Metatarsal / Joint pain

[etreas]

First off, thanks to the docs for this great forum! For the past 9 days, I've had some achiness and tightness near my fourth metatarsal-phalangeal joint extending into the distal end of the metatarsal. It's mildly tender if I press directly on top of the metatarsal, but nothing beyond a slight bruised feeling. There's a little swelling around the joint, mostly on the bottom (ball of foot). It hurts the most first thing in the morning and when I first walk after long periods of rest, but feels a little better after some easy walking. I suspect either a stress fracture or capsulitis, but can't get into my doctor for another 2 weeks.

For some background, leading up to the injury I'd been logging 50-60 miles per week, approximately half barefoot and half in minimalist shoes. The day before, I ran a shod 16-miler and felt fantastic. Then, 6-miles into a barefoot run my 4th metatarsal / joint began to tighten up and ache, so I immediately stopped. I tried running a week later, but made it only 2 blocks before my 4th toe began to ache, turn numb and whitish-blue! I've been able to do the elliptical and yoga with no problem. I suffered my first stress fracture 5 months ago (2nd metatarsal of the same foot), but have been running otherwise pain-free for the past 3.5 months.

Does anyone have insight into whether this sounds like a stress fracture or joint problem? I'm unsure how to treat it over the next 2 weeks until I see my doc. Emily Splichal's advice would be very welcome, as she was a great help during my previous injury (http://www.thebarefootrunners.org/threads/suspected-capsulitis-of-2nd-mpj.7557/) but I would of course love to hear anyone's input!

Thanks!

 

[Backfixer]

I think the clues you are giving us point to other problems since you had a stress fracture not too long ago. While shod runners heel strike harder, barefoot runners with tight legs will hit harder into the midfoot. The result is stress fractures. Since the pain is in the ball of the foot, I would think that the calves are tight and you are likely tight in the IT bands and gluts and your core is distorted.

Thinking outside the box on this would be helpful because it gets us to why are you striking so hard on the ball of the foot and why that foot. Most likely that is your understride side and while you did not mention it, I am wondering if you get groin soreness or straining on the other side which would solidify my thinking on this one. My book Cheating Mother Nature, what you need to know to beat chronic pain can put this into a better perspective for you.

I would suggest you foam roll the it bands, gluts, quadratus and abdominals as well as the back of your knees and calves. Then see how this feels. Again, we can all try to guess if there is a stress fracture, but IMHO, a better way is to understand why this would happen in the first place and treat the mechanism, rather than obsess on the pain. I have found this approach keeps more runners on the road and prevents future injuries.

 

[etreas]

Thanks so much for the reply, Dr. Charschan. Indeed, I've had very tight calves for years, beginning well before I began running barefoot. I have a history of achilles tendonitis on my right (currently injured) side, and chronic glut / hip tightness in my left leg. Interestingly, these issues have actually all improved since switching to barefoot/minimalist running. I've been trying to treat these issues for many years, and currently get regular ART, massage and chiropractic treatments, and regularly foam roll. I have also had a running gait analysis done and was told I have exceptional form (although my own impression is that I tend to over-supinate). I'm pretty much at a loss for how to prevent further injuries, as I don't know what more I could be doing. Any additional recommendations are certainly appreciated!

I completely agree that a long term preventative approach is always best, and would love to get to the root of the problem. But in the meantime, do you have any recommendations for how to expedite healing of my current injury? If it is a fracture, capsulitis, or other, I'd like to be doing all I can to best treat it. Thanks!

 

[Backfixer]

I wish I could be of more help however, without actually evaluating you personally, it is difficult to be more specific but I am glad you have someone who performs ART which can be quite helpful. Perhaps, you may consider reading my book, it may give you some ideas. Unfortunately, biomechanical issues are present whether you are shod or now and as you found out that running and retraining barefoot alleviated some problems and created others, so the main factors that had you switch to barefoot are still present. I am confident that when you figure this out, the foot and leg problems will resolve or greatly improve. Good luck.

 

[theshortwhiteguy]

No kidding? So, now I know why I just started to feel groin pain on the other side. Thanks Doc.