Metatarsal Injury and the Hoka Shoe

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It’s 2005 and a I am in my running store the San Diego Running Institute.  Here is the scene: Guy walks through the door and shows the store manager and I a shoe that is called a Vibram Five Fingers and looks ridiculous.

Rep:  You need to place an order now everyone is going to want this.

Me:  Are you freakin’ serious.  Get out of my store.  No one will ever wear that.

Fast forward to 2010 and I am in my running store.  A guy walks in and shows the store manager and myself what is quite possibly the most ridiculous shoe I have ever seen.  It is 3x as thickly cushioned as any other shoe I have ever seen and it is bright yellow.  “What the F&%$&# is that”, I ask?

Rep:  It’s called the Hoka One and you need to place an order…..everyone is going to want one.

Me:  Are you freakin’ serious?  Get out of my store.  No one will ever wear that.

Fast forward to 2013.  I was COMPLETELY wrong on both counts and I no longer have a running store!  Ha!  That shows you what I know!

In fact I still think both the Vibram and the Hoka are ridiculous and most people purchase them for the wrong reasons but I do believe they both can have a function in a runners “quiver” of shoes.  In fact, I had a personal experience with this today and I thought it would be worth sharing.

2 years ago I was suffering from ‘Metatarsalgia” which is pain in your metatarsal bone near the ball of your foot.  One day while running the pain went from bad to worse in an instant.  It felt like a white hot knife had stabbed my metatarsal.  I limped home….and continued to limp for days.  Man that hurt!  I scheduled an MRI and it turned out the metatarsal pain had been a damaged ligament called the Plantar Plate.  When the pain went from bad to real bad that was my Plantar Plate ligament waving bye-bye and rupturing.  Ouch!  I was in a walking boot for months and narrowly avoided surgery.  When it got better I began running again and competed in a 50K, a 50 Mile Mountain race and a 100 mile endurance run…..no metatarsal pain.  The out of nowhere about 2 years later I am on a easy morning trail run and I feel an eerily similar pain in the same foot and in the same Metatarsal area.  It wasn’t the white hot knife pain but it was definitely painful.  When I got home I checked my foot and now the third metatarsal was exquisitely painful to stretch or push on.  2 years ago is was the second metatarsal that was torn.  I could not believe it…what are the odds of suffering the same injury to the same foot on another metatarsal?  After I was done feeling sorry for myself I dusted off the old walking boot and wore it for the next couple of weeks.  I was too busy to make time for an MRI so I figured I would simply wait this injury out.  Weeks later it was still painful and I had some time so off I went to get the MRI.  I was both happy and shocked to see that I had NOT torn my plantar plate.  What I had was bone marrow edema.  Bone marrow edema is simply swelling within the hollow cavity of the metatarsal bone….and it hurts just like a fracture.

I began running on the Alter-G treadmill at 70% body weight http://sdri.net/services/alterg-anti-gravity-treadmill/ with minimal pain.  I was enjoying running at 30% less my body weight but I really wanted to run at 100% on Terra Plana.  Then a thought came to me….back in 2010 the Hoka rep had given me a pair of Hoka One’s.  I had put them in my closet with the rest of the gimmick shoes rep’s had given me over the years.  I think they were wedged somewhere between a Skecher’s Shape up and a pair of Newton’s.  I fetched the shoe out of my closet and inspected its design.  My thought was correct…..it had so much cushioning that it was extremely inflexible.  Inflexible enough that it would change my foot strike so that I did not bend my third metatarsal region which would then hopefully eliminate the pain.  I laced them up and went out for a run while it was still dark.  They are about 30 inches thick and bright yellow….I was a little self-conscious but what the hell, if my foot does not hurt who cares what they look like right?

