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Foot pain under "ball" of foot @ base of 3rd and 4th toes

 

   


type-B

Apr 5, 12 21:25

Post #1 of 16 (31008 views)
Foot pain under "ball" of foot @ base of 3rd and 4th toes Quote | Reply

Background:

-I'm 6'4" ~180-185lbs and have been practicing running with a mid-foot strike (essentially just working on getting my damn feet to hit below my center of gravity) for the last year and a half. I've been wrestling with tight calf mussels for the last few months, but they've actually been feeling better during the last month or so.

-I've been averaging about 30-35 mpw for the last couple months now after a slow build up from the 20ish that I'd been holding for quite some time before that (following BarryP's plan.)

-I've been running races and training in Kinvara 2's (replacing every 300 miles or so) until ~2 months ago when I picked up a pair of Brooks Pure Flows which I've been using for training miles. (I will note that my casual shoes are a pair of Nike Free 3.0's that are probably more than worn out.)

-I also wanted to add that I've really been in endurance sports for about 3 years (was prior military, so had a light run load) and completed IMC last year and have been pretty much injury free this entire time.

Problem:

During my last middle distance run, 8 miles at a cruise pace, I started to feel a bit of a sensation that reminded me of when I'd done a run with a tiny sliver in the ball (somewhere in the area of the of my foot. It was enough that I noticed it, but not enough that I felt the need to stop and even try to scratch at it or anything. This was probably around mile 2 or so and I don't really remember feeling it during the rest of the run. Upon returning, I stretched and it wasn't until coming home that I felt anything again. That night (last night) I felt just an ever-so-dull pain in the area around the base of the 3rd and 4th toes and mentioned it to my wife in passing.

This morning it was slightly worse, but still not much more than a dull sensation. However, after moving about during the entire day it started to feel more and more like a really deep bruise at the base of those two toes. When I made it home today I convinced my wife to take a look at it and there was (barely) noticeable swelling in the area compared to the other foot. After taking my shoes off, it definitely hurts more barefoot and on hard flooring. Also, it hurts more during the push-off phase of walking; essentially when using the toes to push off. There's no pain at all from the top, and even pushing and prodding from the bottom doesn't really hurt much at all. Most of the pain comes if I pull my toes back a bit.

Solution?

I'd love some opinions from y'all in the time that it takes me to make a doctor's appointment next week. The only big race I have this year is Leadman Bend in September, so I really don't mind taking the time off that I need (see my screen name) in order for whatever this problem is to heal correctly. Though I must say really enjoy running and was trying to build eventually up to ~50 mpw so I could have a go a several running benchmarks and sprints this summer / fall.
--------------------------------------------------------

It seemed like a good idea at the time. . .

(This post was edited by type-B on Apr 5, 12 22:07)


MukMuk

Apr 6, 12 1:19

Post #2 of 16 (30975 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [type-B] [In reply to] Quote | Reply

Sounds exactly like what I went through and the cause was a shoe switch. ...pain under the second/third toe (metatarsal / metatarsalgia..google metatarsal pain for lots of info). It felt like there was a lump in my shoe under those toes and it got to the point where I had to remove my boot at work because of the pain. Just sitting around the house it would throb. The only thing I was doing different was a shoe and insole switch. It took a bit less time than you, maybe a month, but then the pain slowly developed to the point where I thought worse case I had fractured it.

Long story short, I went back to the old shoes and insoles, took a bit less than a week off running and now no pain whatsoever :-)

The odd thing was that the new shoes I was using felt great to run in so I am a bit bummed about that but I'll take no injury / pain any day!


MukMuk


kevin1716

Apr 6, 12 1:24

Post #3 of 16 (30974 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [type-B] [In reply to] Quote | Reply

Its called Morton's Neuroma. You can google to determine symptoms. Basically you will receive an initial steroid shot on first visit followed by a series of alcohol based shots every other week until pain is gone. Toe numbness usually accompanies the pain but it is treatable. I had my 4th shot on Tuesday and am very pleased with the progress. My Dr. reduced my running by about 15%/week but allowed me to swim and bike as usual.


dreaming~big

Apr 6, 12 2:36

Post #4 of 16 (30956 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [type-B] [In reply to] Quote | Reply

If you get no relief after trying everything else, google radiofrequency ablation. That's what I needed to get rid of it. Good luck.

~~ kate


rroof

Apr 6, 12 8:49

Post #5 of 16 (30860 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [type-B] [In reply to] Quote | Reply

Love your screename ...

