Metatarsalgia - ball of foot pain

[san0]

After a badminton match, gym session and weekend cycling all within a week at the beginning of the year, extreme discomfort developed on my left foot if I stood or if there's pressure just int he area behind the ball of 1st toe and the arch.

I've iced and massaged the foot for a week, there was hardly any swelling, and now with the help of off the shelf orthotic insoles (Othoheal, Orthosole), I can walk a short distance. I've not been on the bike for 3 weeks now, and i'm itching to ride again.
I normally wear Odour Eater insoles in training shoes and have Specialized BG Sport MTB shoes when cycling.

The GP said it might take 2-3 months to heal properly, and I should try not to put any pressure on ball of foot. My Chiropractor used a tuning fork and placed in various places on my foot to see if there was a micro fracture - I didn't scream in pain so I don't think I need an X-ray.

I'm driving again in heavy traffic (hate it so much), operating the clutch is a pain.

How long does it take for the pain to completely go away?

[steady eddy]

You have my sympathy all I can say is 15 years and still hurting - I now drive an automatic car.Traffic was unbearable. You may just have agravated a metarsal joint and ice and or Ibroprofen gel may solve the problem. More likely if you are in your 50's the fat pad on the sole of your foot is starting to shrink in which case you will have to get used to this. If you put pads in your shoes - daft as it sounds put them in both or you will change the position of one foot only and that will give you hip displacment and possibly back pain.

Beware custom orthotics which are only moulded to the shape of your foot - as all they do is support your foot in its present position. If you want to get pressure off the ball of your foot then the support needs to be behind the area of pressure not under it. It is easy to conclude that just putting a pad under the pain will help and that is often what doctors suggest. All that happens is the pad gets compressed to its fullest extent and then the pressure is back. I now wear custom orthotics made by an orthopaedic shoe maker shaped to support the foot rather than provide padding(they were not expensive) and I get some relief - some days are better than others and some shoes are better than others. You mostly want shoes with lots of toe room - most cycling shoes dont fit the bill. As posted last week beware the snake oil pedlars who offer you expensive custom insoles with a promise of relief - many of them dont work as they are wrongly shaped and too hard. I am presently investigating dual density orthoticcs to support the foot leaving the joint pressure point suspended over a softer material to see if this might help.

Avoid spds as the cleat position seems to be right where the pressure is and use wider flatter pedals which give some foot support

If going any distance (more than 20 miles) I dont travel without painkillers.

PM me if you want to discuss this more

[Ayesha]

Are you sure its not Plantar Fasciitis?

[cotswolds]

I mentioned this thread to my partner, who is a podiatrist. She burst out laughing and said "they must have been told that by a GP". Metatarsalgia means pain in the area of the metatarsals, which could arise for 100 different reasons. It's a general term GPs use which sounds like a diagnosis but doesn't tell you anything you haven't already told them. GPs do not get the training needed to diagnose the many things that can go wrong with the feet, and neither do chiropractors.

Lack of accurate diagnosis doesn't initially matter for musculoskeletal injuries because mostly they respond to RICE - rest, ice, compression, elevation. Ibuprofen can also help, preferably gel rubbed in locally, and keep feet warm if they are inclined to be cold (poor circulation slows down healing). It sounds like you don't feel it's improved after 3 weeks. This may be because you haven't rested it enough, and are constantly re-injuring it, or it may be something that's going to take a long time to heal.

The best person to see is a podiatrist who specialises in biomechanics (not all of them do). This service should be available through the NHS, but you may have a tough time getting your GP to refer you. You should be able to find one privately, but the biomechanics specialism isn't that common, and it's important, as lots of podiatrists mainly treat corns, callus, etc. A good podiatrist should be able to give you a more accurate diagnosis (but that may require X-ray/MRI). More importantly, they should be able to give you a custom orthotic which will offload the painful area. (Over the counter orthotics are very good for standard problems, but your problem needs something specific to you.) You may also need advice on footwear.

