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...

QUESTION:

"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 mileage...like 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!

Gretchen
San Francisco


MY RUNNING DOC's ANSWER:

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.

Marathon Strategy Made Simple

Run when you can,
walk when you have to,
crawl if you must.
-Dean Karnazes


Dr. Christopher Segler is an Ironman Triathlon Finisher and award winning foot doctor specializing in elite athletes. His podiatry sports medicine practice is at Doc on the Run Podiatry Sports Medicine House calls in the San Francisco Bay Area. You can register for a FREE membership and will receive the monthly newsletter “Finisher’s Circle,” which provides expert advice on increasing your running efficiency and preventing injuries and foot pain by visiting http://www.AnkleCenter.com .

Ring in The New Year with a 3 Day Run!

While most settled for watching Dick Clark and waiting for the ball to drop, a Scotsman named William Sichel was taking the ultra-marathon scene by storm. He ran in the new year by winning one of the toughest races on earth, the Across the Years 72-hour event held in Phoenix.

For three days he ran, sleeping little and logging more miles than most Americans would in a year, and more than most well trained marathoners would in a month. During the 72-hour event he saw temperatures ranging from near freezing at night to over 100 degrees during the day. All told he ran 269.36 miles through the Arizona desert. He ran almost continually and finished 34 miles more than the second finisher.

Hard to imagine beating someone by more than a full marathon distance.

Although tis sort of event might be enough any mortal, for him it is a warmup. He will follow-up with a 6-day race aiming to cover 567 miles during the Athens International Ultra Marathon Festival starting on 3 April. The 55 year-old runner will be running on an outdoor cinder circuit used during the 2004 Olympic Games.

With all that pounding, he’ll need more than a soft track and a truck load of Gu. We wish him luck!


Dr. Christopher Segler is Marathon Runner, Ironman, as well as an award-winning podiatrist, and sports medicine foot surgeon practicing at the Doc On The Run: San Francisco Podiatry Sports Medicine House Calls. For more information about heel pain, bunions, ingrown toenails and ankle pain, and other common causes of foot pain, you can order a FREE copy of his book, My Fit Feet, by visiting http://www.MyRunningDoc.com or http://www.AnkleCenter.com.

Marthon Champion Dies at Age 41

On Monday it was announced that Australia's double Commonwealth Games marathon gold medallist Kerryn McCann has died from cancer at age 41. She has long been regarded as one of Australia's best female long-distance runners. She was first diagnosed with breast cancer in 2007. Apparently the cancer spread to her liver four months ago.

It is reported that she died in peace at her home south of Sydney with her husband and three children by her side. "On behalf of the entire athletics community, I would like to pass on my sincere condolences to the McCann family," Athletics Australia President Rob Fildes said in a statement. "Kerryn will fondly be remembered for being an extremely popular team member who represented her country on 14 occasions, across an athletics career that spanned 22 years."

In 1996 at Atlanta and 2000 at the Sydney Olympics McCann competed in the marathon but saved her best performances for the Commonwealth Games.

She won the gold medal in Manchester in 2002 and later defended her title in Melbourne Australia four years later with an incredible last-lap effort against Kenyan Hellen Cherono. At that time she was 38.

She will be missed by the running community throughout the world.


Dr. Christopher Segler is an award winning foot surgeon and Ironman Finisher who treats elite athletes. His podiatry sports medicine practice is Doc On The Run: San Francisco Podiatry Sports Medicine House Calls. To learn more about increasing your speed and avoiding running injuries like tendonitis, shin splints and stress fractures, you can register for a FREE membership and copy of his monthly newsletter “Finisher’s Circle” by visiting http://www.AnkleCenter.com .