I left the house and went out for a 4 mile run, half street the other half trail…with rocks….which my metatarsal hates.  As soon as I started running I knew I was right about the mechanics of the Hoka.  The shoe caused me to run a little more flat-footed and the thick cushioning took the rest of the stress off my Metatarsal bone.  But would it last mile after mile?  2 miles into the street run the foot was good.  I entered Tecolote Canyon and bombed down a hill towards a creek with no pain in the foot.  I crossed over the bridge and down the trail plowing over rocks that I normally have to pick my way through in my minimal shoes and still no pain!  These things are like running in a 4-wheel drive, I thought.  I left the canyon and began the familiar climb up the 11% grade back towards home.  There was no pain running uphill either.  I finished the run back at the house and checked my foot.  There was none of the usual pain that I had on all previous test runs.  This is great I thought, I’ll just wear Hokas, start running outside again and I’ll be able to run my 30 mile leg of the Ragnar Trail Relay in November…..but not in these ridiculous bright yellow shoes.  After checking online I found a nice pair or muted grey ones.  I ma headed over to Milestones Running Company http://www.milestonerunning.com/ in North Park right now to get them.

 

By | 2013-10-24T17:34:51+00:00 October 24th, 2013|Gear & Equipment, Running Injuries, Trail Shoe Reviews|40 Comments

About the Author:

Dr. Runco is a U.S. Navy and Gulf War Veteran. He began private practice in 2000 primarily treating and fixing running injuries. 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 11 50 mile Ultramarathons.

40 Comments

  1. Mark Johnson October 26, 2013 at 4:36 pm - Reply

    Dr. Runco,
    I currently race and train in Hokas. I believe they will keep me running healthy for years to come. I am new to trail running but still was able to run 3 of your events this season. I will be back with my friends to run them all and have some beers with you next year. I am currently training for the Catalina 50 Mile in Jan 2014. Do you have any endurance training runs planned for Nov and Dec? Thanks again for hosting the Dirt Devil Series!
    Mark Johnson

    • Dr. Runco October 28, 2013 at 3:07 pm - Reply

      I am glad you enjoyed running with Dirt Devil Racing Mark. I would recommend you join the San Diego Dirt Devils. Go to meetup.com and create a profile then search for San Diego Dirt Devils and request membership…it is easy and free

  2. Trasie Phan October 28, 2013 at 4:36 pm - Reply

    Thanks for sharing the story. Every time I put on my compression socks I think of you and now I have you to thank for possibly pushing me over into the world of Hokas! They are so repulsive but I saw someone wearing a pair of Bondi’s yesterday and it wasn’t so ugly.

    • Dr. Runco October 28, 2013 at 7:55 pm - Reply

      I just bought Krista a pair…they are purple and do not look too bad

  3. jim van dine October 30, 2013 at 12:11 am - Reply

    Hi,

    In the fall of last year, Deckers Outdoor Corp. purchased Hoka One One from its founders, Jean-Luc Diard and Nicolas Mermoud. The CEO of Deckers, Angel Martinez, is a runner – 2:21 marathon many years ago. I am now the President of Hoka One One. I have been a runner since 1967 and even had a running store together with Angel in the early 1980s. Both Jean-Luc and Nicolas are still involved with the brand helping us to continue to innovate.and create great new Hoka shoes. I have my own, similar, story about Hoka. I had been unable to run for about 7 years. Due to Hoka, I am back to running 25 miles per week. Hoka has helped many runners overcome injuries. Not just old and injured guys either. We are getting more and more high performance athletes realizing that they can use Hoka shoes for all of their long runs and recovery runs – allowing them to go further and recover from races or high intensity workouts faster. Thanks for the wonderful post and keep running!

    • Dr. Runco October 30, 2013 at 2:36 am - Reply

      I would be interested in speaking with you live regarding what characteristics the Hoka has that allows runners t overcome injuries. I have my own personal thoughts on that but would be very interested to hear from you. By the way Iran 7 miles today in the Bondi….half trail and half road. Still no metatarsal pain. I can tell the Bondi is much more flexible than the Mafate I ran in the other day. Is this part of the new design or is the Bondi, in fact, created to be softer and more flexible than the Mafate? The Bondi also had a more narrow toe-box which caused a blister on the side of my first metatarsal so I will have to figure that out.

