During a swim & cycle focused training period my left foot started to get sore. At first I though it was my arch, and now it turns out it is in the ball of my foot that I feel the pain.
Only feel pain when I walk on my foot. Can only feel the pain when I press around the 2nd metatarsal area of my foot. Foot tingles at time. Reduced mobility in my toes. Fore foot is swollen, both on the top and the bottom.
Xray showed up nothing, and MRI showed up nothing. Both say there are no abnormalities.
I’ve seen Physio, 2x GP, Podiatrist, Xray Expert and the MRI expert and nobody has been able to figure out whats going on.
Anybody got some suggestions as to what the problem maybe?
Could be Metatarsalgia? Metatarsalgia seems hard to diagnose. I had a forefoot issue that lasted a year. I ended up getting orthotics (which I no longer need) and it off-loaded the affected area to reduce the pain. Because I never stopped training, it took a year to resolve.
Jay is correct - metatarsalgia, a junk term/catch all phrase is it. 2nd MTP joint capsulitis is common from chronic overloading for various reasons (long 2nd met, forefoot varus, hallux valgus deformity, etc.) Biomechanical issue, so no true/real pathology noted on imaging in most cases, but a good clinician should be able to help offload the area. Of course, not running, cycling, walking will eventually resolve it as well - but not really an option for most
Jay is correct - metatarsalgia, a junk term/catch all phrase is it. 2nd MTP joint capsulitis is common from chronic overloading for various reasons (long 2nd met, forefoot varus, hallux valgus deformity, etc.) Biomechanical issue, so no true/real pathology noted on imaging in most cases, but a good clinician should be able to help offload the area. Of course, not running, cycling, walking will eventually resolve it as well - but not really an option for most
Can there be swelling of the foot top + bottom associated with Capsulitis? I guess I will take it that its Capsulitis, should I get one of those protective foot cases that people wear when they have a stress fracture?
At the moment I am just on crutches so no running or cycling, will keep my swimming up though.
How about Gout or some other weird aliment? Anything I should consider there?
yes, you can and generally will see/feel some localized swelling on both the top and bottom centered around 2nd MPJ and it should be tender to palpation or end range of motion of the joint. Crutches are bit overkill, but won’t hurt. A CAM boot also a bit overkill with a negative MRI (assuming no plantar/volar plate tear), but will be helpful. Gout in the differential, but unlikely especially if this has been present for over 10 days.
I had/have similar, but 3rd metatarsal. Not sure EXACTLY what has helped, but its pretty much gone now (fingers crossed) .
These are what I think worked best;
Stopped running
stopped flip turning/strong push offs
NSAID’s (aspirin)
used green metatarsal pads, both feet, religiously, every pair of shoes all the time
after several weeks of padded shoes, pain was slightly less, then started rolled the bottom of feet, including ball-of-foot, with tennis ball several x daily, especially before first step in AM
moved to flatter (low heel) shoes, both walking around and running (yes, eventually started running and flip turns again)
cut out a “relief hole” in my insoles that exactly matches the painful metatarsal head location (this may have been the single most helpful)
stopped cracking toes
most recently “stretching” toes using a tennis ball between toes and ball of foot and rolling/pushing down
Good luck, took ~8 mo for me, with ~ 2 replapses when I started running too soon. Now I’m up to 3x wk ~10-15 min, increasing a few minutes each week. Will be adding in 2 more short runs next week. All done with the green metatarsal pads in running shoes. So far so good.
