Tales from the IC: Getting to know my Metata... - Bridge to 10K

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Tales from the IC: Getting to know my Metatarsals (# 1)

CBDB profile image
CBDBGraduate10
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Warning: long but hopefully informative post.

Ok, so for the first time since starting to run nearly 2 years ago, I’m taking a cautious step back and am preparing to be on the Injury Couch for a stint. With this I hope to minimise the risk of a more serious injury.

About a week ago, I noticed the slow and increasing discomfort whilst running and a remnant throbbing afterwards. It was a slow increasing burning sensation in the ball of my right foot, fairly in the middle.

This started my new acquaintance with my metatarsals.

First website I looked at, dedicated to running injuries is Runners Rescue, run by the Birmingham Podiatric Clinic, and it’s a great first start into comparing running injuries. Both Morton’s Neuroma and Metatarsal Stress Fractures are featured: runnersrescue.com

As part of my decision-making on how to address this new metatarsal challenge, I have collated some readings and videos below for runners who might have similar aches and pains, focussing on two possible conditions. Reading into possible running injuries I thought it felt a lot like Morton’s Neuroma (NM). Discussing it on the forum, the other possibility mentioned was that it was a metatarsal tension (MTF) fracture, which in its pain characteristics is often mistaken for a Neuroma. So now I know much more about either condition and also know the closest podiatrist in my region. But by the time my appointment comes along, I hope to be gently running again.

Recap. I’ve stopped running since 5 days ago, soaked my foot in Epsom salts to reduce any potential inflammation (none which is discernible), iced it at times, understanding that the initial 10 - 14 days are the most crucial ones for the initial healing process, no matter if we’re talking about Norton’s Neuroma or Metatarsal Fracture. I don’t have any pain now, at 5 days in, but I had a slight discomfort when putting weight on it for a couple of days, and so I’m thinking I’m doing the right thing. And after I will have rested my foot for 14 days or so, I’ll start with some gentle runs to keep fit.

My findings, I think, confirmed I’m doing all the right things, so below some interesting facts and findings about both conditions.

Definitions of Morton’s Neuroma:

( NHS nhs.uk/conditions/mortons-n... and WIKIPEDIA en.wikipedia.org/wiki/Morto... )

“Morton's neuroma is where a nerve in your foot is irritated due to pressures on the metatarsals. Pain in the ball of your foot is often caused by exercising too much or wearing shoes that are too tight. Some people also have a foot shape that puts extra pressure on the ball of the foot – for example, if you have small curled-up toes (hammer toes) or high arches.”

Definitions of Metatarsal Stress Fracture, Fracture or Broken Toe, sometimes also referred to as March Fracture

( NHS nhs.uk/conditions/broken-toe/ and WIKIPEDIA en.wikipedia.org/wiki/March... )

“A broken or fractured toe can be very painful, but isn't usually serious and can often be treated at home. Most will heal in four to six weeks. Doctors will usually suggest you treat a broken toe at home first if: a) it's not your big toe; b) the bone is not sticking out of your foot or pointing at an odd angle or c) there's no wound on your toe.”

This is what the NHS site says and I’m glad to report that in my case none of a, b or c applies. Another NHS site relates this condition to specific sports injuries:

“Repetitive activity or a heavy impact while playing sport can injure bones, causing stress fractures, caused by tiny cracks that develop in a bone as a result of repeated stresses (for example, during high-impact activities like distance running)”.

Experienced runner-hubby also mentioned his run-ins with running and foot problems, most which were advised by his trainers to be treated at home.

So what to do immediately after noticing the pain?

An interesting question actually, as many sites suggest that fractures often go unnoticed . And as many bones, including the middle metatarsals have plenty of blood flow, the healing process is very quick. Strangely enough the 5th metatarsal (pinkie toe) has much less blood flow, so is notoriously slow to heal. (And yes, both mine broke in my childhood just due to outdoor play, although I was a bit of a tomboy) .

So for stress fractures, the first 14 days, the initial healing period is important. And that means keeping inflammation (caused by fracture) down and weight off the fracture so it has time to harden again. No running, yup! I heard you, my lovely metatarsals, loud and clear.

