Running Injuries Foot Pain & Running Injuries: Torn Metatarsal Ligament vs. Metatarsalgia and Stress Fractures

Foot Pain & Running Injuries: Torn Metatarsal Ligament vs. Metatarsalgia and Stress Fractures

Metatarsal stress fractures are common running injuries that are often confused with metatarsalgia or plantar plate tears. This video and article will help you differentiate between these three conditions.

4 Minute Video: Torn Metatarsal Ligament, Metatarsalgia, or Stress Fracture?

Common Running Injuries – Foot Pain

Foot pain and injuries are common in the running community.  The most common conditions we treat are 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:

  1. Pain under the big toe can be sesamoiditis or a fractured sesamoid bone
  2. Pain under the 2nd -4th metatarsal can be metatarsalgia, stress fracture or a torn transverse metatarsal ligament.
  3. 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.  Let’s look at the diagnoses of metatarsalgia, stress fractures, and torn transverse metatarsal ligaments. 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.

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 Fractures

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.

Stress Fracture Symptoms

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.

Stress Fracture Treatment & Diagnosis

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. 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.  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.

Torn Metatarsal Ligament Symptoms

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.

Torn Metatarsal Ligament Treatment

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.

Help with Running Foot Injuries

If you would like help in resolving any of these conditions, the San Diego Running Institute recommends Dr. Victor Runco. Dr. Runco is a running injury specialist as well as a marathon runner. He has helped hundreds of runners and non-runners with painful conditions. If you would like to make an appointment call (858) 268-8525.

Read the comments on this post to see questions asked by real patients with running injuries and foot pain. Dr. Runco personally responds to each question and provides valuable information for anyone suffering from stress fractures, metatarsalgia, or torn metatarsal ligaments.

About Victor Runco

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.

Comments

Traci 10-07-2012, 19:54

Dr. Runco, can you please clarify something for me? Regarding the torn metatarsal ligament scenario you describe above, are you saying that 6 weeks in a walking boot is an alternative to surgery? I was under the impression that only surgery can repair a torn ligament.

I’ve been dealing with pain in the ball of my right foot for about 8 months (particularly under the 3rd and 4th metatarsal heads). I’m a runner and my problem really started to bother me while training for a marathon last fall. My podiatrist diagnosed me as having a neuroma and I received two steroid shots. They didn’t seem to help much. The same foot seems to have a more diminished fat pad as compared to my left foot. I thought this might be a result of the steroid shots or poor running form (I used to land smack on my metatarsal heads). I cut back my mileage, trained to land more mid-foot, got custom orthotics, and used metatarsal pads. All of this helped quite a bit, but I still have some discomfort and about 3 weeks ago my third toe went completely flacid – I can’t bend it like the others. A term I have seen that seems to apply is “sublexed”. It also seems to drift slightly away from my big toe.

I am scheduled to undergo an MRI this week. Based on all my web research I expect to find that I’ve torn a ligament and that all this while my foot pain was attributable to a stressed and weakening ligament. My question for you is this – is surgery absolutely necessary for me to continue running? Will I cause irreparable damage if I keep running? Aesthetically, it doesn’t bother me (the deformity actually makes for a cool party trick – I can give someone the bird with my foot ;-) I just don’t want to make my foot any worse than it already is. I would greatly appreciate any thoughts you have.

Sincerely,

Traci

Dr. Runco 10-07-2012, 23:53

Depending on the grade/severity of the ligament tear (partial. complete, thickness) will depend on whether or not a boot is a reasonable thing to do. Up until now you have been given tools (orthotics, cortisone, met pads) that have allowed you to only damage yourself further resulting in a more severe issue. The MRI will tell how bad the tear is. if it is not a rupture then a boot along with therapy may work…..i see it work on a regular basis. In fact, I had the same injury with a partial tear and a walking boot plus therapy for 3 months solved it. If it hurts to run on and the toe deformity is getting worse and you continue to run surgery will likely be your only choice. That will be at least 3 months of painful recovery………

Traci 17-07-2012, 20:33

Thank you for taking the time to reply. Is there something on the web that could show me what kind of physical therapy I would be expected to perform?

