pain in first MTP and arch - UPDATED with MRI impressions

[buzzie]

Problem started 8 months ago when I overdid it on some hillwork... been off and on ever since (typically aggravated by hillwork) - mostly off, but has been ON for the last month.

Since flaring up again this past month, I haven't let it hurt me when I run. And, mostly, it doesn't hurt when I run (some days, but not all or most, there might be a momentary twinge); but, it does come up during day-to-day activities and it does, often, hurt for a few minutes getting up after rest.



Been having pain from the arch of my foot, running under the ball of my big toe.

When it's bad, I can't extend the toes on the injured foot (bending them back, like being on the toes in push-up position) nearly as far as the other without significant pain. But, have been able to greatly relieve this by digging for and working on trigger points in my foot and calf.

Meanwhile... The big toe on my injured foot doesn't have nearly the ROM as the other. And, the MTP joint has become rather painful (dorsally). (FWIW, there has also been a good bit of cracking/popping going on in that joint - often with some relief.)

I've been working on mobilisation - grasping either side of the MTP and trying to move the joint fore-aft and side-to-side, with no luck (unlike on the other side). I've also been working on activating the muscles that would flex (curl) the toe and have had some success, working to mirror the movement of the toe on the opposite foot.



At times it feels as if the whole foot is catawampus - locked up in odd ways, nothing working or feeling as it should.

So, I've also been doing work on proprioception (all manner of balance and wobble board stuff) and general foot strengthening exercises (grasping, scooting, pressing the big toe while lifting toes 2-5, etc.)



Foot felt good getting out of bed this morning (first time in a long time) and the first loop of my run was feeling great, until it wasn't... ow, ow, f'in ow! Walked it home.

A couple of hours later - the foot looks good (no swelling or bruising); no pain with passive or active manipulation; nothing sore to the touch; no pain just standing (one-legged) on it; but... pain in MTP and arch during push-off when walking (and maybe some on the top of the foot, base of the first met), and even when just lifting the foot straight up (removing it from weightbearing).

MTA - 24 hours later... still no discernable swelling or bruising; now, tenderness over 2nd met, just beyond the base; some pain (soreness) under 5th met on eversion. Looks like I'll be hauling out the old aircast...



Any idea what might be going on? And, what I might do to address it?

 

[Longboard]

When you were examined last

When you were examined last time did the doc take radiographs?

Was the joint space normal? (as far as evidence of presence of cartilage?)

The reason I ask is the symptoms sound a lot like mine, but in my case a simple x-ray confirmed major loss of cartilage as compared to one taken years earlier when we were ruling out a fracture of another toe when I dropped a weight on it.

 

[buzzie]

Haven't had anything examined

Haven't had anything examined on this foot. It's my "good" foot!

MTA: This (Saturday) evening, feeling much better in a conventional shoe - Pro Keds, similar to a Chuck Taylor. Amazing how much of our feet we don't "need" in these shoes!! Really, I'm amazed at how dis-engaged / un-engaged my feet are. (My big toe is still just a bit cranky, but only if I force the issue). :-(

 

[Stephanie Agosta]

Hallux limitus or hallux

Hallux limitus or hallux rigidis? I know, I have it in my right toe and had surgery one year ago. Compensated on it for years and about 3 years ago it became a constant pain. The arch of my right foot still seems to have some danaged tissue, although it does not cramp up like yours - but use to.

I wear a dancer pad on my right foot which helps tremendously in keeping my toes spread, and I never push off of my toes, just the forefoot. I've been using Dr. Ray's correct toes for several months which helps keep the limited mobility that I have.



i would guess you have this condition - just not diagnosed.



Steph

 

[Longboard]

Steph, let's hope buzzie just

Steph, let's hope buzzie just has an acute inflamatory issue that will go away with rest. That's my guess, since she runs ultras and frequently trains twice a day.

I have hallux limitus in both feet, with plenty of classic bone spurring to go along with it.

