After three straight days of intense running, I noticed an acute pain in my
right foot. The pain is centered at the ball of my foot, and shoots to
outside edge of the foot. The ball is tender when pressed. The big toe
also hurts when it moves up and down.
The intensity of the pain tends to wax and wane - ranging from a twinge to a
level that causes me to limp.
It has been about four days since the injury. I obviously have not run -
but have done some biking and ski machining without noticable effects.
P. It sounds to me as if you have developed a condition commonly known as turf
toe. It is common to athletes who play on astroturf, and it is a function of the
pounding on an unforgiving surface. There are bones that live in the tendons
under the big toe, called sesamoids, which act as a fulcrum changing the
direction of the long toe flexors as they make their way into the toe from the
foot. You are actually expected to weight bear these sesamoids. Failure to do so
secondary to decreased ROM of the MTP jointleads to the foot rolling slightly as
you get close to push-off during the gait cycle, and the rolling (in the
direction of pronation) leads to one slipping off the sesamoids, and weight
bearing on the MTP joint itself. Turf toe.
In the clinic, we place our patients in orthotics to correct their mechanics,
and we tape and protect the MTP as much as possible acutely. Then we ice and
NSAID load for inflamation management, and gradually introduce running as the
individual gets used to the orthotics. AS far as orthotics are concerned, make
sure you get yours posted to sulcus, and with a first ray cut out refilled with
poron in order to provide a greater degree of motion while cushioning the
sesamoids. This usually works well for us.