I am a 20ish or so mi/wk runner-two 5 milers during week and long run on weekend. I have suffered metatarsalgia for some time now. I usually run through pain. Recently due to increased pain and burning in tip of 2nd toe, I was forced to seek medical care. My primary care doc ruled out stress fx through x-ray. She dx with tarsal tunnel syndrome and prescribed topical steroid cream. I disagree with that dx bc in the past I have experienced some relief when using off the shelf metatarsal pads. This last set I bought don’t seem to offer relief. I would like help in purchasing or ordering the correct size and density for me. Thank you.
Hi and thank you for your inquiry. It is paramount that you understand (even though your doctor does not seem to) what Metatarsalgia is and also why you do not seem to have Tarsal Tunnel Syndrome. Let’s cover Metatarsalgia first.
Metatarsalgia is the Latin word for “pain in the metatarsals”. It is derived from the words Metatarsal which describes the 5 bones that make up the “palm” of your foot and connect to your toes also known as phalanges. The second part of the word “Algia” simply means pain. So Metatarsalgia is not a legitimate diagnosis as it only describes pain in a region of your foot not WHY you are getting pain in that area.
Epic Fail #1: In the doctors misguided attempt to rule out a stress fracture in your metatarsals an x-ray was taken. It is a well known fact even among laypersons that an X-ray will not reveal a stress fracture. So taking the X-ray was a useless procedure!
Epic Fail #2: Now that the doctor did not see a fracture which they were not going to see anyway they diagnosed you with a condition that is not common and does not even match your symptoms! There are many other diagnosis that should have been considered based on your symptoms well before Tarsal Tunnel Syndrome. Lets see what those are.
Mortons Neuroma – Is a swollen nerve that can occur between the 2-3rd, 3-4th or 4-5th metatarsal bones. If the metatarsal bones pinch the nerve it can get swollen and cause nerve type symptoms “oddly” enough very similar to the symptoms you describe “increased pain with burning into the tip of my second toe”. Since you described the primary symptom of burning into the 2nd toe a qualified doctor would have then asked you the following questions. “Does it ever feel like you are running on a rock or marble or maybe your sock feels bunched up under your second toe”? If the answer is yes then either Mortons Neuroma or a Plantar Plate sprain/tear must be considered. The next question should then have been, “Does wearing tight shoes cause the pain to increase or if you loosen your shoes does it help with the pain”? When wearing tight shoes the metatarsals can be forced together resulting in further pinching of the Neuroma which then causes even more pain. If loosening the laces or wearing wider shoes helps a Neuroma should be considered.
Plantar Plate Ligament Tear/Sprain – If you answered yes to feeling like you were running on a pebble or marble or your sock felt bunched up under your second toe AND you are feeling burning into your second toe a plantar plate tear must be considered. This injury is often missed by many sports doctors and misdiagnosed as a Mortons neuroma. A competent doctor will then ask you this question “Do you limp after you run”? If you answer yes a Plantar Plate Sprain/Tear must be considered. A ligaments job is to stabilize your joints and prevent them from becoming dislocated or deformed. So if you have torn your plantar plate ligament in a severe manner it is obvious by looking down at your feet while standing and comparing your injured toe to your non-injured to. “Is your toe deviating (usually to the medial side or towards your big toe) away from your other toes compared to the non-injured foot”? If the answer is yes than a Plantar Plate tear is the most likely diagnosis and can be confirmed by MRI. An X-ray is useless in this case as ligaments can’t be seen on X-ray.
Epic Fail #3: Only a proper diagnosis can lead to effective treatment. Unless you see a qualified doctor and receive an accurate diagnosis you will continue to suffer from your symptoms and your injury may worsen.
Now lets look at the symptoms common to Tarsal Tunnel Syndrome.
Tarsal Tunnel Syndrome: Patients with TTS typically complain of numbness in the foot radiating to the big toe and the first 3 toes, pain, burning, electrical sensations, and tingling over the base of the foot and the heel. According to WebMD “Tarsal tunnel syndrome is a rare disorder caused by damage to the tibial nerve or its branches, usually due to compression as it passes through the tarsal tunnel (entrapment neuropathy).” A simple google search by anyone will show that the symptoms you describe do not match Tarsal Tunnel Syndrome and that Tarsal Tunnel Syndrome is rare anyway.
Epic Fail #4: Instead of ruling out much more common conditions that would affect your metatarsal they choose to diagnose you with a rare condition without even considering much more common and probable diagnosis. This complete failure could have resulted in you going to physical therapy but it obviously not working because the therapist would have acted based on in incorrect diagnosis by providing treatment to the wrong location. Following this you may have been referred to an orthopedic surgeon who would have injected your Tibial nerve with drugs only to declare that they were not working. Next you may have undergone surgery to “release” your Tibial nerve from its supposed entrapment only to have the surgery fail……all because the doctor rendered an inaccurate diagnosis and started the ball rolling down the wrong proverbial hill.
So most likely you are suffering from either a Mortons Neuroma or a Plantar Plate Sprain (or both) which are much more common in runners with your symptoms. A proper exam by a competent doctor possibly followed by an MRI will reveal exactly what you are suffering from. Only with an accurate diagnosis can an effective and proper treatment regimen be implemented. If you would like my help any further you would need to call my office at 858-268-8525 and either
Schedule an appointment for an exam and possible treatment
Schedule a phone consultation where we will further discuss your condition, I will walk you through a series of simple orthopedic tests and following that provide you with a written and effective treatment plan so that you can avoid further injury and recover from this painful condition.
If you require further information please email firstname.lastname@example.org
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