All shoes hurt (including flips and sandals that strap nowhere near the joint) either from abrasion of the spurred area (dorsal bunion) or just the joint pressure or altered motion required.

Fast barefoot walking irritates the joint, while slow does not. Running barefoot is pain free.

When barefoot the joint can find it's ideal position, and yes that is a form of compensation. Fast walking is an unatural gait and requires pushing off and dorso-flexion. That's why it hurts.

My podiatrist says that I have gotten away without surgery for so long because I am barefoot 24/7 except for certain periods of the work day, allowing for constant range of motion exercise as part of daily life. I would have been in full hallux rigidis long ago had I not adopted an almost total barefoot life.

Even socks prevent the joint from floating free.

I did 60 minutes run and walk yesterday in 33 degree temps, dry and sunny but windchill in the teens No problems.

But let my toe come to rest even in my own home on a slightly elevated small object and I am in incredible pain lasting more than a few minutes!

Spent a long time in WalMart barefoot yesterday, had to deflect one manager by telling him he was wrong on both counts (health dept. and store rule), but when leaving ran into a greeter that was pro-barefoot! She also thought it was a store rule, so I got the real store manager on the phone (he's on speed dial) to correct her. Ended up giving her an SBL brochure, and went back to the car to fetch a copy of Dr. Howell's "The Barefoot Book". It made her day.

Did a sunny walk after that in a warmed parking lot, and decided to catch the last few minutes of the Lions game at a crowded sports bar a block away. Plenty of odd looks, a few smiles, but no problems.

Sorry for the drift into full blown 7700 Liz, but the prospects of total barefoot life in December in suburban Detroit without being a hermit has me intoxicated........and I only had one pint of Bell's Two Hearted Ale at the pub yesterday.

 

[NickW]

Board you amaze me with the

Board you amaze me with the way you fight for the rights of barefooters. I always throw on some sort of minimalist footwear because I don't want to cause a stink when I go to stores. I am contemplating starting to try go to school everyday barefoot next term. I had one teacher last term who was cool with it and I went to her class everyday barefoot. This term however, most of my teachers are not, one for actual good reasons. Geology class sometimes slides get broken and don't get swept up well, plus the use of some acids which can irritate skin, plus it's a part of the required safety equipment for the course. Anyhow, this got really long winded.

 

[Longboard]

NickW wrote:..... I always

..... I always throw on some sort of minimalist footwear because I don't want to cause a stink when I go to stores.

I'm for everyone doing what they feel comfortable with. I've found that pushing the limits and handling it correctly more often than not results in an increase in barefoot freedom for all. Others have found that it only hurts future barefooter's chances.

Admitting to management that a pair of flips can just be thrown on when required makes them think we all can do that (I can't, as I already posted in this thread)

Exactly a year ago a manager at a pub wanted to kick me out (he was wrong, owner agreed with me) and countered my defense with : "There was just a guy on T.V. that wrote a book and usually goes barefoot and even HE said he puts on shoes or goes elsewhere". I was pleased that he caught Dr. Howell's Good Morning America appearance , but fortunatly I was able to correct his misinterpretation. Daniel had said that he would become shod (to avoid a problem if with others) or else go elsewhere. He definitly would try to make his point if alone or with other barefooters.

 

[Stephanie Agosta]

  It wouldn't hurt anything

It wouldn't hurt anything to try a dancer pad or metatarsal pad on that foot - and might as well put one on the other. The met pads do such a great job in making sure the stress distrubutes more evenly across the foot - all stress goes somewhere and this helps it to distribute.

I have no pain in my arthritic toe with the met pad there. I have tried to go without and it gets narly - always end up with it back on the foot - tape it there with coaches tape - I wear it with minimalist footwear and when I am barefootin' also.

Won't cost you more than a few bucks to try .

 

[buzzie]

Steph - thanks for the idea.

Steph - thanks for the idea. I see there is a wide variety of products availble - do you have a recommendation for manufacturer and source?

