What's going on with my foot?

October 22, 2008 4:22 AM

I've started getting pain on the top of my right foot after running. I've had it x-rayed but the doctor seems a bit stumped.

The x-ray looked fine, no fractures or anything out of the ordinary. The doctor's best suggestion was arch support insoles. The pain is about half-way up my foot, just about in-line with my big toe. It's not painful to the touch, just kind of a dull, achy pain. No swelling. I plan to try insoles as the doctor suggested but was hoping someone may have some other ideas as to what may be causing the pain. If it makes a difference I run about 20 - 30km a week.

(I'm also looking for a good podiatrist, but I'm in Japan and its proving a bit difficult.)

posted by rsk to health & fitness (12 comments total)

I have terrible feet, so while I can't offer a diagnosis I can offer some advice. You may have a ligament or muscle injury, which wouldn't show up on an X-ray- only on an MRI.

This may very likely be an arch support problem, and if the store-bought insoles don't help enough you may want to try custom-made ones (made by the same guys who make artificial limbs).

However, the fact that the pain is occurring on top of your foot and that it's in line with your big toe suggests that this might be nerve pressure or an incipient bunion problem. I'd suggest going to an orthopedist rather than a podiatrist. You want someone with a medical degree on this one, and in addition to my own experience of being given all the wrong advice by a podiatrist, I've heard some disturbing stories about podiatrists making major misdiagnoses, missing the obvious, and being way too trigger-happy re: surgery.
posted by foxy_hedgehog at 4:35 AM on October 22, 2008

Look for someone who treats sport related injuries.

In general, this falls under Classic Doctor Joke #1. "Doc, it hurts when I do that?" 'Well, do don't that." Repeated pain after use may be hinting that you need to lay off for a bit.

Can you swap out biking, or better, swimming, for a few weeks?

There is a muscle in that position that extends (lifts) the big toe, amongst other movements. An X-ray wouldn't have spotted that injury.
posted by eriko at 4:58 AM on October 22, 2008

My guess would be that a combination of how you run and the shoes you are wearing is causing ligament/muscle stress in your foot.

I started jogging a few months back and at one point a muscle in my right calf started hurting, after a visit to my GP I went to an orthopaedic outfit where they sell shoes, make custom soles etc. They had this video thing where I had to run and a camera at about calf-height mounted on a wall videoed it. Then they showed the video slowed down and I could see how it just didn't look right when my feet came down on the ground. Now I have extra supportive jogging shoes + insoles and haven't even had a hint of trouble from my previously hurting muscle.

Running is stressful for your legs and feet, give them the support they need.
posted by bjrn at 5:31 AM on October 22, 2008

When I was in college, I had a Lisfranc fracture with exactly this kind of pain. It took a while to get it to show up on an x-ray as some of the bones on top of the foot are so tiny. I think most of the Lisfranc injuries are caused by a trauma of some sort, but it might be worth looking into. After many visits to the orthopaedist and some physical therapy and pool walking/running, things are totally back to normal today.
posted by weezetr at 6:54 AM on October 22, 2008

I had this exact pain as a beginning runner. Turns out, my shoes were too tight on the top and I needed more arch support (I have low arches and am an overpronator, FWIW). Doctor was stumped. I went to a specialty store where they told me my shoe was all wrong. Switched shoes and haven't had a single problem with that pain since.
posted by smalls at 7:58 AM on October 22, 2008

I had this sort of pain in high school cross country. The sports trainers wrapped my foot and ankle before practices for awhile and had me get new (not worn out) shoes. It went away on its own, but it took some time.
posted by salvia at 7:59 AM on October 22, 2008

I had a stress fracture, and your symptoms sound exactly like mine. Like weezetr's, mine didn't show up immediately on x-ray. Sometimes they only appear after they heal.

Mine was caused by repeated high-impact exercise. Running would certainly fit into that category.
posted by Evangeline at 8:18 AM on October 22, 2008

The two things I would try are a new pair of shoes and/or running off-pavement. Both can make a major difference.
posted by M.C. Lo-Carb! at 8:39 AM on October 22, 2008

It sounds like your pain is about in the middle of the big metatarsal leading to your big toe, and that makes me wonder whether that metatarsal might be flexing too much as you run, especially since the area is not tender to the touch.

That could lead to a stress fracture of the sort Evangeline is talking about, I think, and could be an indication that the mineralization of the bones in your foot is not all it could be.

Even though Tokyo seems to get around 350 more annual hours of sunshine than London, I am concerned you might not be be getting as much vitamin D as you're used to and may need, particularly since Japan does not seem to practice vitamin D fortification of foodstuffs.

So I would say add a good vitamin D supplement to the good advice you are getting here.
posted by jamjam at 10:25 AM on October 22, 2008

I had the same type of problem. I went to a podiatrist who suspected stress fracture. I even went an had an MRI done, which revealed nothing.
Guess what, it was bunions. Yes, bunions, not just for old ladies any more. They just started hurting, although I'd had them all my life. It's just how my feet were (bunions can be hereditary). I found this out through a second opinion--the first podiatrist missed it completely, and I didn't fit the typical patient profile for bunions.
So... if you have bumpy knobs on the side of your feet (protruding off your big toes and/or little toes), don't discount bunions as the problem. They are very common and can get very painful really quickly. To alleviate the pain you can take ibuprofen or naproxen, and get orthotics (the kind a doctor prescribes, not the kind you buy in a pharmacy). Or you can get them surgically corrected like I did... best thing I ever did. EVER.
posted by FergieBelle at 11:33 AM on October 22, 2008

I had a similar pain when I ran, getting new shoes and arch supports helped with multiple foot and lower leg pains. Your feet can get bigger as you age, maybe you need to go up a shoe size?
posted by TungstenChef at 1:35 PM on October 22, 2008

I run about 25 miles per week with a coached team, and I've been dealing with a similar problem with the top of my left foot. The problem has been hanging around for about six weeks, but now finally seems close to healed.

It does not hurt to push, twist or flex the foot in any direction, but when running, I get an ache from the front of my ankle all the way down the top of my foot, wrapping around toward the outside. A possibly related annoyance (or unrelated caused by changing shoes) is sore balls of both feet, particularly after long runs.

There are quite a few ligaments and tendons in that area that lift the foot and hold all the small bones in place, so that's the obvious first suspect for both me and my coach. My biggest worry was a bone bruise or stress fracture, since that would require me to stop running for weeks or months to let it heal.

I've tried:
1. RICE: rest, ice, compression, elevation + ibuprofen.
2. Ice massage, by freezing water in a styrofoam cup, peeling it and directly massaging the ice into the injured area (and the rest of my legs - feels great).
3. Immersing my feet in ice water for 5-10 minutes after long runs. That seems to reach deep in the foot, numbing where the pain is concentrated.
4. Changing shoe brand and model (was using Asics Gel Cumulus, now using Mizuno Waveriders after trying a pair of Brooks that didn't work at all).
5. Examination by podiatrist with x-rays, which came back negative.
6. Cross-training with swimming and weightlifting.

All of these helped but did not fix the problem after three-four weeks, and I was gaining weight, so I eased back in to running. After about three weeks back, I occasionally have sore balls of my feet after a long run, but overall everything seems to be gradually improving. I'm running a half marathon in a little over two weeks, so hopefully the taper for that will give me even more rest to let everything heal.

Not sure if any of this is helpful to you, but at least I can commiserate.
posted by letitrain at 10:40 AM on October 23, 2008