Most of the likely diagnoses have been mentioned by other suffers. The short differential would be Morton's (intermetatarsal neuroma), capsulitis of the 3rd and/or 4th MTP joint, or metatarsalgia (which is really a generic, non-specific term and not an actual diagnosis). Treatments (in runners) varies a bit, so a good diagnosis is important. Of course, not running/rest treats them all, but type-As don't want that ;-) Type-Bs, maybe.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


d-elvis

Apr 6, 12 8:58

Post #6 of 16 (30847 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [rroof] [In reply to] Quote | Reply

Had the same thing.... ice and ibuprofen helped... freeze water in small water bottle and roll the front of your foot on it, curl your toes over it... about 15', 3-4x per day
Also massage the toes and ball of the foot, separating and manipulating each toe or metatarsal

Try different shoes, or as said above go back to old brand. Lacing the shoes real loose on foot with the issue helped too


"if you chose it, it's not really pain"


smarty

Apr 6, 12 9:00

Post #7 of 16 (30843 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [type-B] [In reply to] Quote | Reply

Sounds like a neuroma (enlarged nerve). I dealt with it for over a year, and did the cortisone shots and alcohol injections, etc... Nothing worked, so I had it surgically removed by my podiatrist - problem solved. As a long time runner, I really didn't want anyone cutting into my foot, but it resolved the issue and I've been problem free for over 2 years. Post surgery, you can't run for about 3-4 weeks, so I had my surgery in December. To help get through the season without surgery, cortisone may provide some temporary relief?


Cody Beals

Apr 6, 12 9:40

Post #8 of 16 (30823 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [type-B] [In reply to] Quote | Reply

I agree with the other posters that it sounds like Morton's neuroma (an inflamed nerve between the 3rd and 4th metatarsals).

I have had two episodes (lasting ~2 weeks and ~4 weeks). I'm also a midfoot/forefoot striker and I run 80-150 km/week throughout the year. I'm not certain about the trigger, but both times I was running in old Kinvaras. Those shoes have a relatively narrow toe box. The key to dealing with Morton's is to find a toe box that is wide enough to allow your toes to splay in an unconstrained way. Here are some common-cited solutions that I tried, in order of effectiveness:

  1. New shoes with a wider toe box (check out other Saucony shoes, NB Minimus and Altra Instinct among others). More cushioning could help, but it's not the main factor.
  2. Taping/padding - this took a lot of experimentation but was eventually quite successful. I found that the best technique was to cram a lot of foam padding (I used foam make-up pads - cheap and easy to find) between the 3rd and 4th toes and secure it lots of athletic tape. I also taped my 3rd toe to my 2nd. They key is to lightly tape the foot while it is loaded. You don't want to create any kind of compression. This technique forces the toes apart and takes pressure off the nerve.
  3. Rest - During the second episode, I took a full week off running. I'm not convinced that this was necessary or helpful, but it was the off-season anyways.
  4. Ice - I have to idea if this did anything, but I did it all the same.
  5. NSAIDs (I used IBU) - Again, no idea if this helped at all.
  6. Off-the-shelf metatarsal lift - complete failure. Because the painful area is so localized, I had slightly better luck making my own lift out of a foam mouse-pad and supergluing it to my insole in just the right spot. Really it just felt annoying while running and improper shape/placement made things worse.

Forums are full of Morton's neuroma horror stories involving failed surgeries, years of recovery etc. Don't get discouraged, I think that only people with severe cases take the time to post. Also, at the one physio appointment I had, she was pushing custom orthotics. Views on orthotics are very mixed and I have had success with cheaper options. Good luck!

ETA - 7. Minimize walking in bare feet. I wore flip-flops around the house at all times.


Cody Beals | @CFBeals
Ambassador for: MultiSport Canada | CompuTrainer | Nineteen Wetsuits | Vorgee | Altra Zero Drop | Coached by: David Tilbury-Davis | Magnolia Masters


(This post was edited by endorphin on Apr 6, 12 9:42)


ether

Apr 6, 12 10:47

Post #9 of 16 (30797 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [type-B] [In reply to] Quote | Reply

I didn't even read the post, but the proper course is go see a podiatrist.


IanH

Apr 6, 12 13:00

Post #10 of 16 (30754 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [atilley] [In reply to] Quote | Reply

atilley wrote:
I didn't even read the post, but the proper course is go see a podiatrist.

I tried that with very similar symptoms. The podiatrist was useless, had no idea what it was. Said he treated hundreds of running injuries, never heard of this. So...not all podiatrists are helpful.

I took a week off running, iced my foot everyday and the pain was gone. About 5 months later I had the same problem come up again. I looked at similarities in my training in both time periods and it was a change in cycling shoes that caused it for me. They toe box is tight in my tri shoes. Over the winter after my first problem I went back exclusively to my road shoes (just what i used, wanted to save the tri shoes for summer). When I got back out to hard riding in my tri shoes, I had the problem come back up.