Final two thoughts. Firstly, from your description, my partner thought you might have a fractured sesamoid bone or sesamoiditis (dancers get it, it kinds of fits with the badminton). And secondly, don't ever believe any diagnosis you get over the internet. This is just one of many specific things you might have. A podiatrist would spend at least 20 minutes examining it, and even then they might be unsure.

Hope it feels better soon.

[cotswolds]

Beware custom orthotics which are only moulded to the shape of your foot - as all they do is support your foot in its present position. If you want to get pressure off the ball of your foot then the support needs to be behind the area of pressure not under it.

Sounds like you've had some bad experiences with custom orthotics. I sort of agree with the above, except the support needs to be around the area of pressure, not just behind it. If you want something simple you can try yourself, just get a reasonably thick, dense ordinary insole and cut a hole at the pressure point. I have something like this to treat functional hallux limitus - another source of foot pain your doctor will never diagnose.

[san0]

Thanks for the info folks, looks like I'll try seeing GP again once the X-Ray is taken to rule out any fractures, and go to a podiatrist for expert advice.

Seems like Ibuprofen is good in the morning before driving, but I don't want to take it throughout the day when I'm at work, not walking most of the day and gaining weight!

Do I still have to ice the area? Or do I just need to massage my foot now and again?

What a pain in the 'arsals!

[Ambler]

I too wish you the best of luck. You will need to be polite and very persistent.
I awoke with a swollen foot/ankle in nov 2007. No apparent reason.
After a week I could only stand for about 2 mins and walk about 400yds.
GP started with blood tests and x ray. Blood tests (for gout and "other things") were clear.
X ray said ankle strong and a just a little arthritis. " should improve with Diclofenac"
No improvement, pain worse, "must be pseudo gout"
Another week or 2 , no improvement "did you play sport when younger? - yes rugby but only at a v. amateur level. If you play any sport you must expect problems in older age " REFUSED TO SEND ME TO CONSULTANT.
Peed off with GP I paid for premier league club physio that I knew had a good reputation. He laughed when I told him.
It's probably your tendon but you need a scan. I will fax the GP and suggest to start with UV scan.
1st week Jan, UV scan. Tendon a bit stretched but no other problems.
Finally persuaded GP to refer me to orthopeadic consultant. Appointment end FEb.
day before appointment. Phone call. We've just realised its your foot, that is for a specialist foot doctor.
4 weeks later I saw him. "You need an MRI scan"
9 weeks wait for non urgent scan, so I paid for one.
Private orhtho consultant said on the £200 second visit, "according to the scan doctors report you have a ruptured tendon. I don't do that operation so. I'll refer you to someone else. He never looked at the scan.
Mid April, could barely walk.
New consultant. Specialist foot surgeon. " they are all wrong. It is staring them in the face. How did they miss it on the x ray and previous scans. You only have 2 tarsal bones showing when there should be 3. You have a tarsal coalition."
I had the operation eArly may 2008 and whilst its not perfect I can walk for about 2 hours without pain.
I missed out a further x ray visit and an appointment with a totally useless locum.
I was 55 at the time.
Apologies if this seems like a rant but if my experience helps you or anyone else then it has been worth posting.
Good luck.

[cotswolds]

Thanks for the info folks, looks like I'll try seeing GP again once the X-Ray is taken to rule out any fractures, and go to a podiatrist for expert advice.

Seems like Ibuprofen is good in the morning before driving, but I don't want to take it throughout the day when I'm at work, not walking most of the day and gaining weight!

Do I still have to ice the area? Or do I just need to massage my foot now and again?

What a pain in the 'arsals!

Icing is most effective in the early stages of an injury when there's a lot swelling. If it works, it suggests there's still inflammation. But basically do it if it helps, if it doesn't, don't bother.

[steady eddy]

Cotswolds - I am sorry if I appear cynical about professional advice, and I accept that the condition referred to is a generic one my experiece to date supports my views. My comments are based on numerous visits first to podiatrists both NHS and private and the prescription of a variety of orthotics, none of which have improved the condition, except those I now have from the orthopaedic shoe maker. The NHS ones for example were made of hard plastic - why would anybody prescribe such an un-forgiving material to solve the problem of ball of the foot pain.When these people are challanged they have no answers.
"This is too hard I cant walk on it" - seems to elicit the response of "oh well that is all we have" so it will have to be ok.

