Foot Pain After Marathon

author : AMSSM
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Member Questions

I've been trying to figure out what is up with my foot. I ran my first marathon on Oct 21st. The run was in Vibrams which has been the only shoe I have run in for as long as I have run (two years). Admittedly, I could have probably used one more long run as my longest run before the marathon was only 17 miles when I was hoping to get up to 18 miles beforehand. Other than that I felt well prepped for my first marathon. 

Since the marathon I have kept my mileage down with only five real runs since then (2.5-4 miles) with one mile runs and trainer rides on the other days. I expected to hurt after the marathon, and I did but there was nothing that I was immediately alarmed about other than some pretty decent swelling in my right ankle/foot for a day or two after. I wasn't super concerned because my other ankle was also swollen - just not as much. Since then, the foot pain that popped up after the marathon has not really gone away. 

The pain: It's very localized on the bottom outside area of my right foot, behind the ball area but in front of the heel area. It gets better with icing and worse with running anything over three miles. There is no pain if I push on the "knuckles" of the metatarsals on top of my foot. Whenever the pain is acting up, the area is sensitive to pressure. The best way I can describe the pain is that it feels like a lot of tension. It feels like there is something in my foot that has been cranked too tight in that one area. 

Only thing that I have come up with is a stress fracture, but I've never had one before so I have no clue what they feel like. Any thoughts?

Answer from Vijay Jotwani, MD
Member AMSSM 

Dear Runner:

Thanks for your excellent question.  I agree that the primary concern for the symptoms you mention is for a stress fracture, although a full examination by a sports medicine physician will help to determine that you are not suffering from a different overuse injury, nerve entrapment or alternative diagnosis.

Stress fractures are a common but unfortunate injury to active athletes.  The injury occurs when a bone is put under repetitive loading which exceeds the body’s ability to heal itself.  There is a spectrum of disease ranging from a stress reaction where the bone is irritated but not broken to a stress fracture where microscopic breaks are found within the bone.  If this process persists one can develop a full fracture through a bone.   

Patients will complain of the gradual onset of sharp, aching, and sometimes burning pain which is present with activity and can progress to pain at all times of the day.  The pain will be located on or near a bone although touching the area does not always reproduce the pain.  Stress fractures often occur when someone has significantly increased their activity such as when making a jump in running mileage. 

A physical examination may show tenderness over a specific bone.  I will apply a tuning fork to the affected area during the examination as the vibration will cause movement of those microscopic bone edges and cause sharp pain during examination.  X-rays will not always show an acute stress fracture but may show the signs of bone healing in a stress fracture that is resolving.  Both a bone scan or MRI are useful tests to look for stress fracture or stress reactions within the bone. 

It is important to evaluate for the possibility of the female athlete triad, the combination of disordered eating, infrequent or lack of periods, and fractures, in female’s with stress fractures.  If this syndrome is occurring, it is important to improve nutritional intake and see a physician for other possible treatments. 

The ultimate treatment for stress fracture is rest.  Sometimes a walking boot or cast may be used to allow maximal rest and allow the fracture to heal over a period of 6 to 8 weeks after which an athlete may gradually return to activity.  Certain fractures may require surgery for fixation.  Correcting any biomechanical factors noted on the exam would be important to keep this injury from recurring.  Keeping a diet high in calcium would be prudent during the healing process. 

I hope that you begin to feel better and can get back to running as soon as possible.  I would urge you to have an evaluation by a sports medicine provider if you are not improving quickly.

Best of luck. 

Vijay Jotwani, MD

Primary Cares Sports Medicine

The Methodist Center for Sports Medicine

Houston, Texas  

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date: December 18, 2012

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AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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avatarAMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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