The Metatarsalgia (Ball of Foot Pain) Post!

I got motivated to put this together after a friend announced she was diagnosed with a Morton's Neuroma. I have that, I've had capsulitis, I have Morton's Foot, high arches, you name it I have fucked up feet. But, over the years, I've done my homework and found (this is typical for things like this) that there is information spread all over the fuck place, so I am consolidating what I have found here. If this helps even one person, my work here is done!

Please pass this along to anyone who has any sort of foot pain, because although this is focused on metatarsalgia, pain anywhere in your foot needs to be evaluated on the basis of the below. Physicians won't look at all of the factors, so YOU need to! Feel free to contact me either via Facebook or blog comment if you have additional items to add to this.

Disclaimer: I am not a doctor, nor do I play one on TV. I am not telling you what to do, just what things to consider when you have this pain.

·        Possible Medical/Biomechanical Conditions:

o   Do you have Morton’s Foot? If you do, ALWAYS point this out when seeing a medical provider. If they don’t know what it is and why it affects you, find another doctor. If you do, you might benefit from metatarsal pads in both running and regular shoes. This condition alone can cause all sorts of issues, like walking/running with splayed feet, excessive supination, hip issues, etc.

o   Might you have a Morton’s Neuroma? Consider how bad it needs to get before considering surgery. Make sure you’ve read everything here before you go that route.

o   Might you have 2^nd MTP Joint Capsulitis?

o   Are you experiencing Trigger Points affecting your foot? If you are at all athletic, you should own this book and use it for ANY aches and pains you experience. Even if you have a bonafide medical condition, you will probably benefit from working on identified trigger points.

o   Do you have muscle imbalances that are propagating to your foot or caused by it? (A qualified sports physical therapist is helpful here)? These can lead to pain while running and/or biking.

o   Have you been running for many years? The fat pads wear out on everyone’s feet over time. The more you run or do impact sports, the faster this may happen.

·        Are you committing run training errors?

o   Too much volume with insufficient rest

o   Sudden increase in volume/intensity

o   Always running on hard surfaces (asphalt/concrete)—try and at least do longer runs sometimes on soft surface like trail or crushed limestone

o   Too much hill running

o   Inconsistent training

·        Running shoes:

o   Are your run shoes really sized properly? Both numeric size AND width.

o   Is there enough room in the toe box? I have Morton’s foot, and cannot wear Nike shoes due to the taper in the toe area. New Balance shoes are great, though!

o   Are you wearing the appropriate type of running shoe for your mileage and surface?

§  Do your run shoes have sufficient cushioning? Note that more is not always better, but some is good.

§  Are you really able to cope with zero drop shoes (not everyone is)?

§  If you wear orthotics, be aware that they might increase the drop, and that if they are ¾ length and you can’t keep the base insole in the shoe, you will lose some toe cushioning.

o   Are you using standard lacing? This pattern is great for metatarsalgia.

o   Are you using elastic laces? These can put pressure over the top of your foot and lead to all sorts of issues. If you do use them, you might try the alternate lacing pattern or keep them looser than you currently do.

·        Regular shoes:

o   Are your regular shoes sized properly? Both numeric size AND width.

o   Do your regular shoes have sufficient arch support?

o   If you need orthotics for running shoes, you might need enhanced insoles for your regular shoes, too.

o   Do you wear flip flops often? While there are some newer ones with actual support, the traditional variety aren’t exactly good for your feet.

o   Do your regular shoes have sufficient toe box? Pointy toed shoes and high heels are contraindicated (even for men!) as they will squeeze the toes together if you have a Morton’s Neuroma

·        Socks:

o   Are you wearing the appropriate thickness/padding socks in your bike and run shoes? You might have correct shoe size but thick socks are making them feel too tight on your feet.

o   Are your socks too tight in the toe area?

·        Do you have bike fit issues?

o   Cleat selection: Speedplays aren’t for everyone. I find that Look-type pedals spread out the force over more of my foot, and I won’t use Speedplays anymore.

o   Cleat position: A qualified bike fit professional should ensure this is right.

o   Overall bike fit, particularly saddle height: if you get this wrong, you will have all sorts of issues from neck to back to hip to foot pain.

·        Do you have more than 5 lbs. to lose? Any excess body weight will contribute to joint wear and tear, typically affecting the knees and feet first. If you want to run, be as small as possible (within safe limits).

·        Do you do strength training either under the guidance of a qualified trainer or with experience? I believe ANYONE who runs or does triathlon should do it, no matter your age.

·        Actions you can take while you sort things out:

o   Keep track of how often and under what conditions you experience the pain before seeing a physician

o   Get a sports massage. I find regular massage helpful in both validating and correcting muscular issues.

o   Add metatarsal pads to your shoes—regular, running and possibly biking.

o   Get evaluated for whether you might benefit from orthotics. There are schools of thought for and against these. Some people (like me) really DO need them.

o   Consider a cortisone shot: I would only do this once, as cortisone can destroy tissue. Best you fix the underlying issue, but one shot might get you over the hump.

o   Wear a toe separator (like you use to paint your toenails) in the evening for like ½ hour

o   Icing: If you truly have muscular issues, then icing will be beneficial

o   NSAID: Avoid overuse of these. Capsulitis and trigger points might benefit from these, but they shouldn’t be taken routinely (and especially not during races).

o   Rest from running

o   Water running