midfoot pain, W4R3

[mariecyd]

doing these 2-5mins run cause bad mid foot pain that i need to stop during the run. i’ve tried neutral and stability running shoes, both not helping at all. anybody else experienced this? any advise? thanks in advance!

[Yesletsgo Administrator]

The chances are that one of the tendons in your foot is the cause. Which one? The answer is you need to see a doctor or physiotherapist who is the person who can tell you.Feet are incredibly complicated, through running we learn so much about our fascinating bodies... unfortunately this usually happens when something hurts.

Yes I've had a pain like this but it may or may not be the same as yours. A physio recommended exercises to strengthen the arch of my foot and it eventually sorted itself out. Also orthotic insoles but I didn't manage to buy them (downside of living in a small town, few shop).. If the issue hadn't resolved I'd have booked another appointment for more advice.

Do yourself a favour, book a GP appointment. Don't run until then. Take your running shoes with you. Expert advice is the only answer.

Hope you feel better soon.

[MrNiceGuy in reply to Yesletsgo]

You've hit the nail on the head in stating that the human foot remains an incredibly complex structure to those who don't understand it.

However, I'm one of few who does. As such, which tendon is the cause of mariecyd's pain? Is it really tendon pain, weakness or overuse? Or has discomfort simply arisen from the fact that  mariecyd has been inactive for many years...and she needs to ensure that her body remains fit to run whilst she runs to get fit? 🤔

Orthotics? Whilst they may have worked for you, are hugely over-prescribed for the masses Yesletsgo . Unless need exists to bring floor to the foot, the majority simply do not need them (and I say such as a community working physio).

What we as a culture need to focus upon is improving hip and foot health, due to the epidemic WFH culture that now exists in 2025 💯.

A Physio I may be, in as much as I'm rubbing my hands with glee💷 , I'm also concerned 😬, since patterns of behaviour and method of treatment needed to put such right worries me greatly 😬.

As a species, we've grown weak. Unless 50+ they're really should be no need for you to be considering physio intervention.

[Yesletsgo Administrator in reply to MrNiceGuy]

Just to clarify, the physio recommended I try orthotics. Thanks to the way the NHS works I was supposed to make a follow up appointment to get further advice but couldn't work out how the booking system worked so turned to Amazon instead. Couldn't find the product I needed online so left it and just did the exercises. I appreciate you correcting me for saying it could be a tendon. You've just 100% proved why it's better to speak to a professional than to take advice from random internet strangers 😁

[MrNiceGuy]

Hello, mariecyd.

Sorry to learn that midfoot/arch pain currently troubles 😔.

However, you need not suffer. To avoid the dreaded onset of PHP (plantar heel pain) that may arise through midfoot weakness, perform the following:

1) Calf raises with toes upon a rolled up towel (placement of toes in extension activates the plantar fascia).

2) Calf raises gripping a tennis ball beneath medial malleoli (gripping action of tennis ball activates and strengthens the post-tib).

3) Iso contraction to activate the foot core (lift and press toes into the floor, encouraging contraction of intrinsic foot muscles).

Granted, these are the basics/fundamentals of foot health. Once perfected, however, we can then talk about banded resistance toe extension exercises and continued progressive overload of the 👣🤗.

[Oldfloss Administrator Graduate in reply to MrNiceGuy]

Thanks for this... but if there is no respite form the pain, when running begins again, after this kind of exercise regime, would it be sensible maybe to go and see the GP?

[MrNiceGuy in reply to Oldfloss]

Absolutely!! If NSAIDs, alteration in training load and rest fail to resolve pain/discomfort within 4 weeks, it's considered chronic. Therefore, a GP consult or similar (preferably biomechanical) is always advisable.

Sharing structural similarity (to tendon tissue), the past 10 years have seen PF/PHP viewed as a degenerative condition rather than inflammatory, so early assessment/intervention is needed to prevent the PF moving from a reactive state to one of the disrepair or degeneration - as is the case with tendinopathic tissue.

Once disrepair or degeneration occur, while some functionality can be restored, chance of a return to a completely uninjured state remains unlikely, due to presence of mucoid degeneration (death of once healthy tissue), loss of mature type I collagen and resulting change in the extra cellular matrix of the PF.

However, since disrepair/degeneration isn't present within the tendon as a whole, all is not lost. Regardless of the latter stage, tendon/ligamentous still healthy tissue has been shown to respond favourably to gradual overload through isometric, isotonic and increased energy loading/storage before an eventual return to running, thus, breaking cycle of injury through improved capacity to tolerate load.

What I'm saying is if degeneration is present (goes away and then comes back), when it comes to stages of energy loading (plyometrics) and an eventual return, plyometrics may simply require adaptation (so not as to excessively overload a tendon in disrepair/degeneration) and that running expectations may require revision (reduced weekly running miles/longer rest periods/increased focus on increasing tensile strength.

However, since the same remains true for elite athletes, the latter really does rely upon the individual having an honest conversation with themselves and setting realistic goals over what they may be able to accomplish.

In doing so, behavioural control is more likely to be maintained post-injury, with sense of control (I'm aware of what my body is currently capable of) forming their intentions (I mustn't overdo it) and continued behaviour (I'm running regularly again. Not as far or fast as I'd like, but I'm still running).

[Upsidaisy Graduate in reply to MrNiceGuy]

A year ago I was diagnosed with anterior tibial tendinopathy by a podiatrist and later, a physiotherapist. This caused sharp pain on the top of my foot towards the ankle when putting weight on the foot and especially when running. They prescribed exercises similar to the ones you suggested but although the condition improved somewhat with rest, as soon as I return to running, the problem comes back and so reluctantly, I have had to make the decision to give up. I really miss it and just wondered if you have any further suggestions which might enable me to run/ jog again please? Many thanks in anticipation!