Thanks again,

Traci

Greg Canning 04-10-2012, 20:13

Hi Dr. Runco
Is there a reference for the predislocation syndrome of the second toe towards and eventually over the first caused by transverse ligament disruption. I have a patient who had a morton’s surgury using a dorsal approach. This cut the transverse ligament and now his second toe has migtated over his first
Thanks
Dr. Greg Canning

Dr. Runco 04-10-2012, 21:26

It is a sprained plantar plate ligament doc. It tears on the lateral side of the 2nd metatarsal which then destabilizes the 2nd metatarsal-phalangeal joint allowing it to subluxate medially. I see this injury all of the time. In fact I had it myself. 5 Months in a stiff walking boot, taping the joint into proper alignment and 6 shots of prolotherapy later and I was fixed.

EDGAR GASSAN 21-05-2013, 22:11

Hi Doc, My problem started a week ago while training running form and strengh, i was doing deep squats heels up, after training a pain around the 4th metatarsal started, i could even fell a small bump on it. its not directly on the metatarsal head , but around. the main symptom besides the difuse pain while walking is that i cant bend my 4th toe plantar (around 30% of whole ROM trying hard). i can flex it toward dorsal side. What would you expect it could be? do i need urgenly go to a DR?

Thank You

Dr. Runco 21-05-2013, 22:59

Hi Edgar,
From the sound of it I am leaning towards an acute plantar plate sprain or tear which is serious business. Injuries like yours can progress and result in joint deformity which it sounds like you already have (the bump). This is serious business and it needs to be fixed or it may result in a surgical situation. Some other conditions it could be include:
1. Mortons Neuroma
2. Plantar Plate Sprain/Tear
3. Capsulitis
4. Metatarsalgia
5. Sesamoiditis
6. Plantar fasciitis
I am an expert in the diagnosis and treatment of these injuries Edgar. I have seen hundreds if not thousands of runners misdiagnosed and under treated by doctor’s when in fact they have a plantar plate tear that eventually ruptures. I highly encourage you to follow the directions below and let me help you resolve this Edgar.
Since you do not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $77 (normally a cost of $125) and by calling my office at 858-268-8525 ext. 2 after 12 noon Pacific Time today, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started (you already have)
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have or feel I may need to know.
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.
Dr. Victor J. Runco

EDGAR GASSAN 23-05-2013, 15:00

Hi Doc, Ok today i have been scheduled for an ultrasound appoinment today, Xrays showed up clear. i visit a traumatologist and a physiatrist. Both agreed on the ultrasound to check any specific soft tissue problem, before going for a MRI which is a more expensive study. they suspect both luxation of the tendon (i dont know detail of which, if flexor digitorum or any other), the main issue for them to believe is tendon related is the Hypomobilty of the 4th toe toward flexion which continue to be no more than 30% of ROM. Full range on extension. Now the pain has evolved to a more localized pain around the 4th met head, still feel like having the met drop or some kind of small bump, i feel it when i walk like if i am stepping on the 4th met first or having something on the shoe.

I am international,i live in Venezuela, is it ok if i still decide for an appoinment? Anything you recommend prior to take the consultation to narrow the possibilities of diagnosis? Thank You i am really interested on knowing from the root what is happening and what o do. i wll be in USA in June, but i would be in Boulder, For a biomechanic and running course.

kirstin 20-07-2013, 13:37

Hi,
Ii injured my foot running a few years ago and it was very painful. I never got an MRI but I did have an xray which showed nothing wrong with the bones. It was painful from my fourth toe to the outside of my ankle and I had the strangest sensation of a wiggling cord like thing on the bottom of my foot-closer to my toes-as if something was completely loose . The injury occurred in may that year and the pain lasted a few months but the wiggling sensation lasted until December of that year. It recently came back and it occurred while wearing flip flops. I had pit pressure on my roes and felt a pins and needles type feeling in my toes and ever since I don’t have pain but I have that bizarre wiggling feeling like something is torn and loose. I run and cycle every day. Do u have any idea of what this could be?
Thank you!
Kirstin

Dr. Runco 20-07-2013, 13:50

I just happened to check my email before going out to meet my running group Kirstin. It “sounds” like you have a ligament tear. Id your toe “deformed” in any way? Are you willing to get an MRI? X-rays will not show ligament but the MRI will. Then again if it does not hurt and you run and cycle every day maybe you do not want to go to that extent to find out? It is bizarre that the pain simply stopped. You could also have a “silent Mortons Neuroma. Let me know if I can help you in any way.

