3rd phalanx, aches and pains or breaks and sprains?

[kozz]

My 3rd phalanges on the right side have a persistent pain that I can't identify. It's not debilitating but it is annoying. It may or may not affect my form. I first noticed it after a fairly fast set of cruise intervals on cold pavement, about two weeks ago.

It manifests when the 3rd phalanges actively plantarflex together against resistance. But it doesn't hurt if one joint or the other is fixed, that is, if I flex just the proximal-medial joint, or the medial-distal joint. Only if both are plantar-flexing in a natural motion and the resistance is at the tip of the distal phalanx. Including, usually, running. There's also significant pain when both are manually plantarflexed to the edge of their range of motion, but less when only the proximal-medial is manually plantarflexed, and none at all for only the medial-distal.

My main concern is how to tell whether it's serious, and also whether it might reduce my performance on footstrike and takeoff, particularly by interfering with the action of the 5th phalanges. Hopefully I've been specific enough, I know you can't tell me much without details.

 

[Backfixer]

From a mechanical point of view, and without knowing your body mechanics personally, it is likely that the joints prior to the third phalanx are locked up. To clarify, when certain joints are not moving properly, other joints will become hypermobile. My guess is that some of the soft tissues from the toe flexors are likely adhesed in the posterior compartment, restricting and creating abnormal motion through the ankle mortise.

I have seen this before. A good sports chiropractor who specializes in fascial release and runners should be able to restore normal motion to the region and use extremity manipulation to restore normal motion. Also, when this happens, it will affect motion at the hip through the kinetic chain and the side effect will be abnormal striding and back pain. You did not mention this but I would follow up with a professional because this is likely to worsen from running on it without understanding why you are experiencing the pain.


Dr. Charschan

 

[Dr Emily Splichal]

Hello Kozz -

I see a lot of less MPJ pain in patients which is symptomatic on resisted plantarflexion or dorsiflexion. The soft tissue structures around our lesser MPJs (knuckle of the foot) is very complex and overuse or deviation from the normal plane of motion can aggravate the area.

With all acute foot pain, we need to focus on controlling the inflammation and stress to the soft tissue.

Inflammation can be controlled with oral anti-inflammatories, topical anti-inflammatories, ice or steroid injection. In patients I treat with this condition, I usually recommend the steroid injection as the anti-inflammatory benefits are the most localized.

To reduce the stress to the area, you can take a few days off from running, buddy splint the 3rd to the 4th digit so that you make one big joint or if the pain is that bad wear a surgical shoe for a few days.

If the pain persists, I would see a Podiatrist who can take an xray and make sure all is okay. Small MPJ pain such as this is very common in active individuals and is typically a capsulitis.

Good luck!

 

[kozz]

no inflammation to speak of, and it's not getting any worse, so I guess I won't worry about it. Thanks for replying.