Went for my usual on Monday - 8 miles on asphalt paths around our neighborhood’s canal system -and noticed no real problems. Woke up the next morning and outside portion of my left foot hurt. As the past few days have passed, it hurts worse than before. I’m actually having problems walking now, and it seems to be bruised.
First, I’m assuming this is a bruise, but I must say it hurts pretty bad and is causing me problems. Second, I have no idea why this happened, as I run 3-4 times per week. It was the same route, shoes, distance, etc. I don’t recall stepping on anything either. This situation is stupid to say the least.
Can you provide some more details? Be more precise with your location and I’ll try to speculate (I am a podiatrist/surgeon). Not a lot happens like you are describing except for a stress fx (sorry). Luckily, that is not a normal location for one -
If my foot were a clock, with the toes being the 12 o’clock area, this affliction is at 9 o’clock. The specific part that is afflicted is the bottom and side of the outermost protruding edge. In looking at an anatomy book, I believe it to be the tuberosity. Yesterday my foot was cramping up, and my inner arch is starting to hurt - likley from the altered step the pain is inducing. This outermost spot is somewhat inflamed.
This is likely insertional peroneus brevis tendonitis. If you look at your anatomy book, the 5th metatarsal tuberosity (called the styloid process) is a “bump” that is there for a tendon insertion. This tendon is the final aspect of the strong everter of the foot and muscle(s) along the lateral aspect of the lower leg. Another test is to try to evert (twist your foot away from the midline of your body) against resistance. This should reproduce the tenderness. If it is “pinpoint” at that spot, ice it and rest a bit. It should resolve fairly quickly. If the tenderness extends into the tendon (runs from that bump up behind the lateral ankle “bone”), then this will require a bit more rest to resolve. Running on hills, uneven terrain or lots of “cutting” or lateral motion tends to aggravate this.
Be more precise with your location and I’ll try to speculate (I am a podiatrist/surgeon).
Hey rroof, what do you make of this? I raced an Oly on Sunday and had a pretty rough day. My form totally broke down on the run, so there was a lot of shuffling going on. The next day I noticed that the head of the 4th metatarsal on my left foot “doesn’t feel right”. There was no pain during the race, but it’s been mildly sore for close to a week now. (No redness or apparent inflammation) Frankly, it feels almost like a stress fracture, but my experience with stress fractures (tibial) have been extremely painful - this is not. Sure it kind of hurts when I poke or squeeze it, and I can feel some discomfort while walking, but it’s nowhere near as painful as I would expect a stress fracture to be.
Any thoughts as to what I might be dealing with here?
Usually pain directly at the metatarsal head, very soon after your race/description = capsulitis. Lesser MPJ capsulitis will also hurt with end range of motion of the joint, but not necessarily with gentle ROM. Try moving your 4th toe into extreme dorsi/plantarflexion (up and down) - if it hurts at the end of the motion, likely capsulitis. Take anti-inflammatory (if able), ice, some rest - should resolve rather quickly.
If not - push about 1 thumbs width behind the 4th MPJ on the top of the metatarsal - if this focal spot hurts, that tends to more consistent with a stress fracture (although the 4th metatarsal is not usually involved). If so, stop running. Wear very stiff soled soled shoe. See a sport med practitioner (shouldn’t matter exactly who - but I always prefer one is also a runner/triathlete etc. if at all possible) in about 10-14 days. Stress fractures do not usually show up until then on plain X-rays. Will save you a trip for a bone scan or MRI to confirm the dx
Thanks for the “tests”. This confirms my suspicions that it is indeed a stress fracture, so I’ll be calling for a Dr’s. Appt tomorrow. I live in Canada, so as long as I have a Dr’s referral a bone scan won’t cost me anything. I just got the name of an excellent sportsmed Doc who’s himself a runner/triathlete, and has agreed to take me on a a patient. Unfortunately he can’t see me until December, as he’s currently in Tibet studying the effects of altitude on exercise subjects. I guess in the meantime a family doc will have to suffice…
My one remaining question, is aren’t stress fractures supposed to really hurt?
“really hurt” depends. First off - 4th metatarsal stress fractures are fairly uncommon. In runners, usually a stress fx occurs in the 2nd metatarsal or the distal tibia (leg). Since an actual cortical break is not usually present at first, they are only painful with direct loading of the bone. The tibial stress fx hurt a lot more because the bone is much larger and is loaded with every step. The 4th met does not bear much weight (hence the rareity of the stress fx in the first place) so it is usually only “achy” unless you palpate right on the spot, then it hurts like …
Think of your bone now as a paper clip that you have been bending - you can tell when it is about to go, right? That is how your bone is right now, so… NO running and get a very stiff soled shoe (like a Birkenstock or something) that won’t bend. Takes about 6 weeks to heal.
That makes a lot of sense… Ok, so no running (yay!), and workboots (stiffest soled shoes I can think of). Can I still ride? My cycling shoes are plenty stiff…
Ah, I was waiting for that question! The reason I suggested you see a “triathlete doc” is for this very reason. It is very easy to order a bone scan, get the radiologist’s interpretation, stick you in a shoe/boot and say stay off of it. Reality (for me at least), is that is not going to happen. I would rather let the athlete know why, what can/may happen if you do THIS or THAT and give them options to maintain cardiovascular fitness.
I would probably let you cycle (especially spinning at high cadence rather than mashing the pedals like Jurgen Zack). This would somewhat depend upon radiological findings (bone scan, MRI, pain film X-rays). If there is an obvious cortical break (no bone scan needed), I would probably NOT bike: risk now outweighs the benefit - swim only. Typical stress fx: bike OK as the risk is there, but probably not very high and minimal morbidity.
P.S. See if you can get the doc to get you an external bone stimulator. You should heal without it, but plenty of studies to show their effectiveness in healing hard to fuse bones. Won’t hurt (I would certainly do this for myself). Caveat is, insurance won’t pay for them (over 4K) unless it is a non-healing fracture or other circumstances (i.e. diabetic, smoker, etc.) Very unlikely to get in Canada. Sometimes though, a patient will turn one in early and I have a few laying around that I give out for free for this very reason (especially to my fellow tri guys/gals)
Cool. Thanks so much for your insight - it’s great to have an athlete doc giving opinions, even if you haven’t had the chance to see me in person/my images.
The upside of all this is that the doctor I’m going to see in my uncle, so if he does have access to one then I might be able to borrow it. I guess I’ll find out tomorrow morning.
I just got the name of an excellent sportsmed Doc who’s himself a runner/triathlete, and has agreed to take me on a a patient. Unfortunately he can’t see me until December, as he’s currently in Tibet studying the effects of altitude on exercise subjects. I guess in the meantime a family doc will have to suffice…