Hiking Foot Pain: Pain in the Front of the Foot

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There are all kinds of uncomfortable sensations that can crop up in the foot when you’re hiking.  Everything from blisters to stress fractures.  I’m not planning on talking about either one of those just now.


What I do want to talk about is one of the two most common types of foot pain from hiking.  


That is pain in the middle of the ball of the foot.  

This type of pain can feel like stepping on a small rock or it can feel tingling and numb.  It can also feel sharp.  You might also feel pain over the entire ball of the foot, or just under the big or little toe as well.


If you haven’t got diabetes, Freiberg Disease or a demyelinating nerve disorder (you’d probably know) then chances are very good that this foot pain is coming from something mechanical in your musculoskeletal system that will respond well to changing the shape and the stresses in the foot.


Chances are also good that this forefoot pain that gets worse from hiking or other weight bearing activity is actually being caused by your shoes.


There are a lot of types of foot pain that wouldn’t exist at all if it weren’t for shoes. 


This doesn’t mean it can be solved by going out and getting just the right pair of shoes however.


Pain in the ball of the foot (that isn’t coming from one of the previously mentioned nerve disorders) is likely coming from one or both of the following causes:  


  • Having the sides of the foot compressed, such as when you wear shoes that don’t have a roomy toe box.
  • Having your body weight perpetually shifted to the front of your foot by wearing a heel lift, i.e. shoes with a raised heel, i.e. most shoes.


I wonder if there’s actually any downside to wearing a shoe that has a toe box that is larger than what’s needed to accommodate the heads of the metatarsals (long foot bones).  I have a notion that some folks might feel it represents an aesthetic problem…but I don’t know much about that.


Compressing the ball of the foot means there is less room between the bones for nerves, tendons, ligaments and muscles.  Morton’s Neuroma is the name for what happens when this tight toe box mashes the nerves in between the metatarsal (bone) heads.  The nerve attempts to reroute around the tight spot and over time a wad of confused nerve tissue forms–a neuroma.  This neuroma takes up more space than the original nerve did and so it continues to be sensitive long after we’ve switched to shoes that allow our feet a bit more space.


Having your body weight shifted to the front not only means that more stress is placed on that area, but is usually coupled with an immobilized foot that doesn’t have nourishing joint fluid production (motion is lotion for joints), as well as a lack of muscle and ligament strength in those tissues (also from being immobilized).


So, removing the biomechanical stress of elevating your heel would be a good start.


You can do this by going barefoot or wearing shoes that keep the heel at the same height as the ball of the foot.


A good next step would be to start moving your foot.  Not the limited ankle flexion that we are exposed to from day to day, but actually moving the whole foot.


You can do this by placing a rock the size of a smushed golf ball systematically underneath every square inch of your foot and putting some body weight on it.  


You can also do this by walking on non-smooth surfaces.


If you walk on enough non-smooth surfaces (when your foot is inside a stiff shoe you are actually walking on a smooth surface…even if the surface is uneven) then your muscles and ligaments will gain strength as well.


Give that a try.  


Notice if the discomfort you get from moving your foot feels more like the healthy feeling discomfort of exercise (or at least less like the discomfort you’ve grown used to), and if all discomfort gradually decreases with time.




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