INJURY - RECOVERY AND MORE INJURY

"I have not been able to run for almost three months now with the ball of foot pain, sort of like a neuroma. I went to a physio and the thoughts were that it is not a neuroma and not a stress fracture. It remains a medical mystery. I had severe pain under the second metatarsal joint and paralysis of that toe. The whole thing started with a lot of arch pain and then settled into that extreme metatarsal pain. I have minimal arches to start with. The fifth metatarsal is also a bit sore, but not nearly as extreme."(Lynn)

From this statement starts one of the topics on the Pose Tech Running Forum. Taking this statement with understanding and sympathy forum's participants came up with lots of different approaches going from a simple advice: "Walk, first. Short distances every other day, gradually build up to longer distances...(rru2s)," to a complex explanation: "When you return from any injury that has not allowed you to bear full body weight for some period of time - severe sprains, stress fractures, fractures - you must recondition the ligaments, tendons, muscles that support the skeletal system. Normally, the bone heals fine and in a stronger condition. It is not the bone that is a problem but the supporting muscular system." (Jack) to sharing own experience: "I have had this problem in the past with the same 2nd metatarsal and it requires 6 months of wearing a donut pad under that metatarsal with activity, icing as needed, and wearing flat shoes whenever possible; Cushioned shoes will actually exacerbate the problem by allowing the metatarsal to remain in the undesirable dropped position." (Jeff)

So where is the solution to the problem? There is a lot of opinions, points of view, desire to help and advice, each having its own merits and usefulness, each full of good intentions, but at the same time they are conflicting and uncertain.

Perhaps the most difficult part, besides the pain itself, is Lynn's frustration from her incapability to run conflicting with her desire and passion to do so. And we have to come up with something valuable and helpful to bring her back to running not knowing exactly what we are dealing with.

In this case the best way (not the radical one) would be to give the foot some rest by changing activity to such one which would not involve the foot into the weight bearing process, such as swimming, strength exercises for upper body, etc. Simultaneously with that you can start exercising the foot by local strength exercises, and also use massage and physiotherapy.

Later you can gradually increase the load on the foot by using different kinds of resistance (free weights, rubber bands, partner's resistance, etc.) and medicine ball exercises with progression to standing on one leg (balance) and then slight bouncing and moving to some hops in place, jumps with a rope and finally running.

This kind of progression requires lots of patience and discipline, focus on small details and perception of the movement and function of the foot. Yes, it probably sounds very long and boring, but it is safe and reliable treatment.

Dr.Romanov