  4. Tim November 6, 2013 at 3:21 am - Reply

    I would give up running before running in Hokas. In fact, I would give up running before wearing compression socks also. If your body is telling you something, don’t ignore it and cover it up by buying more “gear.” Deal with the problem…..your weight, your strength, etc. Lose weight for the love of god….

    • Dr. Runco November 6, 2013 at 3:50 am - Reply

      That might be too “simplistic” of a view Tim. When I ran the San Diego 100 mile Endurance Run this year about 30% of the 205 person field was wearing them. While I agree it is an unconventional design it may have its place in a runners “arsenal” of shoes. After owning a running store for 10 years I have seen many shoes that I deemed ridiculous (Vibrams, Newtons, Hoka) become popular. Some for short periods….and some for long (Newtons). We’ll see if Hoka’s stand the test of time. The point of my article though was two-fold
      1. I was wrong about the running community not embracing Hoka. Sales of the shoe support that!
      2. While the stress feature in my foot was healed it still hurt to run in all of my “minimalist shoes”. So I tried a “regular shoe”. Still hurt. When I tried the Hoka, due to its unique design, NO PAIN in the foot. This was due to the Hoka having a rocker type bottom and being extremely stiff with 2x a much cushion as a regular shoe.
      By the way compression socks are known to increase blood flow in the lower extremity…………in diabetics! Since most runners are not diabetic I doubt they have much use….but they can be comfortable because they cling to the runner like a second skin and reduce muscle “jiggle”/vibration as well as any chafing. As to whether they make that person a better runner…I think not.

  5. Justin Woods November 25, 2013 at 9:07 pm - Reply

    So just out of curiosity, how long does a bone marrow edema take to heal and what else are you doing to help it heal?

    • Dr. Runco November 26, 2013 at 12:13 am - Reply

      Justin,
      Bone Marrow edema typically takes about the same amount of time as a stress fracture to heal. No weight bearing for 4-8 weeks. There is little else you can do to help it heal quicker except the AlterG treadmill.

  6. Christen December 14, 2013 at 10:32 am - Reply

    Wow that was strange. I just wrote an incredibly long comment but
    after I clicked submit my comment didn’t show up.

    Grrrr… well I’m not writing all that over again.
    Anyway, just wanted to say fantastic blog!

    • Dr. Runco December 23, 2013 at 3:37 pm - Reply

      what was your comment in regards to?

  7. Name (Required) May 14, 2014 at 3:35 am - Reply

    Hi: I am just getting over a stress fracture of my second metatarsal and ortho recommended a stiff soled shoe. Does this fit the bill for resuming activity.? He told me my shoe should not bend at the ball of the foot. Thank you.

    • Dr. Runco May 14, 2014 at 3:51 am - Reply

      i would try the Hoka or the Altra Olympus

  8. Teresa July 23, 2014 at 2:54 am - Reply

    Hi, I want to start race walking, not for competition, just for exercise. Are Hoka’s good for that?

    • Dr. Runco July 23, 2014 at 4:14 am - Reply

      they could be, seems like overkill for walking but if they work for you and they are comfortable I don’t see the harm

  9. Daniel August 2, 2014 at 2:57 pm - Reply

    I’m an amateur to the running community. Years ago, I was active with a martial arts and owned a karate club. After college, I became more active with outdoor sports and suddenly my activity levels plummeted when I experienced intense burning pain between my third and fourth metatarsal joint in my right foot. I went to an orthopedic surgeon who confirmed I had a Morton’s Neuroma. This is an inflammation of the nerve bundle at that place in your foot. After three years of inactivity due to increased pain when on my feet, injections, and several footwear/orthotic modifications, I was able to avoid pain during work and mild activity but outdoor activities, I.e. Hunting, fishing, hiking, etc., would bring me to my knees with pain. It would increase rapidly and go from zero to ten in a few steps. Once, I was deep on a mountain and had to take my shoe off and hobble on my heel to get home. Very scary.

