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Saturday, January 6, 2018

Painful metatarsals in a Runner: Common sense advice

Dear Dr. Blake, 
I have a way of ignoring issues if they threaten to get in the way of running…..

At least this is on my right foot. Somehow that makes me feel better, though that is the side where I seem to be developing a hammertoe. You noted that on my last visit.

I’d been having some pain in the three smaller toes. Metatarsal area, but bending them up. Not totally one thing, but my foot hurt in that general area for a few days. I was trying to tell myself it was just my neuroma, my non-Morton’s neuroma. But I also kept thinking — it doesn’t feel quite like that.
See the callus under the 2nd through 4th metatarsals and not the first. There is more pressure in the middle of her metatarsals where she is complaining.

Anyway, it finally dawned on me to take a look and I could see that the right side was inflamed compared to the left — the metatarsal pad area, the ball of the foot — but basically that sort of fatty pad just below the toes — not as far over as the big toe.

Looking on the Internet, I wondered if this wouldn’t be called Metatarsalgia. And I suppose with my high arch and longer second toe — I am at more risk for this just as I am for neuromas?
Dr. Blake's comment: The high arch (called pes cavus) places a lot of force on the metatarsals over a flatter foot. Other conditions that place force on the front, so you could be in an overload situation, are forefoot running, shoes with a high heel pitch forward, hill running up or down in general, and sprinting. You may have several of these common causes stacking up against you. 

I am guessing it’s from running, but, possibly, more specifically, a fair bit of hill running that I’ve been doing. Now, the smart move would have been to NOT RUN today, I imagine. i rationalized going, however, because 

1) It seemed improved this morning, and not worse than yesterday night.
2) I am trying new shoes this week — Altras. So they offer more room in the toe box and are neutral, flat, so that should reduce the impact on the forefoot.
3) I plan to ice the area.
4) I thought I would take Ibuprofen for a period.
5) It didn’t hurt while I ran, though I tried to alter my landing somewhat at the few times when I did notice the pain.

Let me know what you think. Do I need to stop running? Should I come in to be seen? Last night I realized I couldn’t stand on my toes. But today, it’s much better.

I attached photos, though I’m not sure they are helpful.

Dr. Blake's comment: When a toe runner begins to get ball of the foot pain, you are thinking the right thought process. Temporarily, avoiding hills, icing for 10 minutes twice daily, trying to run more midfoot (Chi running), lowering the heel drop (Altra shoes are all zero drop), and cutting your mileage in half to see if that can give you 0-2 pain levels. Stay at that mileage for a short period, and then gradually increase 10% or 1/2 mile every 4th day. Hope this helps. Toe running with pes cavus with hills is deadly at times, so shoe changes, gait changes, avoidance of hills are all helpful. Rich

1 comment:

  1. Can anyone on this post tell me how you put a picture up? I’m using my iPhone


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