Foot pain and Running Injuries. Torn Metatarsal Ligament vs. Metatarsalgia and Stress Fractures
27 September 2011
Last Updated on 13 November 2012
Foot pain and injuries are common in the running community. The most common condition we treat is plantar fasciitis and heel pain syndrome. Less common injuries also appear in the foot and are often overlooked or misdiagnosed by most physicians. Pain in the ball of the foot can be a number of different conditions.
- Pain under the big toe can be sesamoiditis or a fractured sesamoid bone
- Pain under the 2nd -4th metatarsal can be metatarsalgia, stress fracture or a torn transverse metatarsal ligament.
- Pain near the heel that goes slightly into the arch can be heel spurs, heel pain syndrome or plantar fasciitis.
These are the most common foot conditions seen and treated by the San Diego Running Institutes Sports Medicine Clinic. Lets look at the diagnosis of Metatarsalgia, stress fractures and torn transverse metatarsal ligaments.
- Metatarsalgia: The first signs and symptoms are pain beneath the 2nd, 3rd or 4th metatarsals. Early on this condition can be treated with manipulation of the metatarsal heads, placement of a metatarsal pad and 1-2 weeks of rest from impact activity. Sometimes a walking boot is required.
- Stress Fracture: Stress fractures of the metatarsal heads are a progression of Metatarsalgia. Once the ligaments of the metatarsals are bruised they weaken. This makes the bone susceptible to fracture. Before the bone actually fractures the marrow inside the bone cavity swells resulting in bone marrow edema. This will then progress to the bone fracturing from the inside out resulting in stress fracture. Once bone marrow edema or stress fracture is achieved the patient needs to have complete rest from impact activity and give the injury 4-6 weeks to repair before returning to running. Signs and symptoms of bone marrow edema and stress fracture are slight discomfort while running but increased pain and LIMPING after running! It is an interesting fact that many with this condition seem to fool themselves into thinking it does not hurt when they run. The tell tale sign however is found AFTER THEY RUN. If the runner has pain and a limp post run they most likely have a stress fracture. X-rays or MRI may help confirm the diagnosis but are not necessary as they do not change the symptom and sometimes are not sensitive enough to find the exact site of the break.
- Torn plantar plate/metatarsal ligament. Detecting a torn metatarsal ligament can be challenging. In the early stages there is no real way to tell the difference between metatarsalgia, stress fracture and a torn metatarsal ligament. It is in the later stages it may become obvious. The pain may be present following 6 weeks of complete rest. While bone typically heals in 6 weeks ligaments can take up to a full year to completely repair. You may notice the toes splaying away from the pain. Most common is to see the second toe splay towards the big toe. This indicates ligament tearing and subluxation of the metatarsal-phalangeal joint. Once a diagnosis of a torn metatarsal ligament is given the patient is placed in a walking boot and restricted from any weight bearing activity for 6 weeks. Custom orthotics with extra forefoot padding and metatarsal pads are prescribed. After 6 weeks the patient is allowed to begin non-impact activities like stair climbing or elliptical. If there is no pain with those activities after 2 weeks the patient can begin walking and hiking. After a week if there is still no pain the patient can begin light running (1-2 miles) for the next 2 weeks. If there is still no pain a prudent and progressive training program can be undertaken.
Dr. Runco is a U.S. Navy and Gulf War Veteran. Graduating as a Doctor of Chiropractic he began private practice in San Diego in 2000. He has been a professor of Anatomy, Physiology, and Biomechanics at various colleges and continues to teach continuing education in the fields of rehabilitation, custom orthotics and athletic taping. He is also a member of the American College of Sports Medicine, National Strength and Conditioning Association and is a Certified Strength and Conditioning Specialist. He has completed over 15 Marathons in 15 states and has run 9 50 mile Ultramarathons.