Managing Metatarsalgia

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November 5, 2019 at 9:33 pm #31297

todd.struble
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I started feeling some aching in my foot during my goal season that has persisted for a few months now, even through my unstructured period with a scale back in volume, and now through about an 8 week period where I’ve really scaled it back to basically just dog walks (~1 hour a day) and swimming and biking a few times a week. It’s a fairly minor pain that I can easily ignore while running (my last big goal was a 20 mile trail race, I noticed it a few times but it didn’t impact my gait or anything) but since it hasn’t gone away I’m really working on addressing it.

I got a referral to a podiatrist a few weeks ago and was told I have metatarsalgia. X-rays were negative for any stress fractures. Doc didn’t order an MRI. I have been taking the advice of icing a few times a day and doing calf stretches and calf-raises and been wearing the metatarsal pad, but none of it really seems to be making it feel any better. The doc didn’t really say don’t exercise; he said it’ll heal faster if I take it easy, and I’ll make it worse if I do too much. Not that helpful, and I can’t tell if my daily walks with the dog are “too much” or not.

I imagine this will be like the plantar fasciitis thread where there are a number of causes and everyone’s experience is slightly different, but I’m wondering if there’s anything I can do to accelerate my return to running. In my case, the discomfort really seems to stem from toe-off. For instance, I can pull my toes back with my hand and it will be pain free, but if I assume a lunge position and really crank on my toes, it starts to hurt a bit. Other questions I have:

1) Would a walking boot help these types of injures heal faster? I’m looking at the splints on Amazon that cost like $40 for broken toes or similar injuries.

2) How about custom orthotics? I asked the doc and he said I didn’t need custom ones beyond the aftermarket insoles I already have.

2) What does a return to training look like when recovering from these times of overuse injuries? Does one wait until the pain is completely gone for several days before going for a run or is it safe to try and go for a walk/jog session when things start feeling better? Put another way, if one tries to do too much too soon, does it land you back at square one, or is it safe to try and keep some level of activity going while recovering from these types of injuries without setting you back too much?

3) What other things have folks found to help work through these types of injuries? How long has it taken for folks to feel like they were “out of the woods” so to speak?

Thanks for any advice – this has been one of the more frustrating things I’ve dealt with. Even when I had plantar fasciitis (same foot) I could feel improvement when I started treating it appropriately. This doesn’t seem to matter what I do – walk a few miles or swim, it feels pretty much exactly the same. Especially since it’s such a minor pain that is so easy to ignore while doing fun stuff.
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Posted In: Injury & Rehab

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todd.struble on November 6, 2019 at 6:06 am #31306

Shoot – remembered a few more questions:

1) Are those rockered running shoes something that I should consider in the future? If so, any brand/model recommendations to look at? I’ve seen Hoka One One and Altra seem to be the most likely candidates.

2) Is there a calf-stretching protocol that works? I’ve just been doing sort of randomized stretches as often as I can but it’s fairly unstructured.

Participant

Pete Dickinson MS,PT on November 7, 2019 at 4:03 pm #31459

Todd,
Thanks for reaching out! Some thoughts..
Do not immobilize. We want you maintaining at least what you have, and not go backwards in load tolerance. With your pain level, I would not recommend a boot. I like the met pad.
If your foot structure is fairly normal, chasing orthotic intervention is just one more variable that should best be considered after trying to make some mobility changes.
Metatarsalgia is like plantar fascitis, it can have multiple causes. After a period of overreaching during your goal season, strength can be compromised, as can tissue mobility. Hip strength can affect the forces at the foot. Of most interest, calf/hamstring soft tissue restrictions affect the loading through the forefoot. Roll out the posterior chain with a ‘Stick/rad roller’, or even better with the end of a 45lb. olympic bar.
I like the Hoka’s for attenuating some of the force coming through the shoe.
There you go! Keep us posted.
Pete

Inactive

Anonymous on November 8, 2019 at 4:14 pm #31524

If it only hurts while you run, I would work on some technique work. Sometimes lower leg and foot things can be from overloading the calves and not using your glutes for the work. Getting full hip extension and not overstriding can be really helpful (and each feeds on the other). I would also check your foot mobility-try picking things up with your toes, spreading your toes out and articulating each toe separately. Good luck!

