Can I play basketball with these blisters?

Question:
Hi MyRunningDoc!

I have a basketball game tomorrow. Can I play basketball with these blisters without causing any problems?   What can put on it while I play?

Thanks!
JM

Answer:
Blisters under the ball of the foot can be painful. In the images above you can see that JM has developed some large blister that cover the entire big toe joint area. The blister may have started draining, or maybe he simply decided to pop and de-roof (meaning cut the blistered skin off) the blister in order to relieve the pressure. With large blisters, it is often necessary to drain blisters ton keep them from getting bigger. Yet doing so can make them more painful and take longer to heal.

In this case the raw pinkish area is going to be painful when running. Suddenly stopping or changing direction will also put a lot of stress on the blistered area and aggravate the raw skin under the big toe joint.

When you run, about 50% of you body weight is transmitted through this area. There are really only two ways to decrease the pressure to the ball of the foot at the big toe joint.

1. Decrease your activity (as in no basketball, walk less, etc.).
2. Move the pressure somewhere else. 

It is a simply rule of physics: you cannot remove pressure, but you can transfer it. It is possible to create a pad that moves the pressure from the big toe joint to the rest of the ball of the foot. By moving much of the pressure and irritation to the little toe joints, it may possible to play with less discomfort.

 

You can purchase pads at any drugstore that are designed for the ball of the foot. The idea is to hold the pad on the foot and identify the painful area. Clear pads obviously make this easier.

 The painful area is outlined on the pad.

The outlined area over the blister is cut away.

The pad now can put more pressure on healthy skin under the ball of the foot. The pad may stay in place well with a sock on. If not it can be taped in place to secure it. If properly placed, there will be less pressure on the blistered area. 

Even if properly offloaded, there is a risk that continuing to play will further erode the skin and cause more discomfort. In the end, if continuing to play on a de-roofed blister, it will take longer to heal. The increased mechanical irritation of running increases the chance of the blistered area becoming infected.

With any de-roofed blister (or other open wound) it is always best to seek an evaluation from your own physician before attempting treatment. You should speak with a sports medicine podiatrist to make sure that the blisters heal properly. You also need to identify the cause so that it doesn't happen again.

Dr. Christopher Segler, DPM is a podiatrist, Board Certified, American Board of Podiatric Medicine. He is also a 12-time Ironman Triathlon finisher. His sports medicine practice caters to athletes He sees patients in person in San Francisco, Houston, and Hawaii. He also offers remote consultations via webcam to athletes living abroad. If you have a sports injury question and are trying to figure out how to keep running, you can reach him directly at 415-308-0833. You can also learn more about blister causes and treatment at AnkleCenter.com and DocOnTheRun.com



 

What is The Best Way to Tape a Plantar Plate Sprain In the Ball of the Foot?

The plantar plate is a small ligament that reinforces the bottom of the joint capsule at the ball of the foot. When you sprain this ligament, the ball of the foot can be sore and ache when you walk. One of the best ways to decrease the stress to an injured plantar plate ligament is to tape the foot so that the ligament it stabilized and can heal. This video will show you how to tape the ball of the foot when the plantar plate is sprained or injured.

The first thing you need to do is get the correct type of tape. The very best tape is called Tensoplast (or Elastoplast). It is good because it stretches when you walk. With Tensoplast tape, the toe can flex slightly without getting irritated. You should order one roll of tape that is one inch wide by five yards in length.

Now that you have the right tape, you will cut a piece of tape to the correct length using your hand as a reference. The correct amount will reach from the tip of your finger the base of your palm. Next you will cut that piece of tape into two equal size pieces. Just cut the piece of tape lengthwise splitting it right down the middle. Take one of the two pieces and place it back on the roll to save it for later use. Now you are ready to tape the toe to help the plantar plate heal.

Take the piece of tape and center it on the top of the second toe. You should place the tape between the foot and the last knuckle in the toe. The tape should be right at the base of the toe. Wrap one strand around the toe, pull down slightly to create some tension in the tape and stick the tape across the ball of the foot so that it is in place on the bottom of the foot under the little toe joint.

Now take the other strand and it wrap it around the toe in the opposite direction, pulling down slightly to create some tension in the tape. This strand will cross over the other as you stick the tape across the ball of the foot so that it is in place on the bottom of the foot under the big toe joint.