So rest and ice during painful period worked for me. Take a hard look at your shoes and see if going back to your previous model makes a difference.


type-B

Apr 6, 12 13:15

Post #11 of 16 (30747 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [endorphin] [In reply to] Quote | Reply

So I woke up today and the discomfort was barely noticeable. . .even when putting pressure backwards on the toes. Maybe I just got spooked at an odd pain. I think I'll just rest, ice, and use NSAIDs for a couple days and see how it goes. I met with a couple PT friends this morning who after working in the area of that nerve didn't get much of a pain response didn't think it was Morton's neuroma.

It's interesting that you mention that endorphin, I did a 1/2 marathon and the last two runs prior on a pair of Kinvaras that should probably have been replaced.

Thanks for the responses guys!

endorphin wrote:
I agree with the other posters that it sounds like Morton's neuroma (an inflamed nerve between the 3rd and 4th metatarsals).

I have had two episodes (lasting ~2 weeks and ~4 weeks). I'm also a midfoot/forefoot striker and I run 80-150 km/week throughout the year. I'm not certain about the trigger, but both times I was running in old Kinvaras. Those shoes have a relatively narrow toe box. The key to dealing with Morton's is to find a toe box that is wide enough to allow your toes to splay in an unconstrained way. Here are some common-cited solutions that I tried, in order of effectiveness:

  1. New shoes with a wider toe box (check out other Saucony shoes, NB Minimus and Altra Instinct among others). More cushioning could help, but it's not the main factor.
  2. Taping/padding - this took a lot of experimentation but was eventually quite successful. I found that the best technique was to cram a lot of foam padding (I used foam make-up pads - cheap and easy to find) between the 3rd and 4th toes and secure it lots of athletic tape. I also taped my 3rd toe to my 2nd. They key is to lightly tape the foot while it is loaded. You don't want to create any kind of compression. This technique forces the toes apart and takes pressure off the nerve.
  3. Rest - During the second episode, I took a full week off running. I'm not convinced that this was necessary or helpful, but it was the off-season anyways.
  4. Ice - I have to idea if this did anything, but I did it all the same.
  5. NSAIDs (I used IBU) - Again, no idea if this helped at all.
  6. Off-the-shelf metatarsal lift - complete failure. Because the painful area is so localized, I had slightly better luck making my own lift out of a foam mouse-pad and supergluing it to my insole in just the right spot. Really it just felt annoying while running and improper shape/placement made things worse.

Forums are full of Morton's neuroma horror stories involving failed surgeries, years of recovery etc. Don't get discouraged, I think that only people with severe cases take the time to post. Also, at the one physio appointment I had, she was pushing custom orthotics. Views on orthotics are very mixed and I have had success with cheaper options. Good luck!

ETA - 7. Minimize walking in bare feet. I wore flip-flops around the house at all times.
--------------------------------------------------------

It seemed like a good idea at the time. . .


matto

Apr 6, 12 14:11

Post #12 of 16 (30726 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [kevin1716] [In reply to] Quote | Reply

kevin1716 wrote:
Its called Morton's Neuroma. You can google to determine symptoms. Basically you will receive an initial steroid shot on first visit followed by a series of alcohol based shots every other week until pain is gone.

I had a mild Neruoma and did not need a shot.

My Dr. modified my orthotics to add support higher up under the metatarsal bones, which relieves pressure up by the base of the toes. I could immediately feel the difference when running and it hasn't been a problem since.


sesel

Apr 7, 12 1:34

Post #13 of 16 (30638 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [type-B] [In reply to] Quote | Reply

Sounds just like the symptoms I had back in June last year. 10 months later and unfortunately I'm still dealing with the issue. First I went to the doctor, who was less than helpful. I had it looked at by a podiatrist (who is a triathlete) who was experienced with athletes, and he said that it seemed to be Mortons Neuroma. I reduced my run volume, no change. I reduced it even more, no change. The pain wasn't enough to stop me from running, so I continued along. I was always conscious of it during training sessions, but it normally wasn't until after running that the pain really came on. There was one period of time where the pain was so bad, I thought something must be broken. I remember sruggling to walk and being in real pain when depressing the clutch whilst driving and changing gears (stick shift). I went for an x-ray (a bone scan would have been much more useful, but wasn't possible) which showed nothing.

I couldn't say for sure what brought it on. I'd been in Newtons for ~8 months and felt good transitioning to a midfoot strike. I'd also done a lot more work at the track, which was likely the main root cause of the problem. I bought new shoes and went up a size to have a wider toebox, which didn't help. I've since moved on from Newtons, but there has been no change. I found ice to be effective in the short-term, but the next day it would be no better. Also, I'll second what endorphin said about not walking barefoot. I have to wear shoes all the time now. I really, really struggle walking on sand or loose surfacing, as it triggers the pain and causes discomfort. Thankfully, it's not noticeable when cycling.