[MrNiceGuy in reply to Upsidaisy]

Hello Upsidaisy.

Was the mechanism of ant tib tendinopathy considered to be foot/calf weakness and that's why exercises similar to those above were recommended?

Furthermore, was an assessment of existing foot posture conducted, to assess how feet presented during static load bearing and how they behaved when walking and running?

What about the ant tib itself?

Was ankle DF/PF RoM and resisted strength assessed and were exercises prescribed to improve?

If not, do look into band resisted ankle DF/PF exercises (not neglecting band resisted ankle inversion/eversion) and also consider ant tib raises against a wall:

youtube.com/watch?v=VzIcGAg...(Not working as expected?)

Too difficult? Try regressions to help develop tensile strength.

youtube.com/watch?v=UUVq8fE...(Not working as expected?)

youtube.com/watch?v=A2s7_mH...(Not working as expected?)

What about developing and improving ankle stability and stored energy capacity (plyometrics) within the ant tib needed for running, such as penguin marches, ankle dances and bi/unilateral pogo hops for example?

youtube.com/watch?v=eInM5IB...(Not working as expected?)

youtube.com/watch?v=7WrhRDJ...(Not working as expected?)

youtube.com/watch?v=Uo7xSkV...(Not working as expected?)

Additionally, see recent post by CBDB over on the strength and flex forum with links to exercises aimed towards improving foot/ankle strength and stability.

Hope some of the above helps 💪🦶🤗

[Upsidaisy Graduate in reply to MrNiceGuy]

Huge thanks to you MrNiceGuy!

I am so grateful to you for taking the time to look at my problem in such detail and for providing all of the links to exercises which I am sure will make a difference, and hopefully might make it possible for me to return to running in the future.

Neither of the professionals I saw carried out the assessments you mention to the best of my knowledge. The podiatrist gave me orthotics for arch support and told me not to run for two weeks, and the physiotherapist asked me about the pain, printed off some exercises and advised me to take up swimming or cycling instead of jogging. When I saw him on another occasion about lateral hip pain, (greater trochanteric pain syndrome) he did say that I have tight hamstrings, so maybe that is part of the problem.

Thank you again for your splendid advice, and for giving me hope that in time I might be able to take up running/ jogging again. 👟🏃‍♀️😊

[MrNiceGuy in reply to Upsidaisy]

Good evening, Upsidaisy.

You're incredibly welcome. Hopefully, you find some of the exercises useful in facilitating an eventual return to regular running 🤞.

Some time ago now, I suppose it's probably difficult to recall what was discussed with both pod and physio. However, orthotic provision with arch support by pod possibly suggests some assessment of foot posture (to correct static pronation?) The 'couldn't care less' attitude of physio in helping you to manage your tendinopathy, however, leaves me somewhat saddened 😔.

As for greater trochanteric pain, it's possible that tight/weak hamstrings may have contributed, resulting in overuse of gluteal muscles and tendons. Equally, weakness of glute med, for example, may have resulted in over activity and tightness of hamstrings. It'd be interesting to know if physio performed resisted knee flexion and hip abduction tests as a potential indicator.

Did treatment/exercises resolve the issue or does such still trouble too? Furthermore, was pelvic position assessed?

Anterior pelvic tilt, for example, causes lengthening of hamstrings and may increase internal tibial rotation and knee valgus, particularly if medial foot arch is flat/collapsed too.

This means the tibial bone cannot internally rotate as it ought to during the mid-stance/shock absorption phase of the running gait cycle as it's already internally rotated, causing mid portion of the ant tib to absorb downward vertical and upward ground reaction forces rather than plantar fascia, which remains in a constantly elongated state (due to flattened arch and permanently internally rotated tibial bone).

Similarly, if medial arch is high/rigid, impaired ability of the tibial bone to sufficiently internally rotate prevents the foot from flattening (pronation). As such, the PF cannot perform its role as a shock absorber since foot remains in a position of supination, therefore, tendon insertion portion of the ant tib is likely absorbing the dissipation of downward vertical/upward GRF.

If you wish, let me know which of the two scenarios remains most applicable to your foot morphology/posture and I'll provide you with more specific foot and ankle exercise/mobilisation strategies to reduce unnecessary loading of your ant tib and provide it with the opportunity to heal so that you can return to running.

For now, I hope the above provides greater insight into the possible mechanism(s) of injury and how to (hopefully) break the cycle 🤞🦶🏃‍♀️

[nowster Graduate in reply to MrNiceGuy]

I'm not a fan of orthotics myself, having worn them for the best part of 30 years before finding an alternative that worked better for me. Podiatrists have had a habit of trying to immobilise the foot to fix it, whereas for me the fix has been to get the foot to do some work.

Of course this might not work for everyone, but if the same approach was taken to hands, you'd be wearing a stiff pair of boxing gloves most of your waking hours.

[T2runner Graduate]

I have suffered with Plantar Fascilitas in the past, really painful and took ages to recover. I do calve stretching regularly as well as other stretched and movements, I even purchased a boot to go on my leg and foot when in bed to stop the foot from naturally pointing down, increasing the angle over time, this 'cured' me but that was diagnosed by my doctor. Like anything, get medical advice there should be an improvement that will work for you, Once you can get a prognosis of the issue you can look for the answers. Good luck.

[Runningbird1]

I had similar situation with my knee. Unfortunately I had to seek medical attention. I'm resting my knee for at least 4 weeks. But will be back jogging as soon as I recovered.

[drl212 Graduate]

I think it’s really important for you to have this checked out by your health provider whether that’s GP or physio.

Don’t want to re-injure chronically.

I’m struggling with a bit of metatarsalgia and my physio is sending me to podiatry…

Let us know how you make out!