Metatarsalgia Ball of Foot Pain

[MyFeetHurt]

How do I correct this?? My feet always feel fatigued after putting in some miles, but this weekend seemed excessive. The balls of my feet starting hurting 5 miles into a 30 mile hike. By the end of the route, I didn't want to stand up, just continuous mild pain, which translates into major pain as it never goes away. It basically just feels like I've bruised the balls of my feet, such that every step slams down on a bruise. I have tried lots of different footwear, and have tried super feet in the past. I see no difference regardless of what I've tried. Suggestions?

[sunny1]

My feet hurt reading this!

It sounds like it's time to see a Sports Podiatrist (or a general Podiatrist).
Feet are intricate and important.
You need a diagnosis and a professional's help.

[John Landers]

Agreed you should seek professional help.

What type of shoes and insoles are you currently wearing? Depending upon your foot an approach shoe which tends to run narrower in the forefoot can cause problems. I have had to give them up and go to trail shoes. A proper footbed / insole is also important. Foot and lower leg exercises and stretching may also help.

[hikingmtn]

Have you switched shoes/boots recently? I had the same issue when I switched to a more minimalist running shoe. It took a full week of rest and (painfully) walking in my normal shoes before I could ease back into running with the lightweight shoes. I am fine running for miles in the same shoes now, but I think my feet had to get used to the beating or I compensated with my form to avoid irritating the nerve. Just a thought based on my experiences with metatarsalgia. Good luck!

[Mark Maxon]

The most important thing is to properly support your foot with a custom molded footbed. (Not the generic, trim-to-fit type that you grab off the shelf for $30-$40) If you want to save alot of $ compared to seeing a Podiatrist, go see a custom ski boot fitting specialist. Many of the good ones are certified Pedorthists which focuses on the biomechanical side of Podiatry. They can make you a custom footbed appropriate for whatever activity you're doing(general hiking, trailrunning, serious mountaineering, etc) They should have several different types of insoles that can be custom molded to your foot if they are a good shop. This will help to distribute the weight more evenly over your whole foot instead of concentrating it on the balls of your feet. A good bootfitter will also be able to make little tweaks if needed to further improve the weight distribution and proper functioning of your foot through the entire gait cycle. Something like this will probably run you $60-$150. You will pay at least $300 usually for an "orthotic" made by a Podiatrist which is technically a medically corrective device which is designed to make some form of correction to your biomechanics over time. What you want is something "accomodative" to your foot.

With all this said, there still may be some underlying medical issue like a neuroma which is caused by your metatarsal heads squeezing together and putting pressure on the nerves between metatarsal heads. (So make sure your boots/shoes are wide enough also) You could also have a dropped metatarsal head which will put excess pressure on that spot. These things are normal with age and use but with a properly molded insole and a couple of modifications the severity of these problems can be lessened quite a bit.

For the record, I have been custom fitting ski boots for 20yrs, specializing in biomechanical stance allignment & balancing for skiing, and worked alongside several certified Pedorthists over the years. I have experienced these problems 1st hand with my own feet so these recommendations come with alot of trial and error with my own feet.

Hope this helps. Happy hiking!

[jeremy27]

The most important thing is to properly support your foot with a custom molded footbed. . . . [sound, thoughtful comments] . . . Hope this helps. Happy hiking!

Obvious followup questions: Mark, where do you work?

[companion1]

I don't weigh in on 99% of the stuff I could but will give it a go. I am a podiatrist who sees many athletes, especially climbers and hikers, as well as see patients in a trauma clinic. I also teach and lead for the CMC. Forefoot pain has MANY causes, and if it keeps up you should see a professional that specializes in that area. Good advice from the others by changing boots, inserts and even socks. Unfortunately there are too many factors that muddy the water, including weight, surface, mechanics, past medical history, age, etc. Also, don't spend a large amount of money on inserts until you have a diagnosis. If you have a hammer, you fix everything with a hammer. Good luck!

[SarahT]

I have had pain like this in one of my feet and the diagnosis in my case was a neuroma. The fix for me was custom orthotics. I can still feel something funny in there every once in a while but the pain has never really returned since I started wearing them several years ago (fingers crossed).

[Mark Maxon]

The most important thing is to properly support your foot with a custom molded footbed. . . . [sound, thoughtful comments] . . . Hope this helps. Happy hiking!

Obvious followup questions: Mark, where do you work?

I am not currently bootfitting but can point you in the right direction. I'm in Vail and up here I would go to Double Diamond Ski Shop in Lionshead and ask for Matt Carroll. Also Greg Hoffman is very good at Vail Sports in Lionshead. In Boulder I have heard good things about Larry's Bootfitting. http://www.larrysbootfitting.com/" onclick="window.open(this.href);return false;

[rob runkle]

I think that the foot doc (companion1) hit is best. But, I'll give my experience just as another data point. And, also to reinforce the thoughts from companion1 that there are many possible factors.