    Yesterday, I weighed myself and became very disgusted. I heard about a specialty footwear store for runners and I decided to make a visit. After a couple hours of explaining my condition and trying on several different types of running shoes, my joint would start to feel a small pop, which happens when the bone movement is restricted and moves around the inflamed nerve, the salesman offered a Hoka Bondi 3. Instantly, I felt better. I ran around the store and I didn’t get any pain.

    I’m planning on trying to run a short distance to try them out. I’m still skeptical on the anticipated outcome because of all the disappointments I’ve experienced in the past but I’m staying positive.

    I’ll return and post the result when finished for anyone else in a similar situation. It may change my life. Prayers welcomed. -Dr. Dan

    • Dr. Runco August 3, 2014 at 6:26 pm - Reply

      You may have a plantar plate tear Dan……whether it is a plantar plate tear and/or a neuroma the Hoka sometimes helps due to the decreased forefoot flexion. I have found the Mafate or Stinson to work better than the Bobdi. Good Luck

  10. Daniel August 7, 2014 at 3:28 am - Reply

    Update: I’ve tried the Hoka Bondi 3 with a test run. I did a run/walk for approx. 1 mile and I began to feel the “pop”, burn, and pain. It wasn’t as bad as previous episodes but enough to know it’s a problem. I returned to the specialty store and we discussed insole/orthotic options. After an intense review of these options, I decided to go with the Hoka Bondi 3 with Superfeet “orange” insoles with metatarsal pads. Yesterday, I did the same routine as Saturday’s trial but with the new set up. My overall result was a significant positive outcome with a completion of 4.5 miles Run/walk with zero pain during or after the trial and no modalities (I.e. ice, anti-inflamatory meds, etc) used. 24 hrs later, no pain present. I would call it a very successful start. If Morton’s Neuroma is affecting your activity, I would be interested to hear more. Thanks for the advice about a possible plantar plate tear. I’ll be sure to investigate it further. With my experience, it can have similar presentation/symptoms as a Morton’s Neuroma and we may have overlooked it. Thanks again. -Dr. Dan

  11. Dr. Runco August 7, 2014 at 5:34 pm - Reply

    That’s Great Dan! i have found the Hoka Mafate and Stinson to be stiffer than the Bondi and therefore work better for patients with metatarsal injuries but it seems like you may have found the combo that works well for you. I am glad you are back to running!

  12. Bruce October 23, 2014 at 7:32 am - Reply

    How about a shoe for someone with achilles bursistis? It’s been too long now!

    • Dr. Runco October 23, 2014 at 12:44 pm - Reply

      Shoes are not medical devices. They do not make shoes with an intent to treat injuries. Have you consulted a competent doctor? What have you done to try to alleviate this condition?

  13. RJ October 24, 2014 at 2:37 pm - Reply

    I’ve been trying to embrace the Hoka shoe… I first purchased the ‘Stinson’ which was comfortable to run in at the start..but didnt allow my feet to breath. At the end of a 9 mile trail run, I could literally ring out a cup of sweat from my socks. I could hear my feet squishing around in my shoes as I ran. I traded them in (which had no problems doing) for the ‘Conquest’. Now I have no issues with sweat but after 8 miles, my left foot, near the ball region are in agony. At about the 6mile area, they start to go numb…after a 10 mile run…I am left limping in pain and no feeling in my toes. I dont know what to do at this point. I want the cushion it provides to help prevent a previous near femoral stress fracture but I cannot deal with the ball pain.

    • Dr. Runco November 17, 2014 at 9:54 pm - Reply

      try different shoes. Skechers makes a oversized running shoe as does ALTRA……Hoka is not the only show in town anymore. Merrell is going to release an oversize shoe come February as well

  14. Andrew July 12, 2015 at 11:58 am - Reply

    Very informative post, thanks! I have been looking at the Hokas, as I am recovering from a partial 2nd MTPJ plantar plate tear. One confusing thing I find is the early vs late “metarocker” which is not well explained on their website. Any thoughts which might put less strain on the forefoot? I’m assuming that lower heel-forefoot drop is also likely to be better.