If placed correctly and looking at the bottom of the foot, the tape will look somewhat like a breast cancer awareness ribbon. With the tape in this position, the pressure on the tape when you walk will keep it secure. There should be just enough tension in the tape that the second toe is pulled downward slightly lower than the third toe. This will decrease the tension on the plantar plate at the bottom of the second toe joint and help it heal.

You should keep the tape on 24 hours a day to protect the plantar plate as the sprain heals. Change the tape if the adhesive wears out and isn’t sticking to the the bottom of the foot. If your skin becomes irritated, discontinue use. Don’t tape the toe if you have an allergy to tape or adhesives. Heal fast, and get back to running!

This instructional video was created by Dr. Christopher Segler who a 10-time Ironman Triathlon finisher. He is also an internationally recognized expert on running injuries and healing foot injuries while running. He is often invited to lecture on the rapid treatment of complicated running injuries to foot surgeons, podiatrists and sports medicine physicians at medical conferences. He practices sports medicine podiatry in San francisco, CA, but also offers remote consultations world-wide. To learn more about the causes and treatment of capsulitis and plantar plate injuries, visit the ball of the foot information page at www.AnkleCenter.com. if you would like to learn about how to get the fastest treatment possible for a plantar plate injury, you can learn more at www.DocOnTheRun.com.

Disclaimer: This video is intended to provide general information about sports medicine injuries and self-teatment options. This of course is not (nor is it meant to be) a sufficient substitute for a medical evaluation by a local physician or medical doctor.

Sesamoid injury in a runner?

I recently got from a question from a runner who had been ramping up for the California International Marathon in Sacramento and started having pain in the ball of the foot at the big toe joint...

"Hello Dr. Segler, I have been training for my first marathon and read that hills would be a great way to get super strong. I really wanted to do well and finish in under four hours so I started do hill repeats on Fillmore Street in San Francisco. Things were going great and I really felt like all the training was starting to pay off. Then one morning I got up and noticed this little aching pain in the bottom of my big toe joint every time I stepped on my right foot. It seemed to be worse on the hard tile in the kitchen. I have been really ramping up the miles and I am worried that this may be a stress fracture. Can you tell me the best way to tell if this is a stress fracture or something else? It hurts right in the ball of the foot under the big toe joint. Here is a picture of where it seems to hurt the most. Thanks!"


Great question! And thanks for sending the pic.. Here is your answer...

Pain in the ball of the foot can occur under the big toe joint for several reasons. Based on your description and the location of the tenderness, I would be most worried about the following conditions:

1. Sesamoiditis: inflammation of the sesamoid bones under the big toe joint (first metatarsophalangeal joint). You stand on these two little bones. Because they get stressed more when you run uphill, you may develop sesamoiditis when doing lots of hill repeats. If you push right on the hard little bones, and one hurts more than the other, it is probably sesamoiditis.

2. Flexor Hallucis Longus tendinitis (FHL tendonitis): strain, inflammation and/or micro-tearing of the tendon that pulls the big toe down against the ground allowing you to push off when you run. The sesamoid bones are actually embedded within the FHL tendon. If you push right under the big toe joint and the whole area is tender (and doesn't really hurt more on one specific sesamoid bones) it may be FHL tendonitis. If you pull upward on the big toe (away from the ground) you will stretch the FHL tendon. If this hurts, FHL tendonitis is likely.

3. Sesamoid Stress Fracture: a tiny little crack in one of the sesamoid bones from too many hill repeats and or too much running volume. If this is the cause of your foot pain, it will hurt more on one sesamoid than the other, it will also hurt when you pull the big toe upward, and your foot will most likely be swollen and/or bruised. The best way to diagnose a stress fracture of the sesamoid bone is with an MRI. X-rays don't always show stress fractures right away. X-rays will only show a stress fracture in a sesamoid that has fractured or completely cracked. Based on your story, however, this seems unlikely.

Get better as fast as possible and good luck in your marathon!

Learn more about sesamoiditis, FHL tendonitis and sesamoid stress fractures at www.AnkleCenter.com

Dr. Christopher Segler is a nationally recognized expert on running biomechanics and foot surgery. He has been invited to lecture to foot surgeons, sports medicine doctors, podiatrists, triathletes and runners in training all over the United States, as well as Canada, New Zealand, Portugal and Turkey. If you have foot pain caused by a running injury, you can send a picture of where it hurts and a brief description to him. Your picture and answer to your question will then be posted on our blog so others can learn how to deal with running injuries as quickly as possible and keep running pain free. You can email your pic and question to DrSegler@DocOnTheRun.com If you have a quick question about a running injury and you are not in San Francisco, you can actually call him directly as 415-308-0833. He schedules house calls for runners and triathletes in San Francisco, Marin and the East Bay through DocOnTheRun.com.