And Morton Neuroma also often goes unnoticed for long periods of time as well, as it is rather a slow encroaching condition, with the build up of fibrous tissue formation around nerve tissue, which in turn compresses the nerve which then gets inflamed. In essence it should rather be called Morton’s Fibroma, as it is not a neuroma ( e.g. not a growth or tumor of nerve tissue). And of course it’s benign, meaning that it doesn’t spread. But every inflammation will cause more fibrous build up, which in turn will increase the pressure, which in turn will increase the inflammation …. You get the point. It’s a vicious circle.

So with Morton Neuroma, it’s also about keeping the inflammation down, but also then about giving that nerve some space. Therefore the stretching, rolling and massages of the foot to find relief.

So clearly there is a conundrum if you are not quite sure if your pain is caused by a fracture or a nerve issue. And although Morton’s Neuroma often displays as pain underneath, a fracture as pain on top, it seems it can be quite difficult to tell, especially in the early phases. In both cases icing works well to keep inflammation down, but in one case you want to keep the foot as still as possible and in the other stretching it would help. A conundrum.

Additionally, from the info I received foot specialists quite often treat on the basis of symptoms, as small fractures often do not appear on scans and scans are also expensive. So advice even from doctors tries to achieve guidance in the middle sweet spot of both issues.

In short NHS view is:

NHS Morton’s Neuroma

• rest and raise your foot when you can

• put an ice pack (or bag of frozen peas) in a towel on the painful area for up to 20 minutes every 2 to 3 hours

• wear wide comfortable shoes, low heels, soft sole

• use soft insoles or pads you put in your shoes

• try to lose weight if you're overweight 😤😠

• try regular gentle stretching exercises

• take paracetamol

Metatarsal stress fracture

• take ibuprofen and paracetamol for the pain and swelling

• rest your foot and keep it raised

• hold an ice pack (or bag of frozen peas) wrapped in a towel on your toe for up to 20 minutes every few hours

• wear wide, comfortable shoes with a low heel

• avoid walking around as much as possible

• strap up your broken toe – put a small piece of cotton wool or gauze between your sore toe and the toe next to it, then tape them together to support the sore toe

So I opted for the in-between, icing and Epsom salt baths to keep inflammation down, some careful foot massages and rolling on the arch, but keeping most of my foot fairly stable and static to allow healing to occur if it is indeed a fracture.

I should note that I’m not in any pain, it’s just still the remnants of discomfort I feel. So if it is either Morton’s Neuroma or a stress fracture, I’m pretty sure their very mild ones that 8m hoping to have caught early to support quick healing.

In terms of keeping fit and mobile, I have continued with daily yoga and squats, but simple taking care to opt out on any positions that would put too much stretch or weight on the feet or one foot. So no tip-toeing for now. I plan to also start adding again a serious program of rowing, but haven’t started yet.

So what to do in the medium to long term?

So for runners, the immediate questions will be around how long your stint on the IC will be, and more daringly…

Can you exercise with a Metatarsal fracture?

And I found this intriguing video

Doc on the Run (11 min) 12 Steps to healing and running with a metatarsal stress fracture youtu.be/Zlk_-YgOmxs

And

Doc on the Run (7min) Top 3 stress fracture takeaways from IFAF Sonoma youtu.be/UlTzRb53F3Y

His suggestion is that the first 2 weeks of healing are important and it helps to keep the foot stable, but that after 2 weeks a gentle return to running is often possible. It will keep the foot mobile and the foot becomes stronger as it slowly heals. Constant monitoring is crucial he suggests, and his website has plenty of free resources and free assessment

He even has a podcast, talking about metatarsal stress fractures.

podcasts.apple.com/gb/podca...

And just one more website and video that comprehensively looks at how to identify, treat and continue running on stress fractures:

runnersworld.com/health-inj...

For Morton’s Neurone medium to long term strategies look somewhat different:

Exercises for Norton’s Neuroma (including lovely suggestions from HU community ❤️❤️❤️):

The ‘good’ thing about Morton’s Neuroma is that nothing is broken, only inflamed. So the following exercises provide immediate relief as well as long term relief. The idea behind them is to spread your metatarsals! (Fly fly my Metatarsals!), and these exercises will do the trick:

- Walking on toes and walking on heels.

