Discussion: fourth metatarsal

does anybody know anything helpful about pain in the head of the fourth metatarsal (I think that's what they call the next-to-outer knuckle in the ball of the foot)??

it has been ten days and i'm starting to get narky.

happy paddy's day!!!

I once had a pain there for a few months...finally went to the doctor about it...they x-rayed my foot and found out it was a stress fracture. Hopefully that is not it for you....

Happy Paddy's Day to you too!!

I had pain there a few years ago. Thought the toe might be broken or a stress fracture. Doctor prescribed rest but that only helped in the short term. Pain came back as soon as I was running again. Eventually went to an orthopedic surgeon and got it X-rayed. Not broken. Said I had a promenent metatarsal and recomended massage, softer running surfaces, and cushioned inserts. That is when I got my Sorbothane inserts. Seemed to do the trick. Whenever I start to feel pain there I do less road work and wear different shoes, particularly the ones that currently have the inserts.

It's quite likely a stress fracture, although as Tim's story points out, there can be other causes. You should stop running on it RIGHT AWAY and find out for sure. I've had a couple of these. The only cure is 6 weeks of rest. Sorry dude.

Veteran runners are lucky to have any toes at all after a few years of running in badger country. So there's one possibility! Strike the toes, strike the metatarsals. I hope you're decked in green from head to toe and looking basically like a very large frog, as befits the day!

Sounds like it could be Morton's neuroma. Inflammation of the nerve in between the metatarsals. I've had it off and on. Stretching the toes is helpful, as is staying away from shoes with a tight forefoot.

stopped running ten days ago :( first doctor didn't give me any info, just told me to rest a bit. yesterday's medical opinion of the day was nothing is broken/fractured and it is most likely damaged ligament. directions are not to run until pain is completely gone (timescale unknown), and restart easy. looks no running this side of easter at the rate things are going. grrr.

on the plus side, with sunshine and temperatures of 15-20 degrees (centigrade!) sunbathing is quite enjoyable. spring has sprung at last.

thanks to all who replied!

I thought they always prescribed ice cream for tarsalitis.

neil, do you always get your medical diagnoses via attackpoint? what do you use to get advice on mathematics? a frequent flier bulletin board, maybe? :)

we don't need prescriptions for ice-cream over here. has ashcroft been cracking down on pleasure again?

will, who says i need advice on maths? and in any case, good mathematicians are always flying off to conferences or beaches or orienteering competitions, so it mightn't be a bad place to look ;p

Sounds like you may have bruised the head of the metatarsal. Our old copy of the "Runners' Repair Manual", describes your symptom. If you bend back the toes, the area of real hurt should be located by pressing on the spot. It could be callused, bruised or inflamed if it hurts when you press on it. Treatment is to put a 1/4" thick pad of felt or sponge rubber right behind the head. The idea is to elevate any prominent metatarsal (this could happen to several) and take the pressure off. Once you identify the location, tape the pad to the foot. Long term do exercises to strengthen the metatarsal arch - pick up towels/pencils/marbles with your toes.

If it is a neuroma as Charlie suggested, you can relieve the pressure using the pad idea but the problem is a bundle of nerve endings whose coverings or sheath has become inflamed and irritated. Treatment is icing, padding and proper shoes.

Again all this comes from our copy of the book which may be dated but hopefully the suggestions might be helpful. Good luck.

regarding x-rays...
most stress fractures don't show up on x-rays. you need a significantly large one (almost hairline) to see it with a simple radiograph. the gold standard for stress fractures has been a bone scan with SPECT, although some radiologists are now pushing for MRIs to look for related soft tissue edema. as always, time is best medicine