One of the more common conditions treated in our office, is that of pain in the base of the 2nd and/or 3rd toes, caused by strain and pressure in this area with walking.  This is often due to a length discrepancy of the 2nd metatarsal being slightly longer than the 1st and 3rd metatarsals.  During the toe-off phase of gait, we push off the balls of our toes for propulsion.  When the 2nd metatarsal is longer than the others, an increase in pressure is placed on the bottom of this area often causing pain.  Factors that can contribute to this development are excessive walking barefoot, wearing high-heeled shoes, flip-flops, sandals, house slippers, bunions, and hammer toes.  Bunions can be associated with this deformity due to the foot's inability to stabilize the medial column against the ground.  When this occurs, the body weight is transferred to the adjacent, more stable metatarsal, leading to the pain below the 2nd metatarsal head.  Also, contracture of the toes can lead to this type of pain, as the curling of the toes causes the base of the proximal phalanx to ride on the dorsal aspect of the metatarsal head, causing the foot to feel like the metatarsal head is protruding out the bottom of the foot.  Treatment is focused on reduction of the inflammation by way of arch supports, avoidance of barefeet, flip flops, sandals, and shoes with a heel, as well as ice applied below ball of toes x 20-25 minutes 4-5 times a day.  Anti-inflammatory medication can also help.

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