Sarah Fencott 06-08-2013, 18:23

Hi there,

I’m really hoping you can give me some advice because no one else I’ve seen has helped so far, and I’m so desperate for some answers. I started incorporating barefoot running into my normal running regime over the last fews months (completely barefoot, not with minimalistic shoes) and had built it up to 3 times a week, 20-25 mins each time. Then I would put my running shoes on and continue (I’m training for a marathon). 11 days ago, when I was just 10 minutes into my barefoot run, I got this severe ache across the top of my foot, and after trying to run on it for a minute or two, I realised it was pretty serious, and hobbled very slowly home, in a lot of pain. My foot was completely swollen on top but no bruising. The pain was not only in the top, but much more severe on the ball of my foot, near the 2nd and 3rd metatarsals. I now have no pain whatsoever at rest, but for every single step I take, when I push off, I get this shooting pain through my foot. I am now walking with a very severe limp, and have now started getting the pain and swelling in my ‘good’ foot, I guess because it is taking so much strain. My doctor thought it was a tendon issue and sent me to a physio. The physio thinks it’s soft tissue inflammation and advised me to use some shoe inserts which have a padded lump in the middle of them. They haven’t helped at all. There’s been almost no improvement in the last week, and I’m getting really worried that nothing is helping. I’ve been icing it around 5 times a day for 20 mins each time, and have tried to limit the amount of walking I do. But it seems nothing is helping. Do you have any idea what it could be, and what I can do to alleviate the pain and help it to heal? I get the impression that each time I walk, I’m stopping the healing process and doing more damage. I would be so grateful for any advice you can give me, this is really getting me down, especially because earlier in the year I was not able to run for 3 months due to a nasty tendon injury in my lower leg (same leg).
Thanks,
Sarah.

Sarah Fencott 06-08-2013, 18:27

One more thing, the 2nd toe of the worst-affected foot has begun to ‘rise’ up above the others so it no longer touches the ground. I’m not sure if this was happening prior to the injury, or since, but it looks like it is being pulled up in the air. Also, since starting barefoot running, my big toe joint has begun to stick out a lot more, and the toe bend inwards (although they have always bent inwards to some extent since I was little). There is no pain on that toe or the joint though. Not sure if this helps but thought I would mention it. I have also developed a very thick callus on the ball of my foot between the 2nd and 3rd toes.

Dr. Runco 06-08-2013, 19:33

Hi sARAH,
You could have;
1. Mortons Neuroma ( x-ray would not show that)
2. Plantar Plate Sprain/Tear (most likely diagnosis based on everything you have told me)
3. Capsulitis (might be secondary to Plantar plate tear)
4. Metatarsalgia (it is possible you have bone marrow edema in your metatarsals)
5. Stress Fracture (not likely but X-rays do not show stress fractures….your doctor should know that and now recommend and MRI)
I am an expert in the diagnosis and treatment of these injuries Sarah. I have seen hundreds if not thousands of runners misdiagnosed, told to get shoes or inserts by incompetent doctors, useless and needless surgeries for neuromas when in fact they have a plantar plate sprain/tear that eventually ruptures. From the tone of your email it appears your is worsening. If you feel the pain is getting worse that is a clear indicator that the damage to the bone, joint or ligament is worsening. I have a personal history with this injury Sarah. I was suffering from metatarsal pain when the pain went from bad to worse instantly. An MRI revealed a torn plantar plate ligament. I narrowly avoided surgery. You said you limp after you run? Is that recently or ever since the initial incident? Are you still running? Do you get burning into your toes? If you look down at your foot does the toe look like it is deviating away from the other toes towards you big toe? From your description of the second toe it sounds like a slight joint deformity. Do you have any other foot condition like bunions? Has you doctor recommended anything helpful?
If you not live in the San Diego area, you can schedule a phone consultation with me. From the sound of it you really need to. So far the doctor and therapist have not helped you at all. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time today, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,
1. Provide me with a detailed history regarding when and how the pain started.
2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you
3. Anything you did on your own that may have helped or hurt
4. A list of any special tests including X-rays, MRI’s, blood tests etc
5. Any information you have I may need to know.
6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.
After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Sarah Fencott 07-08-2013, 07:29

Thank you for your reply, it’s good to finally hear someone who seems to know what they are talking about. Just to answer your additional questions, I had no problems at all (aside from a slight numbness in my 2nd toe when hopping on that leg every now and then) but no pain prior to the injury. It came on suddenly during the run, and since then I have not been able to walk properly, let alone run!! Prior to that, I never felt any pain after a run. I don’t really have burning in my toes, just shooting pain when the weight goes onto the area below my second toe. The second toe is very straight, not deviating towards any other toe, just starting to ‘float’ up in the air.
I have scheduled an appointment with a new doctor this morning, so I will see what advice they give. I’m also going to try and pick up some crutches today to at least help me get around. Thank you for your help so far. I will keep you posted on what the new doctor says. By the way, I am based in the Netherlands.
Sarah.