  15. Andrew July 13, 2015 at 8:34 am - Reply

    Very informative post, thanks! I’ve been looking into Hokas while I am recovering from a 2nd MTPJ partial plantar plate tear. The difference between the early and late stage “metarocker” is unclear, and now well explained on their website. Any thoughts on which is more likely to be appropriate (or if it doesn’t matter) ? I assume that a lower heel-toe drop is likely to be best and put less pressure on the forefoot.

    • Dr. Runco July 13, 2015 at 9:06 am - Reply

      The lower heel to toe drop is better as this puts less pressure on the metatarsal region. The difference between the early and late stage metarocker most likely does not matter as the shoe is not designed to “treat” this injury….pick the Hoka that feels best to your foot

  16. Paul October 12, 2015 at 6:35 am - Reply

    I’ve had runners knee (right leg) and a sore hamstring for the last 5 months. I don’t know which came first but I’m sure the injuries are connected in some way. I hadn’t been injured for longer than a week for the last 4 years and was building to the next marathon. Then my knee became worse and worse along with my hamstring. Even after resting it felt sore again as soon as I ran.
    Running on grass helped but the pain got worse during the run and I had to stop and I couldn’t run the next day. Nothing seemed to work. This week I bought a pair of Hoka Cliftons and for the first time in 5 months I’ve been able to run on consecutive days and my millage is returning to its pre-injury levels. It might not all be down to the new shoes, as some healing should have taken place, but I know I can’t run with my old shoes with ‘normal’ levels of cushioning.

    My running style might have changed, I might not be as fast, but I don’t care. I’m happy because I can run again.

  17. Jackie December 19, 2015 at 2:58 pm - Reply

    Thanks! I apparently have metatarsalgia as well. I thought it was from ballet class and high heels. I quit both and still have the problem, so it must be from my 2 mile walks with the dogs. I just bought some Hoka Ones and was hoping I made the right choice. Now I know I did! Can’t wait to get them.

    But yes, I searched long and hard to find a mellow color because I wear size 10.5, and that just ain’t pretty in bright yellow.

    • Dr. Runco December 21, 2015 at 6:39 am - Reply

      Hope fully they help but please remember that Metatarsalgia is not a true diagnosis and the Hoka is not a medical device. You may want to pursue finding out what is causing the pain in your metatarsal region. Please let me know if I can be of assistance.

  18. Matt December 23, 2015 at 9:35 am - Reply

    I have been running in minimalist shoes since about 2011. My typical run is 2-6 hours on the trails. As of late, it’s been closer to 3-6 hour outings. I simply love running and the spontaneity it enables. Unfortunately, I developed a metatarsalgia problem a few months back. I was essentially sidelined or, as I say, couched. Sad day. Well, I came across your post and ordered a pair of Altra Olympus 1.5 shoes. The first day I got them, I was so excited to run pain free that I ended up doing a 6.5 hour trail run. The next day, no pain. I’ve been running in these for a few weeks now and still pain free. Although I can’t feel the trail as well, I am still able to practice the forefoot strike (thank you zero drop). Additionally, watch out on technical descents, as it’s much easier to roll an ankle when your foot is higher off the ground. Thanks for your suggestion of the Olympus. I’m a happy runner again!

    • Dr. Runco December 27, 2015 at 5:24 am - Reply

      That is good to hear Matt. I believe the initial introduction of minimally cushioned shoes did not translate well to long distance trail running and resulted in many of these types of injuries….which is why we have seen the successful counter-push of minimal heel-toe drop shoes with maximal cushion. I am glad to hear your metatarsal issues appear to be behind you. You might also consider the Altra Torin as it is slightly less cushioned than the Olympus.

  19. Jill April 10, 2016 at 8:54 am - Reply

    Long story short– 15 years hard soccer playing destroyed my ankles. had fusion on the right ankle and am left at a 90 degree angle. until trying the Hoka Bondi, everything hurt to walk in. after 2 weeks, i noticed i am starting to walk more on the outside of my foot. perhaps this started earlier, but i never noticed. there is no pain associated with it as of now, but i am worried about future damage. should i be concerned about this, and do you think there is anything that can be done before its too late?