- Scrunching up towels via your toes, or picking up a pencil with your foot.

- Rolling your foot arches slowly on a spiky massage ball or tennis ball, avoiding the areas of pain, as more pressure at the sensitive spots might create more inflammation. Allowing your feet to be ‘draped’ around the ball also expands the metatarsals to relieve pressure.

- Add Yoga-Toe separators, as spreading your toes and with it spreads the metatarsals that relieves the pressures on the nerves that that keep getting inflamed due to pressure. Some toe separators seem to be able to be worn in shoes.

- Massage your foot

Shoes shoes shoes

And of course quite quickly I came across the issue of shoes and what to do long term. And although I haven’t come across it when reading runner’s websites, it sounds like toe-shoes or bare-foot shoes might be a good thing for addressing MN. And getting shoes with larger toe boxes also helps with allowing your feet with your metatarsals to spread.

Idea is to get feet to spread out more than our usual work/leisure shoe cultures allow. This obviously is more an issue with women’s shoes, which even when one bypasses high heels, narrow toe boxes seem to be the beauty standard.

There is some evidence that “running shoes with cushioning may increase your risk of a fatigue fracture because they lead to abnormal pressure distribution patterns on the lower leg. They also increase plantar pressure in the forefoot and may increase the risk of a metatarsal stress fracture.“

runforefoot.com/raised-heel....

And relevant for me is the annoying intersectional issue of weight. Due to having a Thyroid condition called Hashimotos, all my attempts of losing weight, including following advice from Thyroid focussed nutritionists,, have been only incrementally successful. I have few nutritional vices left, so this is the most annoying part of my health journey.

Until I came across this study I was thinking that once off the injury couch I might switch to barefoot or even toe-shoe running. But the following study gives me serious pause for thought. This study concluded that heavier runners should avoid running in minimalist shoes

orthoconsult.com/running-in...

Of course that controlled study had criteria that are very unlike my context. I slow-run, not even considered in the study. My weekly distance is far below theirs.

But it does give me some conundrums to get my head around, when deciding on my metatarsallic shoe strategy.

From what I can see, there are following options for me if attending to it with Morton’s Neuroma in mind, but also benefitting my overall metatarsal health:

1 - Just shoes with larger toe box (after IC start gentle runs with 3 days rest in-between runs)

2 - zero drop shoes with toe box (start again with C25k)

3 - zero drop shoes with toes (start again with C25k)

And of course as pointed out by our own HU toe-shoe expert, getting used to minimalist running takes time. See this link by Vibram itself us.vibram.com/company/educa...

One should also note that there is a difference between minimalist and zero drop shoes.

But running shoes that have been mentioned on the forum to address conditions like Morton’s Neuroma are:

• ‘Brands that have more wide-fitting options are Hoka, Brooks and Altra

• Vivo Barefoot

• Revivo (outlet shop of Vivo Barefoot)

• Vapour Gloves (some use this one for indoor sports)

• Vibram Fivefingers (toe shoes)

• Merrell (they have zero drop shoes)

• Hoka Clifton Model (wide-fit and rocket sole)

- Altra Lone Peak 5 trail

Also of note

- Rocker soles’ can redistribute weight to avoid pressure points (e.g.fitflops and the Hoka Clifton Model which has a rocket sole version)

And for everyday shoes following shoes were mentioned on the HU forums

• Doc Martin boots (not shoes)

• Duckfeet (Denmark made, sold in the UK by Alpinetrek)

• Birkenstock

• Conkers (custom made shoes by sending outline of feet)

So big topic, and big shift of thinking for me.

I was one 10k away from finishing my 10k consolidation plan, and that would have coincided with the HUHM/10k.

But letting that one run, that one goal, that one target go in order to keep on running stronger in the future, that is also part of every runner’s story.

I’m still gathering together a new strategy together for this next phase, but considering what we runners do when we do not or cannot run, that is just as much a part of what makes us runners keep on keeping on.

So keep on keeping on everyone, and have a wonderful runnner’s weekend.