Sarah Fencott 07-08-2013, 11:59

Just a quick update: the doctor I saw this morning was a runner and thinks he even had this injury once. He diagnosed it as Morton’s Neuroma and gave me a (cortisone?) injection. I haven’t felt any pain relief yet, but he said it could take up to 6 hours, and would then last for around 2 weeks. If the pain comes back after two weeks, I’m looking at a very long recovery time – anything up to 9 months off running. But if it doesn’t come back, I can start running again slowly, and should get much wider running shoes that aren’t clamping my toes together (my feet got much wider since I started barefoot running). I’m hoping I feel the effects soon, and that I can get back to walking normally, and then, one day, think about running again.

Dr. Runco 07-08-2013, 12:32

The deviation is suggestive of a plantar plate tear Sarah. You need an MRI. Please stay off your foot, crutches are a good idea for now. ANy weight bearing will only aggravate the torn ligament.

Dr. Runco 07-08-2013, 12:37

No, NO Sarah. See my first response. You DO NOT have symptoms consistent with Mortons Neuroma! You DO NOT have burning into your toes! You have a joint deformity! Reread my first response. So many runners get mis-diagnosed with Mortons Neuroma. Do not trust this diagnosis. From everything you described it is far worse than a swollen nerve. The cortisone is actually destructive to the plantar plate ligament. I know when you are in the room with the doctor he may seem confident but you need an MRI or you can not trust this diagnosis nor course of action. Please read up on Mortons Neuroma and Plantar plate tears. I know I can help you but now is the time. ( months from now may be too late and might require surgery.

Nandana 28-09-2013, 15:20

Hello Dr Rucco,
I have injured myself while dancing and landed on my foot while wearing flip flops about 2 weeks ago
I had a dull pain 2/10 that slowly stabilized to 1/10 over last 1 week
I aggravated it by going for a brisk walk last weekend and now the pain is 3/10 and constant
Pain is over 2 metatarsal head x rays are negative I have a firm boot but beating any weight is painful so I am walking on the lateral aspect of my foot
It has now been 2 weeks since initial injury should I have an MRI done does this need to be in a cast what is your diagnosis
Please advise
Thanks

Julie 30-09-2013, 18:53

Great info! If you don’t mind, I have a couple of questions. I fractured my metatarsal 6 weeks ago (follow up in a week). Although weight bearing as been much more tolerable, if I were a betting woman, I’d say I have ligament damage. The pain (just sitting still) radiates from the top of my foot right to the ankle and there is clearly marked swelling. Sadly, I have very weak ligaments; both ankles have had ligament reconstruction. Could I have done ligament damage? I had Morton’s Neuroma surgery in April…and unfortunately the fracture was in that same location. Is there away to “test” to see if there is ligament damage before seeing the doc? Hate my feet. Hate my genetic make up.

Dr. Runco 01-10-2013, 15:04

Hi Nadana,
You could have;
1. Mortons Neuroma ( x-ray would not show that)
2. Plantar Plate Sprain/Tear (most likely diagnosis)
3. Capsulitis (might be secondary to Plantar plate tear)
4. Metatarsalgia (it is possible you have bone marrow edema in your metatarsals)
5. Stress Fracture (X-rays do not show stress fractures)

I am an expert in the diagnosis and treatment of these injuries Nadana. I have seen hundreds if not thousands of patient’s misdiagnosed, told to get shoes or inserts by incompetent doctors, useless and needless surgeries for neuromas when in fact they have a plantar plate sprain/tear that eventually ruptures. If you feel the pain is getting worse that is a clear indicator that the damage to the bone, joint or ligament is worsening. I have a personal history with this injury Nadana. I was suffering from metatarsal pain when the pain went from bad to worse instantly. An MRI revealed a torn plantar plate ligament. I narrowly avoided surgery. You said after a brisk walk the pain got worse correct? Where you are describing the pain does fit with a potential plantar plate injury. Walking on the lateral aspect of your foot is also not advisable….better off on crutches or in a boot? Do you have health insurance that will pay for an MRI? Where do you live? How old are you Nadana?
If you not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time today, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,

1. Provide me with a detailed history regarding when and how the pain started.

2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you

3. Anything you did on your own that may have helped or hurt

4. A list of any special tests including X-rays, MRI’s, blood tests etc

5. Any information you have I may need to know.

6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.