    • Dr. Runco April 20, 2016 at 9:44 am - Reply

      if you had a ankle fusion I am guessing your ankle was fixed into an everted position such as you describe. You will most likely suffer from arthritis in the future. Perhaps you should consult another surgeon to see if there are any more modern techinques

  20. MickNYC August 28, 2016 at 7:50 pm - Reply

    The only problem I’ve found with going for the Hoka Stinson instead of the Bondi is that the Stinson feels great for me in terms of cushioning and support with those amazing thick soles, but the shoe itself is too narrow for people like me with wider forefoot and they aren’t available in wide sizing. I am suffering from sesamoiditis in both feet, moreso in left, and struggling to get into footwear that will help relieve symptoms and allow the tissues in the toe joint to heal. The rigidity is key because it keeps the toes from bending so the joint can heal. I am very worried about winding up in a boot for months and months one foot and then the other, so I’m trying my hand at good footwear and orthotics.

    The only Hoka shoe that comes in Wide is the Bondi, but you lose some of the cushion and rigidity you would get in the Stinson. So I think I might try the Hoka. I wouldn’t even be running on it at first, just walking and trying not to wince.

    Oh and Dr. Runco, have you much experience with the sesamoid problems? And have you ever heard about how unbelievably impossible it is to get into a good Dress/Office shoe for men with painful sesamoids? It’s very, very hard to find a really hardcore stiff-soled shoe that is also wind and deep enough to accommodate some swelling and possible orthotics/pads.I’m dying for suggestions and it’s amazing how little most podiatrists (in my experience) keep up on or even care about helping their patients get into the right shoes. They SAY find a dress show with stiff soles, wide and deep toe box, low-heel drop.. but do you think they have actual suggestions? Nope.

  21. Gail October 18, 2016 at 1:48 pm - Reply

    I am wanting to start running and have had Metatarsalgia for about 2 years now. My podiatrist made me some inserts with almost a cm of cotton padding in the me tarsal region. they help but they are falling apart. I have been dying to figure out which Hokas would be the stiffest and would flex the least in the metatarsal region as well as which metarocker puts less stress on that region . I even called the company and their customer service was no help at all. Any suggestions based on the science they are using? Thanks.

    • Dr. Runco October 25, 2016 at 8:18 am - Reply

      I recommend going somewhere to try them on. In the past the Mafate and Stinson have proven to be the stiffest

  22. Lauren November 13, 2017 at 11:38 am - Reply

    I just came across this article while doing some research on Hoka running shoes. I suffered a lisfranc injury in May 2016. I had surgery to place one screw to fix it, and the screw was removed in November 2016. I started running again in March of this year and have been doing pretty well. I even ran my first half marathon in June; however, my foot still gets sore after a good run (although is usually fine during the run). For a while, everyone kept telling me to be patient, and it would get better. I went back to my doctor recently though, and he confirmed that I’m probably as recovered as I’m going to be at this point. He suggested that I look into the Hoka shoes for running, but I don’t think he really knows much about them so I would be curious to know your thoughts. I currently run in the Saucony Guide, which isn’t exactly a minimalist shoe. Would you expect much improvement from a Hoka? Any suggestions for which model to try? I also have pretty flat feet if that makes a difference. I’m hoping to be more comfortable after runs, but I also want to make sure I’m taking care of my foot well enough to keep running on it for years to come. Thanks!

    • Dr. Runco November 13, 2017 at 1:38 pm - Reply

      Shoes are not made to treat medical conditions. That being said sometimes certain attributes of shoes may feel better to specific individuals versus other persons. This is hard to predict in most cases. The Hoka shoes come in various thicknesses but I think your doctor had in mind the original Hokas which have maximal cushioning. This may work well….or may not you would have to try it. It would stand to reason that if you have tried running in shoes that are minimal in terms of cushioning and that made your foot feel worse than those shoes with maximal cushioning might help it to feel better.

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