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.

Running with Pain in the Ball of the Foot

Like any other type of pain, a sharp or aching pain in the ball of the foot can be distracting when you run. Although there are many conditions that can cause pain in the ball of the foot, there are only a few that are common among runners.  Stress fractures are frequent, and may be worrisome, but differ from some other conditions.  Unlike stress fractures that often seem to be related to more diffuse pain, several other conditions are easier to localize. 

For example, if you have a bunion, you will know exactly where the pain is (at the big toe joint).  If you push on that area when it is inflamed, it will hurt. Similarly, you can have very specific pain at the second toe joint. If you have a sharp pain on the bottom of the second toe joint, you may be suffering from a common condition called predislocation syndrome. As the name suggests, the condition is a syndrome that occurs before the toe begins to dislocate. In order for a toe to dislocate, the joint supporting structures must fail. 

The bones in the toes (phalanges) connect to the bones in the foot (metatarsals) at joints appropriately called the metatarsophalangeal joints. The bones are held together and also allowed to move by a number of soft tissues attachments including the joint capsule (which holds the fluid in the joint to provide lubrication) and ligaments (that keep the joint stable). The toes mostly move up and don’t usually move very far down.  As a result, the structures on the bottom of the metatarsophalangeal joints are more prone to stress, strain, and injury. 

The most significant structure on the bottom these joints, is a thick reinforcing area called the plantar plate.  Whenever you move or force the toes upward (such as when you stand up on your toes) the plantar plate resists this movement.  Stress fractures result from increasing the duration of impact faster than the bones can develop the strength to withstand the impact. In a similar way, the soft tissues that support the bones can also become injured. 

For example, if a runner is concerned about the impact of running and starts cross training excessively, injury can result.  Elliptical trainers are a common culprits. The best feature of an elliptical trainer is that it is very low impact. The worse part is that with every swing of the trainer, the athlete’s foot is dealt an unnatural position that puts a great deal of pressure on the ball of the foot as the foot swings backward.  With all of the repeated forcing of the foot up on the toes, the plantar plate on the bottom of the foot can become stressed to the point it develops very small tears. If not rested and allowed to heal these can get worse. 

When most runners come to see me with this problem, they will describe pain in the ball of the foot that is significantly worse when on an elliptical trainer or walking barefoot of hard surfaces such as tile.  It may ache after a run but usually does not hurt much during a run on flat ground. They will also usually describe a “fullness” in the ball of the foot, which they may or may not recognize as swelling. There is almost never any particular recall of how the problem began.

Sometimes, if the condition has been getting worse for a while, it appears that the second toe is sitting just a bit higher than the third toe.  This indicates a weakness in the plantar plate and joint supporting structures on the bottom of the foot. If the inflammation is allowed to continue, these structures will become weaker. With the continued application of force (repeatedly forcing the toes up through the backswing of the elliptical trainer) the plantar plate may tear completely. Then, the toe dislocates.

Fortunately, I have only seen this one time. The patient came in with his second toe pointing at the ceiling and sitting on top of the metatarsal.  He was in excruciating pain and required immediate surgery to reposition the toe and repair the torn structures. 

All of this is, of course, preventable.  Just remember that cross training is good, but it is possible to over do it. Elliptical trainers are great and highly recommended, but resist the temptation to set it at a steep angle. Although setting the machine on a steep angle can make the workout tougher, and hence shorter, it places enormous stress on the plantar plate. Do the same with your treadmill…keep it relatively flat to decrease strain on the ball of the foot. 

If you do start to notice a sharp or aching pain in the ball of the foot, get it checked out ASAP. If you seek treatment early you will likely only need ice the area, take some anti-inflammatories, and tape the toe to stabilize it. You will almost certainly still be able to train and participate in your goal race.  If you ignore what your body is trying to tell you, then you might end up working as a volunteer, handing out refreshments on the course. 

Christopher Segler, DPM, AACFAS

MyRunningDoc.com 

Stay Fit. Go Long. Run Fast. Be Strong.

Doc On the Run Podiatry House Calls in San Francisco, Marin and the East Bay