Participant

todd.struble on November 12, 2019 at 2:24 pm #31802

Thank you both for the suggestions. I picked up some Hokas and the cushioning is nice. I actually have an olympic bar for my garage gym but I’m not sure what the best technique for rolling out is. I’ll see if I can find some youtube videos but for now I’m just using it as an unwieldy foam roller.

Alison, do you have any tips or thoughts on how to ensure I’m using my glutes enough and getting full hip extension? I don’t have any formal running technique training in my history, just team based sports, so any tips or resources would be great.

Participant

Pete Dickinson MS,PT on November 14, 2019 at 10:07 am #31974

Using the bar on yourself is a little awkward but doable. I’d pick a lighter bar to start, most gyms have training bars ~15lbs, or 35lb. ones. In a tall kneeling position, with the bar 90* from your leg out to the side, use the thick end and roll it back and forth across your calf and upper achilles. I like to support under the shin and ankle so you don’t force your foot into excessive plantarflexion. Hope this description makes sense.
Pete

Participant

todd.struble on February 8, 2020 at 12:21 am #37744

I thought I’d loop back and give an update. I started with an endurance coach with a sports MD background in December and their advice helped me return to training. 2 months later it feels pretty close to 100%; though that being said I haven’t been able to return to higher mileage weeks as unfortunately I developed sesamoiditis in my OTHER foot. Doh. I’m a bit demoralized but it feels like I’ll get over the sesamoiditis faster, as it feels far less chronic than the pain I was dealing with in November/December. I appreciated the advice; diligent foam rolling and calf stretching seemed to help.

With all that said, if anyone else is working through it; it will get better, very slowly. What kept my fitness levels somewhat ok while recovering was fairly common sense in retrospect: See what I could tolerate without pain during or after a workout, and try to progress from there. For me, it was every-other-day running starting at 30 minutes, with a mix of inclined treadmill walks and swimming to keep some aerobic work without stressing my foot on other days. It’s taken months, not weeks to feel better.

I don’t know if it warrants a different thread but the sesamoiditis seems to have me back in the same position though. I’m a bit unsure of what aggravated my “good” foot since I was doing very low volume running, but here we are. Perhaps a change in gait or other subconscious correcting?
Participant
Reed on December 29, 2020 at 11:07 am #31960
A few ideas & resources that might be helpful:
- Interlace your fingers between your toes, and gently pull / twist / push for a few minutes. Similarly, put a towel on the ground and practice picking it up with your toes.
- Book recommendations: Becoming a Supple Leopard, Fixing Your Feet
- Cushioned shoes, as suggested – I like Altra shoes a lot
Participant

viyat on March 25, 2021 at 2:37 pm #52396

Hey todd & Pete, I don’t want to hijack this thread but I’m facing a similar issue right now and I wanted to get more thoughts from you about what worked for you. Long winded story below (sorry!)

At the start of my base training period, on my first aerobic run (AeT 135), I ran slow with a bad gait and pushed through the pain (very stupid on my part in retrospect). I couldn’t weight on my foot for 24 hrs but I started to notice a pulling/pebble feeling under 2nd toe MTG joint (attached an image). Its ok on the hardwood floor but on lunges, uphill work and standing on toes, I feel this pebble sensation here (no pain, more discomfort and annoyance). Podiatrist did x-rays and examined the foot – no other issues. I rested for 4 weeks (with deep tissue calf massages, icing the area and using lacrosse ball & TENS unit) until it felt 95% (no pebble feeling, doing single leg calf raises prescribed by PT) better. I went on aerobic uphill hike and the pebble feeling came back and I am lost on how to move forward with resolving this issue.

I have some 12 weeks before my Shasta climb and I would hugely appreciate on some details on what you did with the coach to fix it. I have been training using a bike vs hiking/running and have been doing long uphill bike rides to train around the injury.

Participant

viyat on March 25, 2021 at 2:44 pm #52398

here is the pic of the foot where the discomfort is

Participant

Pete Dickinson MS,PT on April 6, 2021 at 10:19 am #52819

Have you tried a met pad? You have to also deal with any posterior chain tightness. Hoka shoes for shock absorption. Hip strengthening to attenuate load at the foot.

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