Today I'd like to talk to you about some silent foot problems. If they're silent, why do we need to bother with them? Let's take a couple of examples.

Silent Bunions and How They Cause Ball of Foot Pain

First of all, let's talk about a silent bunion. That's where you get a bulge around the great toe joint and the bone sticks out. Many patients come in with a bunion and it's just not painful at all.

However, the bone behind it, the metatarsal bone may be extremely mobile. And when this occurs, it not uncommonly leads to a an overload of the rest of the bones in the ball of the foot and pain in the ball of the foot. So if you have a bunion and it's non painful but you've got pain in the ball of the foot, it may well be related.  It doesn't mean you have to do anything to fix the bunion, but you better do something to re-balance that foot to get rid of your pain.

Poorly Functioning Peroneal Tendons and How They Cause Heel Pain

Number two, weakness of tendons on the outside of the ankle, the side away from your great toe joint. Those tendons are called the peroneal tendons and they're crucial for bringing the weight from the outside of the foot back over the great toe, your big toe, when you try to push off the ground. They often are not inflamed at all, but particularly in high arched people and sometimes even in flatfooted people, they just aren't working well. And with computerized analysis, we can see weightbearing over the right of the foot longer than we want it to be.

So what happens then?

What happens is you come down on your heel and you never get to push off your big toe joint and that can lead to chronic heel pain.


Treatment is often aimed at the other side of the arch, supporting the arch to decrease the pain, over-the-counter supports, custom orthotics, physical therapy and so on. But if those tendons are weak or not functioning at the right moment, you'll never resolve your heel pain.

Functional Hallux Limitus

And number three is called functional hallux limitus. Now that's a mouthful. Well, I abbreviate or translate hallux limitus and hallux rigidus, to big toe jamus uppus. So what do we mean there? That means your big toe joint doesn't move well when you try to push off the ground. And the truth is, it's a jamming of the great toe where it meets the metatarsal bone. Now you'd think that would hurt and eventually it may, but in the early stages of this condition the joint isn't rigid. It's limited to some extent, but non-painful. However, if you come over your foot toward push off, if that joint doesn't move, it's like running into a door stop. And that backs up the force anywhere along the length of the foot, even all the way to the heel.

Exam and Treatment

So once again, with chronic heel pain and other foot conditions if you've got functional hallux limitus, and it looks like it moves normally, it may well not be. In an examination, we can figure this out and we can also see it on a computer exam. And then we just need to adjust the mechanics of the foot to get you back over your great toe joint and stop overloading the rest of the foot.

If you are having foot pain that's not resolving with standard treatments, you may need to look for one of these three silent foot disorders.

Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.