P.s. here’s a site reviewing 2021 running shoes fore wide feet: runrepeat.com/guides/best-w...

★★★★★★★★★★★★★★★★

ALL LINKS TO MY RECOVERY POSTS:

So just to keep my links to my recovery couch available, here the links to the posts during the weeks on the injury couch. I’ve added a few terms to each link, as a means of reference:

Tales from the IC: Getting to know my Metatarsals (# 1) healthunlocked.com/bridgeto... (Metatarsalgia, fracture vs Morton’s Neuroma, shoes, barefoot and zero-drop shoes, exercises to strengthening toes)

Tales from the IC: zero-drop shoe quandaries (# 2) healthunlocked.com/bridgeto... (more about barefoot running, yoga for toes)

Tales from the IC: Reader, I ran today. (#3) healthunlocked.com/bridgeto... (trying out a short hill run, IPhone issues)

Tales from the IC : Stop Go Stop Go … (#4) healthunlocked.com/bridgeto... (back on the IC, waiting for last medals)

Tales from the IC : Baby (running) steps … (#5) healthunlocked.com/bridgeto... (trying out another mini run, ordering zero drop shoes)

Tales from the IC : Row Row Row your Run (#6) healthunlocked.com/bridgeto... (starting to row a runner on Zwift)

Tales from the IC : Festive Rowing-Run (#7) healthunlocked.com/bridgeto... (XMas, finished Zwift Running 101)

Tales from the IC : More Virtual Running Fun (#8) healthunlocked.com/bridgeto... (update on my rowing in all virtual races, also start of RowAlong 30x30)

Tales from the IC : Rowed runner intervals and hot lava! (#9) healthunlocked.com/bridgeto... (third week of daily rowing and missing running)

Tales from the IC (#10): Running vs Rowing. My experience of two different worlds healthunlocked.com/bridgeto... (differences between rowing and running, differences between different running vs rowing online communities, differences in stats)

Tales from the IC (#11): I dreamt I was running healthunlocked.com/bridgeto... (update on all virtual rowing challenges)

Tales from the IC (#12): Strong knees and cute toes healthunlocked.com/bridgeto... (finished Jan rowing challenges, starting to think how to get back to running)

Tales from the IC (#13): Running vs Rowing, muscley toes, and recovery plans healthunlocked.com/bridgeto... (recovery plans rowing and running, year goals)

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CBDB profile image
CBDB
Graduate10
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31 Replies
RunWillie profile image
RunWillieGraduate10

Hi CBDB Hope you’re back out there soon. I ordered some correct toes last week to go in my zero drop shoes. Will let you know how they’re for your on-going research. 😍

CBDB profile image
CBDBGraduate10 in reply toRunWillie

💛👍🏽🦶💪

Maddee_6333 profile image
Maddee_6333Graduate10

Sorry to hear you’ve been injured, but sounds like you’ve made the right choice to get mended soonest 👍

CBDB profile image
CBDBGraduate10 in reply toMaddee_6333

Thank you, here’s hoping! 🙏💪👍🏽

SueAppleRun profile image
SueAppleRunGraduate1060minGraduate

That’s really interesting and hope your treatment works and you can soon run again

CBDB profile image
CBDBGraduate10 in reply toSueAppleRun

Yes! And I might have to shelf 10ks 😔 and enjoy those short runs! 😀

SueAppleRun profile image
SueAppleRunGraduate1060minGraduate in reply toCBDB

Those short runs are fun

tmbtrain profile image
tmbtrainGraduate10

Good luck with this and thanks for posting. I've passed this info on to my partner who ran a marathon recently on painkillers probably due to this issue. 🤞

CBDB profile image
CBDBGraduate10 in reply totmbtrain

Oh no! Hope he recovers well!

tmbtrain profile image
tmbtrainGraduate10 in reply toCBDB

Thanks. He feels it around the 6 mile mark so has been running only 5 milers since the marathon. He's tried 3 different insoles so far but thinking about the toe seperators next. Fingers crossed for you too. Cheers

