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Fifth Metatarsal FractureJulian Edelman is the most recent star athlete to be sidelined by a Jones fracture, but he is certainly not the first. Earlier in the NFL season, Dez Bryant underwent a single surgery to repair a similar injury and sat for 6 weeks before returning to the field.  Kevin Durant, the 2013-14 NBA MVP, missed much of the 2014-15 NBA season and underwent three surgeries to repair the injury. The difference in recovery times for Bryant and Durant highlights the complexity of treating this injury as well as the nuances each individual encounters throughout their treatment.

A Jones fracture is a fracture to the long bone on the outside of the foot, the fifth metatarsal, that is caused by a sudden inward and downward twisting of the foot or direct force to the area.  Patients experience pain to “the outside” of their foot with swelling and pain with walking.

These injuries can be diagnosed with a standard x-ray of the foot and are particularly difficult to treat as they occur in an area of the bone with limited blood supply.  Adequate blood supply is essential for healing.

While 6-8 weeks of non-weight bearing is the typical method of treatment for most patients, surgery is usually preferred for high-level athletes.  Surgery for this injury consists of introducing a single screw into the bone to hold the two fragments together so that they can heal.  Even with surgery, it is approximately 6 weeks until return to activity can be expected.  The most common complication that patients experience with this injury, as seen with Durant, is failure of the two bone fragments to heal.  When this happens, regardless of the initial method of treatment, patients require surgery to repair the non-healing bone.

Disclaimer: The author has never evaluated, treated or reviewed the medical records of the individuals mentioned in this article.  All statements and opinions are based on publicly available material released from the individual or their representatives.

Like clockwork, every spring we hear the same complaint in our office:

"I had pain in my feet/ankles/toes after I ran. And then I ran the next day and they hurt more. I can't understand it, because I'm running exactly the same route I did as last year."

protect your feet and ankles when running

Each spring, every athlete is anxious to jump right back in where they left off. But we forget just how quickly our bodies get out of condition, especially as we age.

Your body has de-conditioned over the winter months (assuming you're not working out regularly at the gym). Ligaments, muscles, bones, and interconnective tissue have become much weaker from lack of use. When we demand the same from them as we did when we were in peak condition at the end of last season, the disconnect between desire, endurance and strength becomes obvious. The result is soreness, stiffness, tendonitis, sprains, fractures or worse, which could sideline us for months.

Whenever we have a significant break from our training schedule, even a few weeks, it's important to build back up slowly to pre-break levels. This is especially true when we lay off all winter, or when we're recovering from an injury or an illness.

In fact, your hard-earned fitness can begin decreasing in as little as 2 weeks, especially if you're in peak condition. According to Dr. Edward Coyle, the director of the Human Performance Laboratory at the University of Texas at Austin, the maximum oxygen that an athlete can uptake and utilize (your endurance) plunges in the first month of inactivity and continues to decrease for the next 3 months of inactivity. Even the enzymes involved in metabolizing energy become less active. In fact, for the casual athlete, all the benefits derived from the previous season -  the ability to uptake and utilize oxygen - may be completely lost when they lay off their routine for 4 months or more.

And after your endurance decreases, your muscle mass and strength also take a hit. Which is when you feel ankle pain or heel pain pushing that last mile.

runner forgot somethingThe good news is, if you've been a runner or otherwise training for 10 years or more, you can maintain fitness longer than those who've been at it for less time. And highly trained athletes don't decline to the same levels as the casual athlete, even after a long layoff.

So how do you get back into condition?

  • Take it slow and don't go BIG right from the start. Begin by working below your break point and don't push
  • Warm up for longer periods before your workout. Make sure you've stretched your legs, feet and ankles sufficiently
  • Allow 1 day of rest between each run or workout. More if you have pain or soreness in your knees, shins, feet or ankles.
  • Focus on consistency and good habits, not speed
  • Progress gradually and extend your workouts by a small amount each session
  • If you feel any pain, stop immediately. Resume your training only when the pain has completely subsided
  • Wear a new pair of athletic shoes to support your feet and legs properly

Breaks are an important part of training, as they're important for your physical and mental health. They can also help you come back stronger and faster. Your best bet is to rest when injured or ill and do some cross-training in the gym during your downtime to maintain strength and endurance. That's a far better strategy than hurting yourself every spring.