Longboard - not sure it was an emergency, but definitely a full-on hijack. ;-) Certainly appreciate all you do for the barefoot peeps (and the rest of us!). You're a wacky dude and I'm glad to know ya!



I did - finally - manage to get some fore-aft movement in that big toe joint today!

And, things are feeling better, although I'm still suspicious (or overly cautious/pessimistic, based on previous experience). I *hope* things are resolving; but, still don't know why I've had the issues that led to Saturday's meltdown. So, as much as I want the current pain to go away, I also want to know what's caused it (and, how I can correct that).

 

[Dr. Mark]

Wow...long and informative

Wow...long and informative thread. sounds like PF may be irritated too. doing some dep massage of the area helps. You can dig your thumbs into the PF anf flex and extend the toes, esp the big toe, this breaks up adhesions.

Barefoot walking good too. think of walking through your big toe to active the arch muscles, ultimatey they need to be strengthened.

Met pads work to splay medial arch. https://nwfootankle.com/products

Hallus Limitus may also contribute...need to see someone to evaluate that, tough on email/message board.

Dr. Mark

 

[Longboard]

buzzie wrote:Longboard - not

Longboard - not sure it was an emergency, but definitely a full-on hijack. ;-)

Hope it was just a typo! Time for me to start studying for the next BFR. Wonder what other cobwebs will be there.

Heck, they don't even call it a BFR anymore!

 

[buzzie]

Dr. Mark - thanks for the

Dr. Mark - thanks for the response! Have been working that PF and am seeing some success. Things are feeling much better in all ways today. If all is well tomorrow, I will start with some BF walking - something I haven't been doing. (Soft Stars Barefoot!)



Longboard - I've made an actual mis-squawk!

 

[Stephanie Agosta]

Hey Buzz: Looks like Dr.

Hey Buzz:



Looks like Dr. Mark gave you a link for metpads. I use felt ones only. Bought some at footsmart.com and there is also myfootshop.com. Hapad has a few kinds also. I use the met pad but I've heard the met bar is also useful, so I ordered some to try them. Like Dr. Mark said, they keep the medial arch spread and in my case seems to keep it from cramping which it use to do - probably to protect the big toe which was painful.



Anyway, I find they work and once the sticky stuff wears off, I just tape them to my foot with coaches tape.



good luck.



Steph

 

[Longboard]

buzzie wroter. Mark

Dr. Mark - ...... If all is well tomorrow, I will start with some BF walking - something I haven't been doing. (Soft Stars Barefoot!)

Question for Dr. Mark:

It's my understanding that for most people the proper feedback needed to LEARN to run with ideal barefoot form can only be achieved by true ground feel as opposed to that provided with even as little as 1mm of artificial sole. That makes perfect sense, because with the fine sensors in the natural soles rendered useless the brain cannot interpret all of the data properly.

I also realize that most people find heel striking while walking barefoot quite natural, and that it is not a high impact event (like shod walking in built up shoes) requiring correction.

For buzzie to reap the healing benefits of barefoot walking as part of her treatment plan, is minimalist footwear like Soft Stars that allow toe splay and unlimited flexibility enough, or does she need to have her sole sensors activated?

 

[buzzie]

Well, the barefoot walking is

Well, the barefoot walking is off the table for now... think I need to get the strain off and let things set up a bit first.

MRI impressions:

• stress reaction in proximal 2nd metatarsal, no fracture
• strain of plantar aspect of Lisfranc and adjacent 2nd & 3rd ligaments
• peroneus longus tendinosis at insertion on 1st metatarsal, no tear
• moderate effusion at 1st MTP; articular surfaces and cartilage maintained

This is somewhat similar to the course I followed last year in my other foot. And, if I handle this recovery period well, things should be happy-happy again fairly soon (not soon enough, but... ;-) )

Curious to know what is going on with the mechanics of this injury. My pea-sized brain thinks that perhaps my feet - after spending their formative years (and many more) trapped in narrow, pointy, high-heeled, inflexible figure skates - might be going through a significant remodeling.