After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Dr. Runco 01-10-2013, 15:15

Hi Julie,
I find it too much of a coincidence that you had a Morton’s Neuroma surgery in April and then a few months later fracture the metatarsal in the exact same spot. It could happen but…..I don’t buy it. Considering your medicla history of “weak ligaments” then it would be a safer bet to think that you may have suffered damage to your plantar plate(s). If you stand looking down at your feet does the injured foots toes look deviated or deformed in any way compared to the other foot? Did the X-rays you had confirm the diagnosis of fractured metatarsal or did the doctor say you had stress fractures? Are you a runner? How old are you Julie? Where do you live so that I may better be able to help you?

Julie 03-10-2013, 18:39

Thanks for the response. I find it odd, too, but with the issues I’ve had with my feet, wasn’t surprised. I’m 45. If I look down at my feet they both looked messed up. They’re so ugly with all the surgeries. Neuromas were removed from both, but I still have a second one in the left, but it must remain. Bunions on both. The right foot, where the “stress fracture” is, yes the toes are a bit deviated. The 2nd toe from the 3rd. The xray was normal, doctor said a Bone Scan was only way to really tell and didn’t want to do that. Runner no, hiker yes. I had also started an intense workout (Insanity Program) when it happened. I live in Vermont.

The pain has definitely subsided in the “fractured” area, but is still there, but more towards the top of the foot and just where the ankle “connects”…that is also where the most swelling is now. I would, and have, described it as a burning, intense pain.

Hannah 19-01-2014, 06:05

Hello Dr. Runco
I have Pain in my 3rd metatarsal bone, I am not sure if my ligament or the bone. It hurts to apply pressure to a certain spot. Whenever I push off of it it hurts, like walking, running, and jumping. There is no bruising or swelling. Pain started a week ago and has been getting worse.
Please help
Thanks

Dr. Runco 19-01-2014, 15:33

Hi Hannah,
You could have;
1. Mortons Neuroma ( do you have “burning” into your toes)
2. Plantar Plate Sprain/Tear (most likely diagnosis. This is a severe sprain common in runners)
3. Capsulitis (might be secondary to Plantar plate tear)
4. Metatarsalgia (it is possible you have bone marrow edema in your metatarsals)
5. Stress Fracture (very possible to be a stress fracture AND a Plantar Plate Sprain)

I am an expert in the diagnosis and treatment of these injuries Hannah. I have seen hundreds if not thousands of runners misdiagnosed, told to get shoes or inserts by incompetent doctors, useless and needless surgeries for neuromas when in fact they have a plantar plate sprain/tear that eventually ruptures. If you feel the pain is getting worse that is a clear indicator that the damage to the bone, joint or ligament is worsening. I have a personal history with this injury Hannah. I was suffering from metatarsal pain when the pain went from bad to worse instantly. An MRI revealed a torn plantar plate ligament. I narrowly avoided surgery. Do you get burning into your toes? If you look down at your foot does the toe look like it is deviating away from the other toes towards you big toe? (you can send a picture) Do you have any other foot condition like bunions? I strongly urge you to follow the instructions below Hannah. After running well over 15 marathons and 10 ultramarathons in addition to treating injured runners over the last 14 years I have learned many “tricks” to help alleviate these types of conditions with simple interventions early on. I look forward to helping you.
If you not live in the San Diego area, you can schedule a phone consultation with me. The consultation is $87 (normally a cost of $125) and by calling my office at 858-268-8525 after 12 noon Pacific Time Monday, Brittaney can schedule a 30 minute phone appointment. These are very successful because prior to the phone consult you,

1. Provide me with a detailed history regarding when and how the pain started.

2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you

3. Anything you did on your own that may have helped or hurt

4. A list of any special tests including X-rays, MRI’s, blood tests etc

5. Any information you have I may need to know.

6. Three Links to either sports chiropractic offices or physical therapy offices YOU FEEL might be able to help you.

After reviewing you information we will have our phone consult. During this time I will ask you very specific questions as well as get you to perform on yourself, with my direction, Orthopedic testing to help me diagnose your condition. I often find runners to be misdiagnosed or under diagnosed. After narrowing it down I will provide you with a written, detailed report with all of my recommendations. I will also research the 3 therapy/chiropractic offices you provided me links for. The two of us will then pick one and I will either email or fax them the protocol that they should use to fix you. My success rate is very high here in San Diego; I personally treat and fix these conditions on a regular basis. I am able to help runners all over the country through this simple process.

Hannah 19-01-2014, 16:25

Thanks for your help, I do not have a burning in my toes. I do however get throbbing pain at rest.