Did you ever have one of those really active days - running, hiking, jumping, maybe just standing for a really long time on your feet - and the balls of your feet ached like crazy? Well my friend, you were probably suffering from the dreaded Metatarsalgia.

metatarsalgia symptoms Metatarsalgia isn't as serious as it sounds. It simply refers to minor pain and inflammation of fatigued and overused metatarsal bones (the long bones in your feet). The pain appears in the area where the metatarsals join your toe bones, otherwise known as the ball of your foot - the area of your sole behind your toes (not just behind the big toe). The pain usually begins as a mild ache and worsens over a period of months.

Usually, metatarsalgia is caused by ill-fitting shoes combined with lots of activity. Most cases of metatarsalgia aren't serious, and rest, ice and over the counter pain medicine will resolve the pain.

But if left untreated, the classic cascade effect may kick in: The balls of your feet hurt, so you unconsciously shift weight to other parts of your feet, which eventually causes pain in those areas, which again causes you to shift your weight. Since your legs, ankles and feet are drifting farther out of alignment, the joints above your feet start feeling the impact and you suddenly have pain in your knees, back, or hips. And it all began with minor, treatable pain in your feet.

Prolonged metatarsalgia which doesn't resolve in 10 days should always be reported to your podiatrist, as it can be a symptom of other, more serious conditions.

Symptoms of Metatarsalgia include

  • Sharp, aching or burning pain at the head of the metatarsals, in the ball of your foot, just below and underneath the toes
  • Pain that becomes worse when you're on your feet, especially when running, walking or flexing
  • Pain decreases as you rest
  • Sharp or shooting pain, numbness, or tingling in your toes
  • A feeling of having a pebble in your shoe

metatarsalgia foot diagramContributing factors to Metatarsalgia

Intense training. Most runners are accustomed to occasional bouts of metatarsalgia, as the front of the foot absorbs significant shock when running. But this can be true of anyone who plays a high impact sport, especially basketball, soccer, tennis, football, or track and field events. It's sometimes a sign that your athletic shoes are worn out and need to be replaced.

The shape of your foot. If you have a high arch, extra pressure is placed on the metatarsals, increasing the chance of pain from overuse. If your second toe is longer than your big toe, more weight than normal is shifted to the 2nd metatarsal head, and that may cause pain as well.

A muscle imbalance. Tight toe extensors or weak toe flexors don't properly support the metatarsal bones and may cause fatigue and pain from overuse. A too-tight tight achilles tendon may be a contributor as well.

Stiff ankles, perhaps the result of a previous injury or arthritis, don't support the foot correctly, placing too much pressure on the forefoot.

Excessive pronation - the side-to-side movement of your foot - may contribute.

Foot deformities such as flat feet, bunions, gout, arthritis and  hammertoe can cause metatarsalgia. Many patients with bunions complain of pain in the balls of their feet.

Carrying too many pounds. Your forefoot carries most of your body weight when you walk of run. Extra pounds means extra pressure on the metatarsals. Additionally, as we age, the fat pad in the foot tends to thin out, reducing its cushioning effect. A weight management plan may reduce your symptoms.

Poorly fitting shoes and high heels. That's right, ladies. While high heels make you look great, they're murder on your feet (like I had to tell you that). High heel shoes are a very common cause of metatarsalgia in women, as they transfer your body weight to the front of the foot, working against how the foot is designed to carry your weight.  Athletic shoes which don't support your feet correctly are also guilty of causing metatarsalgia.

Stress fractures in the metatarsals or in the toe bones change the way you walk, which may result in metatarsalgia.

Morton's Neuroma, a growth of fibrous tissue around the nerve between your 3rd and 4th metatarsal heads causes symptoms similar to metatarsalgia.

Your podiatrist may recommend one or more of these treatments for Metatarsalgia

  • Rest and complete non-weight bearing for at least 24 hours
  • Ice
  • Over the counter pain medicine such as advil or aleve
  • Cortisone injection in the sore area to relieve pain and inflammation
  • Pressure bandage on the sore area
  • Ultrasound therapy
  • Custom orthotic devices to support and realign your feet
  • Metatarsal pads
  • Change in footwear (usually to good quality athletic shoes with proper support or flat shoes with a wide toe box)
  • When pain has subsided, stretching and strengthening exercises for your feet, supervised by a physical therapist
  • Alternate forms of activity may be recommended such as swimming or bicycling
  • Weight management if you're overweight