Doris8 profile image
Doris8Graduate10

What a great post. Hope your back out there and running shortly and out of I C . I’ve just bought Altra lone peak 5 trail and they’re wide like the shape of your foot. Your an inspiration for perseverance when it comes to injuries. You do a lot of research 🤞

CBDB profile image
CBDBGraduate10 in reply toDoris8

Awhhh thank you. ☺️🙏 Altra Lone Peak 5 trail. ☑️I’ll look them up and add them to the list! Thanks! 🙏👍🏽💪🏃‍♀️

Sandraj39 profile image
Sandraj39Graduate10

Gosh - lots of information here CBDB ! You have being doing your research!I had problems with a Mortons Neuroma a few years back. It was always worse if I walked around a lot in bare feet or just socks. What worked for me was making sure I wore something comfy on my feet all the time - slippers, crocs (not great looking I know, but very comfy!) Also, soft soles (my days wearing Converse type trainers are well and truly over!) I rarely get problems with it now and when I do it’s usually because I’ve been wandering round in my socks again!!🤣 I was lucky that it never interfered with my running.

I also wear Hoka running shoes but this is because they are just the best!👟✨

Hope you get some relief and are back out there soon.🙂

CBDB profile image
CBDBGraduate10 in reply toSandraj39

Thanks. I’m learning and so many experiences are all still new. Which Hoka do you wear, do you know? It’s great to get experience from others who went through similar phases, so thanks for posting! 🙏👍🏽🏃‍♀️

Sandraj39 profile image
Sandraj39Graduate10 in reply toCBDB

I overpronate a little so have the Hoka Arahi 4s. Supportive but not oversupportive. I’m tall and have, over the years, found that the mens model fits me better! For muddy/ trails I wear Hoka Speedgoats - they are fab too!🙂

CBDB profile image
CBDBGraduate10 in reply toSandraj39

Good to hear that other women look at men’s models as well! In my limited experience the male models of running shoes gave me the needed space in the toebox! But when in a running shop, I still felt odd asking for the male version of the shoe. 🙏👍🏽🏃‍♀️🦶👍

Sandraj39 profile image
Sandraj39Graduate10 in reply toCBDB

It’s definitely not as unusual as you would think…🙂

DylanTheRabbit profile image
DylanTheRabbitGraduate10

I read this with great interest. Good luck with finding what works for you. Hopefully you've caught this early and can therefore resolve it relatively easily. It's also interesting reading the comments, to find that people with similar issues find such diverse (sometimes opposite) ways of dealing with it. We're all so different!

CBDB profile image
CBDBGraduate10 in reply toDylanTheRabbit

Thank you. Yes, here’s hoping that I caught it early. And I agree, we are so different and i do think one of the most important things about health journeys is to learn to listen to your body. Great stuff and thanks! 🙏👍🏽💪🏃‍♀️

David_G profile image
David_G

Sorry to hear you’re injured CBDB but I think you’ve done the right thing to stop running while you recover.Thanks for posting BBC all the information- I’m sure many of us can and will benefit from it.

Hope you manage to get out there again soon.🙂👍

CBDB profile image
CBDBGraduate10 in reply toDavid_G

Thank you! 🙏🦶👍🏽

linda9389 profile image
linda9389Graduate10

You have been busy CBDB! I wish you speedy healing and am absolutely sure resting it early is the right option . My (2nd) metatarsal fracture kept me off for over four months. It was not discernible on xray but was visible on the mri. With hindsight I could maybe have caught it sooner - it went from a mind, dull ache to super painful (couldn't walk on it) over the course of a HM! After some initial NHS misdiagnosis, they eventually diagnosed the stress fracture and I was booted for months (reduced to cycling and Caroline Jordan workouts). It was very slow to heal. I moved to Hoka Cliftons (which I love) and gradually built the running back. That was a couple of years back now and, fingers crossed, it has not bothered me since. Early intervention has to be best. Take care and heal fast and well xxx

CBDB profile image
CBDBGraduate10 in reply tolinda9389

Oh thank you, and what a story!

Also so many thanks for snipping the HUHM in 5k chunks ( healthunlocked.com/marathon... ).

