I’ve been experiencing a dull bruising pain along the base of the fifth metatarsal of my left foot for about 6 months now and finally decided to visit a specialist. My doctor’s assessment is as follows:
Achilles Tendon - Tendinosis
Acquired Equinus deformity of the foot
Capsulitis metatarsal phalangeal joint 5 left foot
I took the prescription to a physical therapist and based on a simple field test, the therapist thinks the root cause of the problem is from hip strength imbalance. I tend to agree with the doctors assessment that it’s from not fully rehabilitating my left ankle after undergoing reconstructive surgery of the Achilles tendon almost a decade ago. I also agree with the script which specifies the plan of treatment focusing on stabilizing exercises of the foot/ankle + intrinsic muscle strengthening. Nowhere does it say anything about my hips being off. Anyway, I found out later that the brief 40 minute session with the PT is going to cost me $250 and made a decision to forego it for the time being due to cost (approximately $850 for 6 weeks @ two 1 hour session/week).
Has anyone else here dealt with this injury? I’m curious to hear what type of strengthening exercises you did to correct your gait.
I’m currently running 26-30MPW on 3 runs and it usually starts bugging me around mile 8 – it’s more of an annoyance, but I don’t want it to develop into a bigger problem as I pick up the mileage.
If you are remaining supinated throughout the gait cycle as you are describing, you can certainly attempt some of your own “PT” at home first, especially if you are able to run 8 mile at a time/30 mpw.
Start with the typical posterior gastroc and soleus stretches you can find online/anywere, especially the eccentric exercises you will read about. Also, a night splint may be helpful as well. Next, avoid any motion control/orthotic in the shoe that will keep you on the lateral side of your foot even further. Also avoid any “forefoot running” issues that can further aggravate. Ice the lateral 5th met base/met head after activity (even just grocery shopping). I’d avoid any hill running (or running in general really) and more cycling/elliptical until your capsulitis clams down.
How tight are you? Any measurement taken of how far you can dorsiflex your ankle?
Thank you for posting rroof - I’ve read your posts on similar topics and your response is much appreciated. I think I need to clarify the forefoot comment - I push off with my forefoot, but predominately strike with my midfoot after a brief touchdown with the heel. I’ve gone through three pairs of shoes since March, from motion control (very painful) to light stability (less painful) to finally to using my neutral speed/tempo shoes (Kinvara) for all my runs and I found running with low drop neutral shoes to be more comfortable and less painful than the others. Also, the capsulitis isn’t too bad; it flares up for a day or two after a run, right on the base of the 5th metatarsal, but since I run every other day (Tue/Thur/Sat) with an extra day of rest from my Saturday long run, I’m able to get back to running without issue. My dorsiflex on both ankles was measured < 15 degrees, with the left being about 1-2 degrees less than my right.
I’ll look into the stretches/exercises you mentioned - thank you for that.
I just dealt with this personally and unfortunately derailed the back half of my run @ IMAZ … my history is similar to you with a very old ankle injury not rehabilitated properly
History … i triggered this three weeks out from the race while riding (not running) and NEVER had it before … it came from my left hip / glute shutting down a bit which, down the chain, caused the foot to invert putting loads of pressure on the “flexor digit brevis mini” … it really started to bother me running the next few days along with the pressure of my cycling shoe … it never got 100% better once it got aggravated.
Post race i did no running for two weeks (very little light cycling) … aggressive ice massage & two aggressive treatments of “scraping” (deep tissue) from my chiro plus the following … NOTE: I’m currently back running with no issues other than some light irritation
Single leg strength exercises that gets the glute firing and leg / hip tracking straight (single leg bridges, single leg - leg press, single leg squats w/ body weight)
Key with the above is pay attention to making sure the arch of the effected foot is “firing” and not jut collapsing … mine was a bit shut down and now that i’m aware, it makes a big difference in how the foot functions
On top of the above exercises the other two things that have been helpful in mobilizing my foot / ankle are: 1) kicking with fins (dolphin & on your back) … i don’t do much but helps significantly with ankle flexibility 2) Using the TP Therapy lower leg kit exercises … stretching did / does nothing for me. The mobility & tracking should allow the foot to land a little less inverted and make a huge difference
My suggestion? Take 10 days - 2 weeks off with no running and get it squared away, otherwise you might end up in a continuous cycle of being less than 100% … if you feel like you really need to run do 30min (as long as it is 100% pain free) every other day. Take the down time to be aggressive with it and get it right … 10-14 days of no running might be the difference in allowing you to run pain free, more often & longer for the rest of your life. 17 days for me made all the difference in the world!
