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Running related forefoot pain?

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Old 27th April 2012, 03:43 AM
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Default Running related forefoot pain?

Hey All:

Hoping for some ideas as to what's going on with my right foot. I'm fairly medically savvy, and I knew about 2 weeks ago that something was not right with my foot. I have a longstanding history of bilateral plantar fascitis, and this is something totally different.

I had a bit of pain under my metatarsal heads during running (ball of the foot area) in the end of March, so I decided it was time for running new shoes. I got the new shoes and after running in them a few times, I began to notice the pain would increase to a very uncomfortable level during runs, and was hanging around for longer afterward. Finally, one day it didn't go away after the run. My foot became EXTREMELY tender to the touch throughout the arch, ball of the foot, and the top of the foot (again, over the metatarsal heads). It was slightly swollen in these same areas, and I had trouble weight bearing to walk.

I was worried about a metatarsal stress fracture, so I laid off running and made an appointment with a podiatrist. X-Rays at the podiatrist were negative except for a slight flattening of the 2nd metatarsal head. The podiatrist said this could signify a mild case of frieberg's infarction, but that he didn't think that was the problem. He explained that a stress fracture wouldn't show up on x-ray for another several weeks, but that my swelling (mostly on the bottom of the foot) wasn't characteristic of a metatarsal stress fracture.

He put me in a walking boot for 4 weeks, and I'm to return if that doesn't solve the problem. He seemed to think the most likely explanation was a bit of synovitis or irritation of the MTP joints.

It's now been a week since I saw him, and I'm having trouble believing that is all that's going on. I'm young and otherwise very healthy, and I've never had swelling in my foot like this before. It's very tender to the touch along the ball of the foot but the worst over my second metatarsal. After it's aggravated it feels like a spike sticking straight up through my foot over that second metatarsal head. It hurts after prolonged standing or walking, although its easier to walk when I'm wearing the walking boot.

Any ideas? The pain is a dull 2-3 at rest, and about 5-6 (out of 10) after walking or standing. I'm taking it easy, icing, taking ibuprofen, and wearing the boot religiously, but it's not getting better. :-(
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Old 30th April 2012, 02:51 AM
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Default Re: Running related forefoot pain?

Your description is a little vague, however I would query a plantar plate injury. Best confirmed with a diagnostic ultrasound.
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Old 30th April 2012, 06:03 PM
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Default Re: Running related forefoot pain?

Hmmmm....plantar plate injury - that's a new one to me! Briefly googling it that does seem likely, given the mechanism and location of my pain.

Is treatment for plantar plate injury any different than immobilization and RICE for a few weeks? Or should I push for the diagnostic ultrasound to change treatment tracks and help shorten my recovery time?
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Old 30th April 2012, 06:35 PM
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Default Re: Running related forefoot pain?

Actually (this is the OP again), I just checked out a few of the ways to diagnose a plantar plate tear and I do have a medial drift of my 2nd toe! When I try to flex my 2nd toe it likes to "float" over toward my big toe, and it never did that before. Also, my 2nd toe on the injured foot is much harder to flex in general, and likes to stay sticking up in an extended position.

These are the same things I found when I did an image search for plantar plate tears! I was worried it was a stress fracture, so I guess this is a better diagnosis. ;-)
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