I have downloaded them and saved these in my RunGo app and will define run them when I’m back out there again. I really appreciated it so much! It will really get me going again and I’m so looking forward to that! Thank you!

dijep profile image
dijepGraduate10

I'm playing forum catch up this morning hence the late reply.I'm sorry to hear you've had to shuffle over to the injury couch. Especially when you were so close to that 10th 10k, but resting up must be the right call.

What a huge amount of research you've done, definitely a post to keep just in case I need it one day. Hopefully not but you never know 🤞

CBDB profile image
CBDBGraduate10 in reply todijep

Yes, it’s always annoy and seems to always come just before reaching the next goal! 😤😂

Hedgehogs123 profile image
Hedgehogs123Graduate10

Hi, hope you manage to heal in your time and get running again soon. Thank you for this post, its very useful and very informative .I do suffer with pain under the ball of my foot, but Ive always done, and just thought the ball of my foot was a bit pronounced. I have very arch in both feet and I run in Brooks neutral shoes which are supportive but perhaps I need to revisit which model of Brooks I actually should have.

🏃‍♀️👍

CBDB profile image
CBDBGraduate10 in reply toHedgehogs123

Huh 🤔 interesting. From my readings I do now wonder if for most cases the switch to wider shoes tends to minimise this issue, but I don’t know. 👍🏃‍♀️

Grumpypete profile image
GrumpypeteGraduate10

Good luck? I knacked my achilles on tbe left and metatarsals on the right in July and havent run a step since. Slowly getting better but at 68 I reckon it takes a long time. Physio has told me to stop at 5K. I wish!

CBDB profile image
CBDBGraduate10 in reply toGrumpypete

Oh dear. Yes, the older one gets the more patience our bodies demand of us, don’t they?

So sending you some patience and healing wishes!

Scruff55 profile image
Scruff5560minGraduate

So sorry to hear you are on the I C. But it sounds like you have researched the issues thoroughly. This post is so informative thank you so much for all your hard work. I hope that u are able to continue running even short runs. This is where I find myself atm and have accepted that I won’t be running further than 5 k in the near future but at least im still able to run 🤞you’ll be back again soon. Heal well and take care.

CBDB profile image
CBDBGraduate10

So just to keep my links from all my updates available, here the links to the posts during the weeks on the injury couch. I’ve added a few terms to each link, as a means of reference:

Tales from the IC: Getting to know my Metatarsals (# 1) healthunlocked.com/bridgeto... (Metatarsalgia, fracture vs Morton’s Neuroma, shoes, barefoot and zero-drop shoes, exercises to strengthening toes)

Tales from the IC: zero-drop shoe quandaries (# 2) healthunlocked.com/bridgeto... (more about barefoot running, yoga for toes)

Tales from the IC: Reader, I ran today. (#3) healthunlocked.com/bridgeto... (trying out a short hill run, IPhone issues)

Tales from the IC : Stop Go Stop Go … (#4) healthunlocked.com/bridgeto... (back on the IC, waiting for last medals)

Tales from the IC : Baby (running) steps … (#5) healthunlocked.com/bridgeto... (trying out another mini run, ordering zero drop shoes)

Tales from the IC : Row Row Row your Run (#6) healthunlocked.com/bridgeto... (starting to row a runner on Zwift)

Tales from the IC : Festive Rowing-Run (#7) healthunlocked.com/bridgeto... (XMas, finished Zwift Running 101)

Tales from the IC : More Virtual Running Fun (#8) healthunlocked.com/bridgeto... (update on my rowing in all virtual races, also start of RowAlong 30x30)

Tales from the IC : Rowed runner intervals and hot lava! (#9) healthunlocked.com/bridgeto... (third week of daily rowing and missing running)

Tales from the IC (#10): Running vs Rowing. My experience of two different worlds healthunlocked.com/bridgeto... (differences between rowing and running, differences between different running vs rowing online communities, differences in stats)

Tales from the IC (#11): I dreamt I was running healthunlocked.com/bridgeto... (update on all virtual rowing challenges)

Tales from the IC (#12): Strong knees and cute toes healthunlocked.com/bridgeto... (finished Jan rowing challenges, starting to think how to get back to running)

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