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Thursday, January 3, 2019

Sore Metatarsals in a Runner: Email Advice

Dear Dr. Blake, 

Thank you for your website. I'm 60 years old, been running for 48 years with a variety of training regimes (hills, long runs, track intervals).  ~14 months ago at the beach, stepped on a stone barefoot in the left metatarsal 2nd/3rd area.  It hurt but seemed ok when running in shoes. It relaxes and hurts less when running (even fast hard intervals forefoot striking). But upon rest or ice later, it tightens wicked and hurts, especially barefoot walking on a hard floor (which I try to avoid).  Got progressively worse. 
X-ray is normal. MRI does show swelling maybe bone bruise (results below).  Sports Doctor refuses to give a cortisone shot. Skin is very thick and hard to do iontophoresis. I ice it, gently stretch calf and plantar.  I cut back on running. On stationary bike, the metatarsal hangs off front of pedal. Arch supports worn religiously 6 weeks didn't help. Looking into Hokas shoes.  Would ultrasound and Ice/hot water contrasts help?  I assume the running re-injurs it(?).  Other advice would be welcome.  Feel free to post this on your site. Thanks

BONE MARROW: Bone marrow edema is seen within the tuft of the first distal phalanx and the lateral hallux sesamoid. No fracture lines are identified.
SOFT TISSUES: There is ill-defined soft tissue edema plantar to the heads of the second and third metatarsals. No focal drainable fluid collections are identified. The myotendinous structures are unremarkable.

JOINTS: There are mild degenerative changes of the first
metatarsophalangeal joint. There is no joint effusion. There is no
synovial proliferation. This study is not optimized for detailed
evaluation of ligamentous structures of the hind foot, midfoot or forefoot although they appear grossly unremarkable.

 Budin splint over the 2nd and 3rd toes together

 Various Hapads and accommodative pads to protect or cushion metatarsals (be creative!!)

Hapad Longitudinal Medial Arch but used as Metatarsal Pad within Shoe

Dr. Blake's comment:
     The MRI report sounds like the 2nd and 3rd metatarsals have been bruised, not broken. I hope the doctors have evaluated the lateral sesamoid well, and the MRI findings are only from the stress you normally put on them. See my video on off weighting the sore area with hapad longitudinal medial arch pads behind the sore 2nd and 3rd met heads, and 1/8 to 3/16 th inch adhesive felt to off weight the 2 and 3 (weight has to be put on the 1st, 4th and 5th). You can also try a Budin splint to immobize the motion of the 2nd and 3rd MPJs. Typically you buy the single loop and put both toes into it. Start with easy tension for a few days to get used to it before tightening it more. This is separate from the Hapad. If both work some, you can use the Hapad and tape the toes down each time. Ice massage twice a day for 5 minutes. I like ionotophoresis (electrical only) for this. I hope this helps some. Rich


  1. Thank you very much for the advice. I'll try the pads and off weighting. I'm hoping I bruised it on the rock and keep hurting it while running and it never heals right. So now I need to give it a chance to heal. Keep pain at level 1 or lower. Any ballpark time frame for healing ?

  2. Forgot to ask a quick question:
    When you say "Iontophoresis (electrical only)"
    do you mean no medicine applied to the pads (i.e. dexamethasone)?


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.