Since your injuries are caused by some sort of faulty biomechanics coupled with repetitive use then PT is the best recommendation for you in my opinion. You can tell the PT that you want limited visits and that you want education so that you can followthrough on your own. With your combination of symptoms I would be surprised if you can get forum info and internet videos to address your problem effectively. Its difficult to perceive a faulty movement pattern since that movement pattern is imprinted upon your nervous system as “normal”.
Who do you reckon would give better diagnosis & treatment on this - podiatrist or physiotherapist? Suffering similar condition myself, the physio is ok but wondering if a podiatrist session is worth a shot too.
Thank you for posting rroof - I’ve read your posts on similar topics and your response is much appreciated. I think I need to clarify the forefoot comment - I push off with my forefoot, but predominately strike with my midfoot after a brief touchdown with the heel. I’ve gone through three pairs of shoes since March, from motion control (very painful) to light stability (less painful) to finally to using my neutral speed/tempo shoes (Kinvara) for all my runs and I found running with low drop neutral shoes to be more comfortable and less painful than the others. Also, the capsulitis isn’t too bad; it flares up for a day or two after a run, right on the base of the 5th metatarsal, but since I run every other day (Tue/Thur/Sat) with an extra day of rest from my Saturday long run, I’m able to get back to running without issue. My dorsiflex on both ankles was measured < 15 degrees, with the left being about 1-2 degrees less than my right.
I’ll look into the stretches/exercises you mentioned - thank you for that.
Just to clarify a few things: I’m sure you realize that formal PT would certainly be best, but with your history, post about cost and posting here, take all info and digest carefully …
Next, your “capsulitis” diagnosis can not be correct if your on/off sensitivity is at the base of the 5th metatarsal (known as the styloid process) since there is no joint capsule there. This is the insertion of the peroneus brevis muscle and an insertional tendonopathy of some sort is more likely.
If you can dorsiflex your ankle 15 degrees past vertical, that is fine. I’m not sure what <15 means. Is that 14 or is it 3? You want over 10 with 15-20 normal in my experience (closer to 15 in men, closer to 20 women). Some people even get close to 30.
I went to both. I went to a sports medicine podiatrist (specializing in running related injuries) and he analyzed my lower extremity biomechanics, who then wrote a script, which I took to the physiotherapist for treatment.
Formal PT would be best, but I was surprised therapist I visited re-assessed my injury and wanted to work on exercises to strengthen my hip, which I felt was not necessary since I’m very close to being even on both sides and I don’t want to pay for unwarranted PT sessions. I think a full gait analysis would reveal a lot more about muscle imbalance and I’m fairly certain my hips don’t drop much on either side and if they do, I doubt it’s significant. What really stuck out to me was the video the podiatrist and I looked at (hip on down from the back), where you can clearly see my left foot supinates a lot more than my right. This description is slightly exaggerated, but it’s almost as if my left foot rotates clockwise from 180 to 365 degrees after pushing off from the midfoot 5th metatarsal. And if you were to pause the film right as my foot lands and draw a line down from the center of the knee to the center of my shoe, the left leg would be slightly angled in vs. a straight line on the right side.
The base of the 5th metatarsal is the area that’s most tender, but the peroneus brevis muscle was also aggravated. It bothered me a lot in the past, but has largely subsided after switching to neutral shoes from motion control. I mentioned that to the doctor…maybe I didn’t emphasize it enough?
I can’t recall the exact dorsiflex, but my right side was right around 15 degrees and the left side was measured around 13 or 14 degrees.
That description makes me think the PT is correct, you say your hip is not dropping but it sounds like it might be adducting. Your foot is getting the abuse because your hip is not putting it in place to land correctly.
How fast were you running when you were filmed, sometimes running faster than usual will result in adduction and supination.
I think the treadmill was set @ 8MPH - my training pace is between 7.6-9.5MPH (never do sprints). Even if my hip did drop (which the doctor did not see), I’m still having trouble drawing the line between hip drop and supination. Correct me if I’m wrong, but in my case, it seems like the excess supination is more related to my foot/ankle/calf biomechanics than hips?
In the video, do you recall if your foot was landing at about shoulder width, at midline, or across midline? How was your other foot landing?
Do you run on your toes?
The PT saw some weakness but it may be caused by adductor tightness.
Maybe you can ask the podiatrist if he agrees with the PT assessment.
Both feet land slightly across the midline and so naturally, both my feet strike on the outside; however, it is far more proununced on the left side due to my ankle tilting in. My adductor muscles are always tight on both sides after a run and it’s always been that way but I also stretch that part of the body out after each run. I’ll reach out to my podiatrist and mention the PT assessment to him…really hoping to get this sorted out before spring. It’s been a frustrating process, and even more frustrating when the experts differ in their diagnosis of the problem.
Good luck. But my main point is that the podiatrist and the PT probably agree, it’s just two symptoms of the same problem. Fortunately you have been able to run regularly but you will probably have to change to avoid ongoing problems.