The ones from the private podiatrist were high density foam but of insufficient thickness to be worthwhile. The biggest problem with all of these is that you have to rip the insides out of shoes to make enogh space for them. That doesn't leave much in a modern shoe and often contributes to the continuing discomfort.
The alternative that of custom made shoes, is very expensive.

I have seen three surgeons, including one privately who offered to operate on my foot but then wrote to my GP saying he couldn't realy see what was wrong with it- so what was it he was going to do other than take my money?

More recently following x-rays and after some insistence a scan, a more honest one has said that he could try something, but it came with no guarentee that the pain would be any less when he had finished. That's quite a high risk approach. As he said "there are 26 bones in the foot if I adjust one I risk re-arranging the position of the other 25". I continue to live with the discomfort.

[ANTONISH]

I had this condition with my left foot a couple of years ago beginning in audax events. It also seemed exacerbated when driving. I bought some Scholl insoles which relieved the problem somewhat. It occurred to me after some months that the problem had gone and I removed the insoles. All seems ok at the moment - being 71 I expect things to deteriorate eventually
I wonder if some SPD pedals create a local pressure, I've sometimes used the double sided which have a small area but now I use single sided touring pedals which seem to give more support.

[Ambler]

As I said be polite and persistent. If one can't help you try another route.
I had insoles made by a podiatrist. (For collapsed arch).
He took a plaster cast so they fit perfectly.
Without them I have severe pain after about 10 mins walking.
Only the final surgeon mentioned I needed these - never occurred to any of the others.

Somewhere out there is a health professional who can help you. It's just a matter of finding them.

[cotswolds]

Cotswolds - I am sorry if I appear cynical about professional advice, and I accept that the condition referred to is a generic one my experiece to date supports my views...

I'm not surprised at your cynicism given your experience. Biomechanics of gait only started to exist as a subject in the 1970s with the pioneering theories of a Dr Root. While he's very respected as a pioneer, his theories are now considered flawed, and newer theories are becoming accepted, so there are relatively few people out there with up to date training. Even with the right training, prescribing the right orthotic is something of an art, and takes years of experience. I believe some NHS trusts still don't even run biomechanics clinics.

The right orthotic - for a suitable problem - does work. Two examples. My partner treated a woman who had had hip pain when walking for decades. A simple orthotic has eliminated the pain and transformed her life. And my partner herself has a condition where a nerve can become trapped in the forefoot. It's exacerbated by walking and also wearing shoes which are apparently big enough, but don't allow her forefoot to spread. She has a simple orthotic which is a lump of hard material half the size of a postage stamp which goes behind her 3rd and 4th toes. It spreads the joints slightly so the nerve can no longer get trapped. It looks very painful to me, but she doesn't notice it, and it allows her to wear any shoes she wants. I suspect if she hadn't had a career change to podiatry, she'd now be limping around with no diagnosis - the nearest place which could diagnose it is the clinic where she now works, 20 miles away. As a third example, I mentioned before the simple cutout insole I have which has eliminated a pain in my big toe when running and walking.

I understand the problem with getting orthotics into shoes, but there's not much podiatrists can do about that, other than offer advice on the best kind of shoe. Many private podiatrists make a lot of their income from treating people (mainly women) who wear unsuitable shoes and get corns and callus. They are given advice on what they should wear, but the podiatrist knows they will be back in six months wearing the same sort of shoes - their feet, their choice. Unless you have very unusual feet, most people can find shoes with room for an orthotic, but they may not be what you want to wear.

Anyway, this is getting a long way from cycling, I just wanted to post some positive stories. For, anybody who thinks they might benefit from an orthotic, the over the counter ones are very good for the conditions they are aimed at, but there are many conditions they won't help with. If you need more help, the best person to diagnose this sort of foot problem is a podiatrist, but there aren't that many around with the right experience. Be prepared to ask questions about how much biomechanical work they do, and to travel a long way if necessary.