I had plantar facia issues for years. Yours could be PF, but most often that shows up in the heel. Although I'm not a doc, yours scares me a bit and sounds like metatarsal issues (stress fracture maybe?). I digress.

For years I had PF issues. I'd been to multiple foot docs, had multiple inserts, both over the counter, and the $300 special made ones. Ironically the $30 over the counter (like super feet) always worked better for me. The $300 blistered like a mutha. I had various other minor foot and leg issues also. Nothing that ever sidelined me though. Nothing ever stopped me from running. In fact, almost always, my issues got BETTER when I ran semi regular. My theory on that is that regular running provided sufficient blood flow to the tendons and tissue, and also kept things stretched out and strong. While, more idle time made me tight, weak and limited blood flow. And again, I digress.

Ultimately, I stumbled onto the barefoot running theme. I will disclaimer NOW and say that BF running is NOT something to take lightly. It is not something to jump into quickly (as another post noted). But, at least in my case, I was able to slowly work into it. I strengthed my feet dramatically. I also found that my stride changed a bit. And, I gained some flexibility. The most important thing I think from BF running was that I had to focus on my foot placement, and if it was wrong it felt wrong, or if it was really wrong, it hurt, until I changed the way I landed. Eventually I just got more efficient, and my foot placement got softer. I started it a couple of years ago. I really don't run truely barefoot very often. But, I almost always run in minimalist shoes of some sort. Initially I started running in Nike FREEs, and those are my staple shoes now for everything. But, I also run a bit in Vibrams, and a couple other light shoes. When I first started, I really only did a few miles a week in minimal shoes, and sometimes barefoot. Honestly, I've only run 2 miles max in total barefoot. The soles of my feet are too delicate.

Eventually my feet got a ton stronger. I had historically run with over the counter inserts in every shoe, and for every run, for about 8 years. These were needed to prevent plantar facia flares ups. After about a year of training in minimal shoes, I slowly weaned myself of the orthodics. Now, I never wear them. And, I rarely have any plantar facia or achilles issues. Whenever I do have issues, I can always correlate it to being untrained, or tight. Then, I whip myself for being lazy, and I get back to work.

Ironically, I visited a foot doc right before I decided to try BF running. And, she told me without a doubt that my issues could NOT be resolved with BF running. She wanted to put my into another pair of $300 orthodics. I'm so glad that I didn't listen... Sorry for sounding like I'm slamming the foot docs. It just wasn't part of the resolution for me.

Having said all that, in your case... Here is my very generic rule of thumb for preliminary diagnosis: If you can run/walk on it, and it seems to feel better after about 0.5 to 1.0 mile warm-up, then it is probably muscle, tendon or tissue. The thought is that once the blood flow starts, things feel a bit better. If it doesn't feel better after warm-up, then it is either really severe tissue, or it could be bone, or another issue. In the former case (where it warms up), personally, I usually run through it. In the later case, where it hurts like a mutha and does not warm up, I'd not run through it. Keep in mind this is all based only my own experience, running for 15 years, 79 marathons, 60+ 14ers. But, is ONLY MY experience, and how my body talks to me. For others it might be very different.

Good luck with your feet. Feet pains suck.

[MyFeetHurt]

Admittedly I still have not seen a doctor, but as a last ditch effort before another trip I had scheduled, I bought some cheapo Dr Scholls pads to fit behind the balls of my feet (a little tough to find as most stores only sell arch support crap). I had never seen or heard of this style of pad until now, but let me tell you they worked. It was tough to get the placement right, but over 5 days of hiking with a heavier pack and the same shoes, the ball of foot pain was gone, though my feet were still tired. I think I'm on to something...

[bigtrout]

Admittedly I still have not seen a doctor, but as a last ditch effort before another trip I had scheduled, I bought some cheapo Dr Scholls pads to fit behind the balls of my feet (a little tough to find as most stores only sell arch support crap). I had never seen or heard of this style of pad until now, but let me tell you they worked. It was tough to get the placement right, but over 5 days of hiking with a heavier pack and the same shoes, the ball of foot pain was gone, though my feet were still tired. I think I'm on to something...

I also was diagnosed with metatarsalgia a couple of years ago. I went to see the foot doc and he suggested that I get fitted for some $300 custom-made orthotics. Instead, I did a lot of internet research and settled on the over-the-counter Dr. Scholls Active Sport (or whatever they're called) insoles and a little ball of the foot orthotic that fits right behind the ball of the foot. This combination of over the counter shoe inserts has alleviated my pain and now I run basically pain-free. The pain gradually went away and since then I've run a trail marathon, a few half marathons, and a bunch of mountain hikes/climbs.