Member Case Study: Post Marathon Foot Pain

author : AMSSM

comments : 0

Ever since running that marathon I have been experiencing stiffness and discomfort in my left foot, from the fourth and fifth metatarsals to about my mid foot.

Question from 9FAITH
I am male, about 188lb. I have been an avid runner for the past two years. In 2007 I ran my first marathon in Chicago. I came in at about four hours. Ever since running that marathon I have been experiencing stiffness and discomfort in my left foot, from the fourth and fifth metatarsals to about my mid foot (dorsal aspect).

This also radiates from my fifth metatarsal (pinky toe) to the left lateral foot. I do not have issues with weight bearing, but I often feel a tightness or stiffness in this region. I have no point tenderness or swelling. My doc performed an x-ray and saw nothing. I have since laid off running for about six weeks and I have focused on swimming and biking. I do not have issues or discomfort while swimming, but I do now in biking. I usually feel the discomfort or stiffness three to four hours after biking, just as I did after running. As a critical care nurse I am on my feet a lot, and I often have to ice it frequently. Could this be a tendinosis of the foot?

Question from Anthony Lattavo, D.O.

Member AMSSM

Tendinosis is a common running injury, and it can behave in several different ways. It is often insidious in onset, with pain and stiffness that subsides during a run but returns and worsens afterward. Sometimes, however, it begins more suddenly and gets progressively worse during a run. An extended period of rest, as you have tried, may eradicate the pain, but it often returns shortly after the runner begins training again. However, the pain can usually be localized fairly easily because the injured tendon is tender, swollen and/or thickened, and provocative maneuvers reproduce the pain, such as passively stretching the tendon or contracting the tendon’s muscle against resistance.

Your pain sounds more poorly localized and difficult to reproduce. Perhaps your pain is stemming from a nerve problem, such as an interdigital neuroma (a swollen nerve between the metatarsal bones) or an entrapment of one of the nerve branches in your lower leg or foot. Pain from these conditions can often be relieved by modifying your footwear and/or using an over the counter shoe insert or custom orthotic. I suggest you revisit your physician with the goal of establishing a more precise diagnosis. You may also need a detailed evaluation of your lower extremity biomechanics to detect a correctable abnormality.

Anthony Lattavo, D.O.
Grant Medical Center, Columbus, Ohio

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date: May 12, 2008