Thursday, May 26, 2011

Metatarsalgia--A Pain in the Foot

I ended the last post with the protocol for an 18-mile run. I hypothesized that...if I could run 18 miles 3 weeks without getting injured before Rock n' Roll marathon, I would be ready for the race. The results were exactly what I hypothesized. Right down the injury part.

The 18-mile run went swimmingly, actually. I finished the run without incident, ate, took an ice bath and requisite nap. Tuesday, however, I went for a "recovery" run in San Elijo Lagoon. 7 miles of hilly, sandy trail. Not really ideal for a recovery run but I couldn't resist. It's my favorite trail, and I was in the neighborhood. Unfortunately, I also brought the run pair of running shoes, the ones without my orthotics. Looking back, I'm not even really sure I know why. All that damn "barefoot runing" talk. The hype had leaked into my brain, causing me to wonder, "Hmmm. What would happen if I ran without my orthotics? Do I really need them?"

I didn't mean to run 7 miles. I was only going to do 3 or 4 max. Besides, my legs were still trashed from the 18-miler 2 days ago. But after 2 or 3 miles, I started to feel better. And better. I decided to just do the whole trail. I allowed myself to run slowly, enjoying the view. I glanced at the GPS. Oops. Almost immediately after I hit 6.5, the ball of my left hurt started to burn. The burning sensation increased. It felt like my foot was on fire. To be on the safe side, I walked the final 1/2 mile back to the car. I must have bruised my foot, I reasoned. I figured it just a few days of RICE (rest, ice, compression, elevation) max.

Despite 2 ibuprofen, ice and a good night's rest, I couldn't walk without limping the next morning. Walking hurt. I tried stretching my calves and plantar fascia. Nope. Wasn't that. The ball of my foot hurt, right under my toes. Great. I probably have a stress fracture. A few days later, when I was limping around the Atlanta airport on an emergency trip to visit my ailing grandmother like Frankenstein's assistant, I started freaking out. I made a trip to the podiatrist and sat and fretted for the next 10 days waiting for the appointment, wringing my hands with my foot in an ice bucket.

The doc poked, prodded and X-rayed. "Not a stress fracture," he told me. I wanted to kiss him. He informed me I had Capsulitis, gave me 2 cortisone shots between the first 4 metatarsals (toe bones), and assured me I'd be running safely again in 2 days. A little bit overconfident, but, nonetheless, I was relieved.

What is "capsulitis"? It's inflammation of the joint capsule, and can occur anywhere in the body. This was specifically "capsulitis of the metatarsals", better known as "Metatarsalgia". It can be caused by wearing the wrong shoes, running, high-impact sports, or any pounding activity of the feet can cause it. The pain is on the ball of the foot, near the toes and is aggravated by pushing on this region or moving the toes (specifically during the push-off). The pain is very sharp and burning.

My symptoms were textbook. The doc gave me the cortisone shots to shut off the inflammation and gave me some new orthotics. He said to continue the ice and ibuprofen. I guess metatarsal pads would be another thing I could try.

The final result? One week later, my foot is 60% improved. It no longer hurts when I walk, a huge relief. However, the ball under my pinky toe still hurts while I run, although on a scale of 1-10, the pain has been reduced from a 9.5 to a 5. But I don't want to run a marathon with that kind of pain, mainly because it means my foot is still injured. I see the doc for visit #2 Thursday but I will most likely have to sit this one out. Which is a real bummer. This race was critical in training for Cuyamaca 3 Peaks 50K in July. If I can't run San Diego Rock 'n Roll Marathon Sunday, there's no way I should run a 50K a month later.

I'm most likely going to have to be conservative and start over...again. Building the mileage up slowly brick by brick. Perhaps I can have a late season come-back (Noble Canyon 50K is in the fall). Needless to say, I've been biking, swimming and doing weights a ton. Thankfully, I still have 2 other sports! Gotta love triathlon!


Diana said...