Evonne 03-04-2014, 03:42

Dr Runco,
Is it possible while performing a Morton Neuroma surgery for the doctor to have nicked, hit, damaged a metatarsal ligament?
I believe I was diagnosed with Mortons Neuroma accurately as I was having extreme burning pain through the toes and ball of foot. I explain it like being stabbed with a hot pick after running. The pain got so troublesome to the point of putting on socks it began to burn hurt.
I had MN surgery between the 3 & 4 toes April 2013 with minimal relief and then had MN surgery between 2 & 3 toe Dec 2013. Immediately after the Dec 2013 surgery the most tender/sore part of my foot was the bottom on the 2nd metatarsal head. Both surgeries were through top of foot.
6 weeks post op I was still unable to place full weight on foot and had very limited mobility to 2nd toe. At 6 weeks post op doctor gave a cortisone shot between toes 2/3. 10 weeks post op I began Physical Therapy which helped with mobility and weight barring, however the metatarsal head continues to hurt and I am unable to walk barefoot and have a strange “zing” that runs up between my 2/3 toes when I touch the area just below my 2nd toe.
Doctor has suggested metatarsal insert and an MRI. She mentioned a possible ligament tear. I know my foot didn’t feel like this before surgery and I have been trying to tell my doctor it hurts from day 1 post op in the bottom of foot, so back to my question could the ligament be effected during MN surgery?
Thanks for any input.
Evonne. ( 43yrs of age, active, good health, located in Tucson AZ)

Dr. Runco 03-04-2014, 18:02

anything is possible Evonne. It is more likely that you were mis-diagnosed. Strange that you had surgery without an MRI….most likely you had/have ligament damage that was causing the nerve to swell and resulting in the burning and shooting pain.
I would definitely get another doctor for starters. I can also offer you my assistance whether remotely or if you make a trip to San Diego. I am an expert in these conditions and fixing them. I have been very successful in helping runners even by phone by reviewing their x-rays and MRI’s, writing treatment plans to be carried out by their therapist and acting as their patient advocate for them. Is this something you would be interested in?

Rhonda 07-04-2014, 14:14

I stumbled upon this website and have a question. My 14 year old daughter (healthy in every way except for the following) practiced a couple hours a day for 3 days during 1 week (this was not consistently for weeks, just 3 days for a couple of hours) a dance type of thing at church. There was lots of jumping and spinning on her foot. After the 3rd practice, she told me her foot hurt. It was very swollen from her toes to just above her ankle. It hurts when she pushes off when she walks. The pain is on the top of her foot at the 3rd and 4th metatarsal. Not on the bottom of her foot at all. Her pediatrician said she had an enormous amount of pitting edema. X-ray showed nothing. He suggested rest, ice, elevation, and Alleve. 6 days later there was no improvement. We were referred to a pediatric orthopedic. He diagnosed her with a stress fracture (physical exam only) and put her in a boot. After 3 days in the boot, her swelling was worse and her pain was very intense. Ortho suggested an MRI. He looked at it and said there was no stress fracture and he saw nothing on the MRI that indicated an injury. He put her on 4mg of prednisone (a dose where you take 6, then 5, then 4, etc) and at the end of the dose (6 days later) there was NO change. He said, “I don’t know what it is. It’s probably something systemic like lupus, arthritis, or leukemia.” Of course I freaked out. We went back to her pediatrician and he ran every blood test imaginable and all came back normal.He also ordered an ultrasound to rule out DVT and this was also normal. He referred us to a rheumatologist at Vanderbilt Children’s Hospital and she does not believe the problem is rheumatological. We saw a podiatrist and he took another set of x-rays and did not see an injury. He also looked at the MRI and saw nothing. He wants to start physical therapy. The rheumatologist has warned us against that, saying we need a diagnosis before the PT is started. Our next step is another pediatric orthopedic at Vanderbilt.

Please help! Her foot is full of fluid and it is painful at the third and fourth metatarsal when she walks and when you put any pressure on that area. There is no pain anywhere else. Only one foot is affected. She has worn a compression sleeve for a week and there is no change.

