch is naturally low, or if your feet are very flexible.

An acute injury, or mild repetitive injury to the structures in the foot and ankle can also cause the arch to drop. For example, an inversion ankle sprain can damage the ligaments or tendons that hold the joints of the subtalar joint and other joints together. They may become stretched allowing more motion meaning the arch can flatten out more. The more often an injury occurs, the more likelihood there is of the foot biomechanics changing.

When is over-pronation a problem?

There are many people who have flat feet, or over-pronate, and have no problems arising from it. If this is the case, it isn’t always necessary to treat it.

Over-pronation and flat feet becomes a problem when there is resulting pain or deformity associated with it. Over-pronation has been linked to many conditions such as those listed above. If you are experiencing pain resulting from overpronation then it may be worth seeking treatment from a podiatrist.

flat foot compared with normal foot

How is over-pronation (flat feet) treated?

The treatment for over pronation depends on the persons foot type, and the cause of the overpronation. Typically orthotic insoles are used in a persons shoes to support the sub-talar joint and the mid-tarsal joints, thus creating an arch for the foot.

People who have long standing flat feet may also require some mobilisation of the foot joints. This is because, after a joint has been in a particular position for some time, the tissues that connect to the joint (ligaments, tendons, joint capsules) adapt to that position and can be reluctant to move out of it. In these cases a few regular visits to your practitioner to mobilise the joints, along with orthotic therapy, is often more successful than orthotic therapy alone.

Stretching and strengthening exercises for the feet and legs can benefit some people depending of their foot type. It is very difficult for these exercises alone to correct a flat foot, but they can be a useful adjunct to mobilisation and orthotic therapy.

The type of footwear and person wears as well as certain activities can contribute to a person’s over-pronation. High heels place the sub-talar joint in a position which can worsen over-pronation, and sitting on the feet when kneeling also has the same effect. The kind of footwear you use and certain activities may need to be modified if you want to successfully treat problems associated with over pronation.

Do you suffer from flat feet or foot pain? Book a biomechanical assessment now or call 0413 223 156 to discuss.

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