Sore ball of foot/metarsalagia

jmmarshjr

Was hoping to get some advice on some chronic pain in the ball of my foot. I believe it is simply metatarsalalgia aggravated by some modest atrophying of my plantar foot pad. I am running in new Hokas that seem to fit well. I have high arches. I have been icing it frequently. I have cut back my running to avoid longer runs and harder runs (which seem to aggravate it). Recently, I have started a more comprehensive stretching and massage routine (using the Athletes Treating Athletes website) and have stayed off of it for a week. 

Any one had a similar problem and have any advice? 

Jess Withrow

I know all too well...  I have high arches, too, and have fractured the sesamoid bones (two small bones in the ball of each foot that allow the big toe tendon to track properly) in both feet.  I broke the lateral sesamoid just before IMNYC, and not knowing it was fully fractured (doc said it was just sesamoiditis, gave me a cortisone injection and sent me on my way), decided I'd still start/finish the race.  Now I have an IMNYC finisher's medal and a necrotic sesamoid bone to show for it.  

My opinion is that it's more than likely sesamoiditis (but only because sesamoiditis seems much more common than metatarsalagia in my experience and completely and admittedly unscientific research....  but who knows who's actually gone out and had a definitive diagnosis of "sesamoiditis" vs. a doc just giving their general opinion?).  

All I can tell you is, stay off it as much as possible, wear something with arch support as much as possible (this meant I had a dedicated pair of shoes that I only wore in the house, and I literally wore shoes with arch support during all waking/walking hours), never, ever, EVER wear flip flops or similar footwear, and if you go see a doc, do NOT under ANY circumstances let him/her talk you into a walking boot.  Or a dancer's pad.   I also wear the Hoka Constant, which is their stability shoe, but I wear it because it's the widest model they make, not because I need the stability.  Or maybe I do.  Who knows!    

Finally, if you have a chiropractor, ask him/her to adjust your first metatarsal.  Sometimes with high arches, that metatarsal "drops" and puts a lot of extra pressure on the ball of the foot. I've found that adjustment hugely helpful!  

Good luck!!!

 

jmmarshjr

Jess -

Thanks for the information, it was really helpful! Funny you should mention flip flops because that was what seemed to cause the whole thing! 

Agreed on wearing shoes around the house. I am walking in my Hoka Cliftons with a green SuperFeet orthotic (seems to help). I am hoping if rest it a week, stretch, massage, ice and soak, it will go away (or that I can at least manage it). 

So has  you healed or still running banged up?

Leslie Knight

Need more info... Exactly where does it hurt- which bone? Proximal or distal? Does it hurt all day or a particular time of day? What makes it worse? Better? Can you figure out what started it?

jmmarshjr

Hey Leslie:

Left foot. First metatarsal area. Hard to pinpoint exactly when touching. Usually feel it after running for a bit. Or if I jumped. Feels like a deep bruise or like the bones are separating a little bit. 

Injury first seemed to start while on vacation last sprint. Walked through some airports, to ferry, etc. in flip flops. Also did a small speed workout in bare feet on beach. And the next day I was hobbling around. Felt better when wearing running shoes. A couple of days later I could walk on it. Then seemed fine with exception of when I would run at a harder pace (aggravated it after a 5K race). Sometimes on a longer run it will start to hurt. I am very, very attuned to it and stop running if it seems to hurt. It has never gotten as painful as the first instance, but I am very paranoid about it. I frequently ice it (which has been very effective with tendinitis-related issues in the past). Lately, I have been spending more time stretching my calves and feet. Also massaging. Using the "Athletes Treating Athletes" website. I have also tried to give it some real rest (Have not run for a week). In the past I would take a few days off and test it. Also been more focused on running on treadmill so I can easily stop if it hurts (rather than it hurting 2 miles from home). I have been running on a Woodway treadmill with the 'planks' rather than belt.

Feels worst when running hard or jumping. I have been avoiding both. Feels best when I put a compression sleeve on it and wear my Hokas with SuperFeet green orthotics (just started with these two weeks or so ago). I have been wearing the Hokas around the house. No morning pain like I had with the tendinitis. 