Here's what I've done to live with the problem:
- When swimming, push off the wall with more pressure on the 'good' foot
- Minimise wearing racing flats, as there's not enough cushioning. Any time I wear racing flats, I pay for it afterwards
- Revert to more of a midfoot-heelstrike technique. I've had to work on increasing my cadence since consciously adopting this technique
- Always wear shoes - no walking around barefoot. I've invested in lots of 'recovery footwear', which I've found to be incredibly helpful
- Minimise unnecessary walking
- Always wear cushioned shoes when possible. I struggle in casual 'flat' footwear (eg. Converse)/boots/smart shoes etc

I'm sure there are varying degrees of suffering with Mortons Neuroma, and hopefully you don't have it too bad.

Nick Baldwin | @baldwin_nick | Facebook | Coach: Accelerate3
Adidas | Drag2Zero | ENVE | ISPC Seychelles | Click Fragrance


Big

Apr 7, 12 6:13

Post #14 of 16 (30607 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [type-B] [In reply to] Quote | Reply

So one thing I have learned is the importance of identifying the pathology...It my case it appeared to be my running mechanics (related to lower extremeties in my left foot)...I over corrected for a supination issue after a calf strain...longer story that I won't get into. I had the classic case that you are explaining here of Morton's from over pronation. Relieving the pain is the easy part...correcting the problem is usually a little trickier because what we think we are doing isn't usually what is really taking place from a biomechanical perspective.

I am guessing from your shoes...the Kinvara's ...this is where the problem originated. My take on Kinvara's is that they are a minmilist shoe with squishy cushon in the forefoot. This shoe will allow you to pronate and in this case probaby over pronate which causes the metatarsals to squezze together and pinch the nerve. The cushon makes it worse because as the shoe gives too much medially (to the inside)...almost a dissapearing act for pushoff through the big toe and that cushon ends up bunching up under your 3rd and 4th metatarsal making it even worse. Giving you the sensation that you are pushing off with the outside of your foot which really isn't the case...The outside of your foot is really getting trapped as your arch collapses...

Rehab - ovbiously RICE first, but if you find the problem this won't be that big of deal...I stand on Tennis balls to stretch and strengthen my feet...not roll, but stand on them alternating body weight back and forth all along my foot. Do some calf raises...build up to 2x20 single leg...focus on push-off foward through whole ball of foot...not just pushing down on big toe...You can even walk on your tippy toes to build foot strength (google it and/or youtube)...

Get a pair of new Nike Frees...wide to box...good arch and the don't bunch up in the front (they are firm)...walk and run in them for a while if you have too, but just don't run too much (build up slow and/or walk run)

The last and most important thing I did to correct my walking running form...is spread my toes and be strong with the 3rd,4th, 5th metatarsal through the push-off phase of my walking and running gait. You only have to over exaggerate this for a little while off and on until you retrain you foot and ankle to not collapse during the plant/stance and push-off phase of the gait cycle...

It seems counter intuitive, but it isn't vertical force from the ground through the foot that is causing the neuroma it is lateral pressure causing the rubbing/squeezing of the nerves....This pretty much took care of my issuses, so hope it helps...I felt a lot more stability contacting the ground and then began too push-off again through my big toe when my foot was behind me (actually pushing foward)...not collasping or pushing down through my big toe on landing when my foot was underneath my hips...




Warning - I havn't seen your running mechanics and I am just givng some advice for what helped me.... I see this problem often and there isn't a lot of information out there with respect to correcting running form/mechanics...Mostly just how to get rid of the pain and then orthotics and/or some other form of foot support.


alvah_b

Apr 7, 12 19:11

Post #15 of 16 (30554 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [type-B] [In reply to] Quote | Reply

I had a similar pain on my foot, after an initial diagnosis of Morton's and a year of orthotics with no change I went back to the podiatrist and he found a small lump between the toes that he diagnosed as a "ganglion" He drew off a small amount of fluid from the ganglion and the pain went away after a month. It has returned twice in the past few years and a quick visit to the podiatrist has fixed it every time. Not sure if it your problem but if you can feel a small
Lump between the toes where you feel the pain it may be a similar problem.

The podiatrist told me it is a dwelling of the sheath around the tendon and it is a problem the will happen from time to time.


wowmyfeethurt

Jan 9, 13 0:27

Post #16 of 16 (25676 views)
Re: Foot pain under "ball" of foot @ base of 3rd and 4th toes [type-B] [In reply to] Quote | Reply

I have the same problem and was very worried.I bought the ball pads as suggested and I stayed off my feet and iced for several days if not months... No Relief..

Weird as it may seem walk around and stretch your toes by walking on the tips of your toes. I have really high arches and my feet hurt alllllll the time. My pain has been reduced and I can walk again.


I used to wear high heals all the time and now wear orthodontics and pads but after I started to stretch them backwards the pain started to go away.

Try this before surgery.

DON"T result to surgery that's even worse. I have seen crazy horror stories about removing the swollen muscle under the ball of the foot.

   
 
 
 



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