San Francisco Podiatry Video


Monday, August 29, 2011

What is this new pain in the ball of the foot? Question from a runner in San Francisco

Today I got a question from a runner in San Francisco. She says...


"I wanted to get in touch about another issue (!) I'm having with my foot. Honestly, always thought it'd be knees that went...not my feet! Basically here is what happened:

*had been running again, but not heavy 3-miles a few times a week along with perhaps some slower jogs (1 - 2 miles).

*but, then I participated in a TRX class where we did TONS of plyo stuff. squat jumps, etc. the next day, I noticed this pain.

*the pain is on the same foot as my tendonitis was. not sure if it's relevant. I decided to take a photo to show you where the pain is! hope that's not creepy ;) I did some research online, briefly, and thought maybe it's a bursitis?? I don't know, but the class was 3 weeks ago and I've been icing it, not running and the pain is not decreasing, if anything it's getting worse. I haven't been running, just doing the elliptical at the gym and cycling. Cycling does not exacerbate it at all, thankfully!

Also, do I need to get x-rays and stuff to rule out a stress fracture, etc.?

Anyway, thanks for your time!

San Francisco


Thanks for sending the pic and providing the description of the pain in the ball of your foot!

Based on your story and the location of the pain, it is most likely predislocation syndrome. Predislocation syndrome is capsulitis (inflammation of the joint capsule) in the ball of the foot, most often at the second metatarsal phalangeal joint (the joint at the base of the second toe). The capsulitis is what causes the pain, but the real issue is a strain or even tear in a reinforcing structure of the joint capsule called the plantar plate.

I actually see this all the time in active people who spending a lot of time on eliptical trainers. At the back stroke of the eliptical trainer, your heel comes up and the toes bend way up stressing the plantar plate. The plantar plate is a small ligament that reinforces the bottom of the metatarsal phalangeal joint capsule (the joint at the base of the toe in the ball of the foot).

To get it to calm down you have to avoid stressing the plantar plate. Avoid anything that causes you to bend the toes up, such as an eliptical trainer, running uphill, etc. You can also tape the toe down to decrease stress on the plantar plate. Ice, contrast baths and compression socks can decrease the inflammation.

This of course all assumes that your pain is caused by predislocation syndrome. The other common possibilities include a Morton's neuroma or a metatarsal stress fracture. It is pretty easy for any sports medicine podiatrist to tell on physical exam.

Given that 1) most stress fractures show nothing on x-ray until it has been at least 6 weeks, and 2) any sports medicine doctor who specializes in running injuries could tell you with relative certainly whether this is predislocation syndrome or not without an x-ray, I think a physician should just do a quick check and get you heading in the right direction.

Thanks for the question!

Dr. Christopher Segler
Doc On The Run
Podiatry House Calls for Runners
San Francisco, Marin, East Bay

If you have a question about foot pain caused by running, you can email a picture (pointing to the painful area) directly to DrSegler@DocOnTheRun. Tell me how it happened and I will post a an explanation so you will know what is most likely ruining you run. Your name will be changed, and you will never be identified by your real name, so as to protect your identity and shield you from any possible accusations of making a preventable marathon training mistake. I will also never, ever share your email address with anyone.


  1. Do people ever get over this? I developed capsulitis in one foot, and then sesamoiditis in the same foot. Then I started to get both conditions in the other (good) foot. This is after discontinuing hiking, running, walking for more than 4 months. Will this ever get better? I miss running and backpacking. Will I ever be able to run again even if the condition improves?

  2. This comment has been removed by the author.

    1. Hello Anonymous athlete, 

      Yes...some athletes do develop sesamoiditis (which is simply a stress reaction in one of the sesamoid bones), and then may subsequently develop inflammation of the tissue lining the rest of the joint capsule. Once that happens you have both conditions at the same time.


It can (in theory) also happen in reverse. Which sounds like your case. You tweak the big toe joint capsule creating a mild sprain, inflammation ensues and capsulitis results. If left unchecked the prolonged presence of inflammation can actually decrease the strength of the sesamoids. This form of inflammation-induced osteopenia can then result in a sesamoid stress reaction, or even a sesamoid stress fracture.


If correctly treated...Yes, it will get better. If correctly treated AND properly rehabilitated...Yes you should be able to return to running and prevent re-injury.

      To achieve this, you should find a local sports medicine foot and ankle specialist with a particular interest in runners. I only see patients in California, Texas and Hawaii. But there are qualified doctors in every state.

      If you just need a second opinion or in depth analysis of your running injury you can easily get one at a reasonable rate by visiting 

      Best of Luck!

      Dr. Christopher Segler, DPM