Dr. Runco 07-04-2014, 15:09

Rhonda you need help and fast. Your daughter’s problem started after a trauma of sorts (after dance practice)so it is most likely none of those scary diagnosis the inconsiderate and seemingly inept orthopedic stated such as lupus or leukemia….and at least the pediatrician ruled those out after with blood tests. It is stories like these that make me not only angry at the medical profession but also bewildered…..I have to think that the doctor that told you that is a decent man….he probably even has people at home that love him. But at work he can be so non-caring and flippant….and in my opinion grossly negligent considering the fact that he has advanced training in orthopedics. The podiatrist wanting to send the her for physical therapy is also negligent. Without a diagnosis what on earth would the PT rehab?! Talk about negligent….what a terrible thing to do. The only doctor besides the pediatrician that showed they have logic and common sense is the Rheumatologist.
Here is the thing Rhonda, I have to remind doctors of this regularly. I treat patients…not their x-rays or their MRI’s. By manually testing your daughters foot, deciding exactly where the pain is coming from and then diagnosing the most LIKELY injury and treating it accordingly while monitoring for any progression or different symptoms she should get better. I have a pretty good idea what is wrong with her and would like to help. I would need a little more information though. Right now based on the information you provided I think she is most likely suffering from either
1. Bone Marrow Edema
2. Plantar plate sprain
3. Capsulitis
4. Tenosynovitis
MRI technology is not what we once thought it was Rhonda. It missed quite a bit and there is also examiner error to consider. Your daughter’s foot reacted with swelling and pain the way a foot might to trauma. The next step is to figure out the site of trauma…it can only be in so many places. The way her foot reacted to immobilization is also consistent with things I have seen repetitively in the past after patients are put in a boot. By restricting movement you can restrict blood flow and drainage causing more swelling. The excess swelling then causes more pain in the foot due to the increase in pressure on the nerves. I would like for you to set up a phone consultation with me so that I can help you to the best of my ability. If you would like this please respond to my email we will set it up as soon as possible.

Laura 15-05-2014, 08:30

Hi Dr. Runco

I’ve read through this site with great interest. I’m a runner (also currently training for a triathlon) and living in London.

I recently travelled to China and ran a half marathon along the Great Wall of China (on 1 May). The ground was very uneven and there was a lot of going up and down stairs which meant my legs took a lot of impact. I did turn over on my left ankle but it felt fine so i kept going. I’ve been back in London about 10 days now. Last Sunday I went for a 14km run and ever since then I have had pain on the bottom of my left foot (in the midfoot area) on the outside. It particularly hurts when I put weight on the foot. I am doing a lot of training at the moment and I went for another run yesterday as I thought it was a little better and after that the pain was a lot worse – walking home after work was very painful. There is also some dull pain in the bottom of my calf muscle at the back of my left leg. I have been icing it and took some anti-inflammatories.

I am worried i have a stress fracture. I wondered if you could provide me with any advice? I am keen to train but obviously do not want to do myself further damage.

Thank you very much.

Laura

Dr. Runco 15-05-2014, 17:45

It is possible. If it is not better in 2 weeks you should consult a doctor

Alison G 07-06-2014, 10:48

My problem started in October after I kicked the side of a sidewalk. You see, I’m a power walker, and I was walking in flip flops when I miss stepped. The shoe broke, severe pain at the moment of impact, not much worse than stubbing your toe, but the whole front of my foot, and ego. I walk a mile to work every day, and for the next week slight discomfort after the morning walk turned into, on a scale of 1-10, a 7 of major throbbing and stabbing pain between the pinky and ring toe(inside, not top or bottom), outside of the foot near the bottom and big toe joint. When I went to medical, they wiggled my toes which didn’t more pain then they told me I’d broken my toes so I should just try and rest it. After a month of that it’d only gotten worse to the point I called my mother (who’s a doctor) crying, who told me to bind it with an ace bandage cause it was a ligament issue- went from an 8 to a 3 instantly. By the end of the next three months it was better. Then about in March, I hiked around jagged volcanic rocks in running shoes; the next day the pain was back at about a 5. Since then I’ve tried to be nice to it and bind it, but I still have to do my morning and evening walk and more. I tried swimming to keep my cardio but I can feel my pinky toe wigging with the kick, not staying still like it should (which it kinda cool but disturbing). Is that bad? Lunges, Using the elliptical and to a lesser degree squatting hurts. The x-ray came back negative, and there isn’t an MRI I can go to (I’m in Djibouti). I’d like to have an idea of what I’ll have to push for when I get back stateside, and how I can mitigate or stop any further injury. Any advice would be greatly appreciated.

Dr. Runco 07-06-2014, 13:39

I really can not help you unless you call me. Your mother was probably correct. it is a ligament issue and you need help. While taping it is a good idea it “SOUNDS” like you may have a dislocation nased on your description of the toe moving around. There are many taping techniques to stabilize it but I would have ot teach you. If you want to do a phone consultation and then have me send you video call my office at 858-268-8525 and we can arrange it. You need to do something and see somebody who can help you because eventually your foot will hurt so bad you will not be able to walk.

