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)