I had my gf examine the plantar foot pads and she was fairly confident the left foot pad is a little thinner and  smaller than the other foot. 

I was hoping this "run durability" training would help but seems like I am barely durable  enough to do the training?!

Jess Withrow

Would you believe I was running errands in flip-flops when mine happened, too???  They're the footwear of the devil, I swear!  

Your comment about the SuperFeet just reminded me of something else I did...  I took two insoles - one on the bottom with less arch support and stacked one on top with the most arch support you can get in an over-the-counter insole - and I cut a half moon shape out of both insoles under where the ball of my foot would touch.  This relieved a LOT of pressure on the area!  My background is in Occupational Therapy (I did a LOT of splinting for post-op and post-injury patients), so the insoles seemed like the obvious thing to do.  I used them in both my running and bike shoes.  

I haven't had any major issues since seeing Dr. John Connors after IMNYC in 2012 (sports podiatrist extraordinaire and good friend of Carol DeFazio & Turby Wright - Coach P referred me).  He fitted me with orthotics, but at this point I can get away with something over the counter as long as I'm in Hoka's and have that extra cushion.  He DID tell me that, because the bone is necrotic (I had an MRI), if it continues to flare up, I'll probably need to have it removed.  I'll have the occasional flare up, but it's generally because of that dropped 1st metatarsal.  I get it adjusted and I'm good to go.  If I'm being totally, 100% honest, I tried all of the above, too - the icing, stretching, massaging, etc....  and the only thing that really helped was staying off it for a little while.  But that's me...  If this is still acute for you, keep it up.  As far as Run Durability....  yeah.  I think Run Jail - as much as it totally sucks - is a little more appropriate at the moment.  

jmmarshjr

Footwear of the devil indeed! I should just throw mine out!

I will continue to use the new SuperFeet orthotics with my Hokas and see how it feels. The insert modification is an interesting idea, I may try that out. 

What races are you doing this year? I have Quassy in June and 140.6 Vineman in July. I was scheduled to do the NYC Half Marathon but just cancelled that due to the foot.

Leslie Knight

So... Without an exam, hard to tell if it's the metatarsal, the sesamoid, or the tendon/fascia. Your story sounds more like tendinitis/fasciitis, though. You are used to wearing arches and then you stress your tendons by wearing flip flops and running barefoot. Flip flops are only the devil to people who have weak arches from wearing shoes all the time and then go barefoot and stretch their tendons. I know you don't want to hear this, but I think rub jail is the answer. Let it rest. Four to six weeks. If there is still pain at that point, see an excellent primary care or sports doc- X-ray/MRI/bone scan will be in order to get to the bottom of things. While you are in run jail, you should be icing ten to fifteen minutes three times a day (I did this once by standing on an ice pack at my stand up desk). And gentle stretching. A recent study showed that stair step ups helps more than stretching for plantar fasciitis, but I don't think that would be a good idea for tendinitis. Once you are pain free, return to run starts with five minutes on the treadmill. If no pain after a couple of five min runs, can increase to seven minutes and slowly increase thusly. To strengthen your arches, once you are healed, gradually spend more and more time per day barefoot.
Good luck! (I'm an FP doc with interest in sports med).

jmmarshjr

Thanks Leslie. Very helpful. I will keep you posted!

jmmarshjr

spent two weeks in Run Jail. have done two outdoor runs and feels much better. thanks for all the help.

Paul Hough

More running on grass and trails for sure - in fact, I would say a majority on dirt, but bring back more asphalt as you approach key races to ensure you are hardened up for the greater impact.

If you have cheap flip flops pitch them. If you want to wear flip flops get some high quality ones like Birkenstock or the like. I paid $45 for a pair of black rubber flip flops at an IM Expo last year...they feel great. Make sure all of your running shoes have excellent forefoot cushioning. Hokas fit the bill, but do your other shoes measure up?

KARINM

I have high arches as well and use Spenco insoles in a lot of my shoes. They have special IM Training and IM Racing insoles. I still get some aches here and there, but believe they have to with the shoe and run form.