Katherine W. 11-07-2014, 01:00

Hello Dr. Runco
I would greatly appreciate some help or advice with my foot problem! I have been injured for 9 months and have been to 9 different doctors including podiatrist, orthopedic surgeons, athletic trainers, physical therapists, sports medicine doctors, chiropractor and general doctor and have had and MRI, bone scan and about 10 different x-rays and have not been able to figure out what is wrong with my foot! I was just out running one evening and my foot started hurting really bad at the base of the 4th metatarsal and a little pain at the head of the 2nd metatarsal both on the left foot!
I have rested it by being on crutches for a few weeks in a boot for a few weeks and a steriod injection from one doctor. I then was put in a cast for 3 weeks and then given another steriod injection from a different doctor (about 4 months after the first one) and still no relief! I have not been running hardly at all in 9 months and have mainly been biking and using the elliptical because it does not hurt as bad! Running is my favorite thing to do and not being able to has been killing me! It just hurts so bad to run and feels like my bone is popping out of my foot or like something is stabbing it!
At the time of my injury, I was training for a half that was 2 weeks away and had run a different half about 3 weeks before the injury. Also the MRI showed a little cloudiness at the base of the 3rd and 4th metatarsal-tarsal joint and the bone scan lit up a bit in that same area but the doctors have still not been able to figure out what was wrong and how to treat this! I also was going through a very stressful time in my life with some family crisis and work and school issues so I had not had a menstral cycle in about a year and a half at that time but it has come back now! I just want my life back and to be able to run again!
Do you have any advice on what could be going on? Thank you so much for your time!

Dr. Runco 11-07-2014, 01:10

Hi Katherine,
If the doctor does not know what you have why the hell are they sticking steroids in it! No more steroids please! I know exactly what you have and why the MRI missed it. What is most important is what you do from here on to fix the issue. Unfortunately you have been to 9 doctors and therapists none of whom are competent in this area. You need to remove yourself from anything and everything they have told you to do….it has not worked and in fact you are probably worse off because of the steroid injections.
Katherine you would benefit greatly from a phone consultation with me. I will ask you a few questions to make 100% sure what I already know you have then we will go over how you are going to fix this…..I’ll even put it in writing and send you an email report. Please call Krista at my office 619-987-2341 to schedule it. The cost is $125 and you can pay by credit card. I am not sure of what my schedule is but suggest you act sooner than later as this condition will only worsen.

Cliff 24-07-2014, 05:21

Hey Dr Runco, I am of 19 years of age. I had a minor case of sesmoiditis doing too many calf raises, plyometrics, running and basketball. This is the second injury i’m dealing with in my life. I’ve had hip labral surgery before from a bad accident in basketball. I was very athletic and durable prior to and after the hip surgery. Back to the foot, the overuse from training really caused problems on my forefoot. I’m told that I have a high arch foot. Small problems originally diagnosed as sesmoiditis changed my gate and I started to develop more problems. I began having pain in all areas of my foot, to the point where I couldn’t walk barefoot it hurt so much. Now i have pain between the 3rd and 4th metarsal head. I get a lot of relief when I rest but it hurts a lot when I stand for long periods of time. I seem to put a lot of stress on my achiles and my heel and have problems all over my left foot. I started to develop complications on my right foot from compensating so much but they started to go away. My left foot is killing me. I’ve tried custom orthotics (too hard and rigid), different types of shoes, creams, oils, wobenzym N, diet changes, correct toes, and just about everything. I still have a lot of pain in many different areas of my left forefoot. What do you recommend? My friends think i’m old now and don’t do much because i’ve changed. It’s really that I can’t do much of the things I want to do because everything seems like a climb up a hill. I’ve had an X-ray which showed nothing and an MRI wish just showed prominent inflammation.

Dr. Runco 24-07-2014, 12:11

I am really sorry to hear about your situation. That is a lot for anyone to deal with, especially at 19 years old. Cliff you obviously have a significant issue in spite of the lackluster MRI findings (I am sure the radiologist mis-read it….can you please send it to me). Cliff I am going to need to see you in order to help you, or at the very least do a phone consultation. There are many possibilities but from your description you are suffering from a severe case of metatarsalgia…….maybe even a plantar plate tear as those often go unnoticed on MRI. Cliff please call my office at 858-268-8525 and schedule to either see me in my clinic or set up a phone consult. Hang in there I have fixed hundreds like you with similar issues

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