That stinks-but you're smart to sit it out! Unlike myself....I kept getting a numb feeling in my second toe on the left-no burning or pain. Then "the" pain came back to the right side...a pain I've come to know and love! I did my 1/2 marathon, because gosh darn it, it was suppose to be my first full and I had to back off due to "sore" my mind, the feet were NOT going to win! I had a appt booked with the sports medicine doc just 2 days afterwards. My numbness turned out to be 3 minor stress fractures of the 2,3, and 4th toes on L which were encapsulated in ganglion fluid-hence the numbness! On the R was a grade 4 stress fracture of the 5th metatarsal-yeah, I should have sat it out, but ya know....I'd do it again all over because of the great feeling of crossing that finish line. Stubborn and stupid!
I hope things go well for you...

Navy Doc for the Army said...

Had you or the Doc considered/ruled out Morton's Neuroma?
Also, I don't think you can say just yet if you won't be ready to do the 50 in July. You've been healing quickly. Maybe be best to take a wait & see approach, add some pool running & obviously biking, and some eliptical to your training while your foot is healing.
Just some thoughts that may help.
Hope you keep recovering quickly.

MissFancyPants said...

Your being smart and very positive!! i feel your pain!

Marcia said...

Heal up - Looking forward to reading more running stories

Andy said...

Sounds painful, but at the same time I think you have a solid plan to try to get back into the swing of things. I myself and working through an injury right now in my left foot and it is keeping me from running :( Not to mention I have a race next Sunday. Oh well... Sorry about your race. Anyway you can transfer the entry fee to another rock and roll event?

Alisa said...

This sounds very similar to the pain I've been having in my foot as well. Except I think mine in Morton's Neuroma. I haven't been to the doc yet--I've been trying the home remedy instead but if it lasts another week I'm going in.

JackieS said...

I've had metatarsalgia for 9 weeks. I've been waiting to run until I experience "no" pain as I was worried about causing a stress fracture (or that I had a misdiagnosis). However, today, I jogged for 30 minutes and felt great. My problem is that my foot doesn't hurt with my shoes & orthotics, but it does hurt when I am barefoot. I can also still press my foot in the exact point where it hurts and feel it. I'm interested in keeping posted on your recovery. It's comforting to know I'm not going through it alone!


Whitney said...

What at downer Rachel!! Way to play it smart and not cause any more damage. I hope your foots feels better ASAP. Sending you good health and training vibes. Hang in there! :)

Freementia said...

Proud of you for knowing your body and sitting it out. Make sure you're taking your vitamins. I hope you get to do the 50k. Heal up.

Grey Beard said...

Yeah, what those barefoot running zealots forgot to mention is those Inca messengers were probably cross-bred for centuries, and those that didn't measure up were no doubt sacrificed in some blood-thirsty religious ritual to the AT&T gods.

Thus those that managed to survive were massively predisposed to be able to withstand the damage. The advantage, with all the steep terrain, was probably speed, (on level ground a pound on your feet is equivalent to 4lbs on your back) and all else was sacrificed (literally) to that end.

Kind of like those promoting the Paleo Diet don't want to talk about the fact that if you're an Inuit Indian your Paleo Diet consists almost exclusively of whale blubber, or native Afghan, of goat blood and milk. Bon appetit!

ally said...

I suffered a similar pain in the same region, when I got new trainers. I had absolutely no idea what it was. Maybe it was this condition. Luckily it seems to have passed. I do wish you a very speedy recovery.

Cat said...

I seem to have similar symptoms to you. It started almost 2 weeks ago, so i layed off running.. been doing low impact to keep fitness levels up: rollerblade, stationary bike & elliptical. However, my marathon is in 3 weeks ( Chicago Marathon ) and still trying to figure out if i can heal in time. It may mean i won't be running 4 weeks prior but i can keep my fitness levels up & work on my core & other supporting muscles. Do you think its possible to run chicago in 3 weeks, based on your experience?

Andri Septen said...

it is likely to crack. This normally occurs in healthy and fit individuals who subject their body to excess physical activities. This kind of fracture is normally experienced by sportspersons and military recruits who engage in physical activities for long periods of time. They develop a stress fracture that leads to foot pain. The second situation is where people have extremely weak bones. This commonly affects women with osteoporosis.

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