Experience From - Dave Combs , Tim Jantz ,

Dave Combs

Deb R wrote:

"A friend who is a new runner began experiencing pain on the bottom of the forefoot, behind the middle toes. It hurts to bend the toes upward, and of course landing on the foot in running stride causes the pain. The pain is worse when first stepping out of bed in the morning. No pain to touch, just on the motion of landing, walking or running. No swelling evident, and no bruising, but enough discomfort to prevent running. Can this be plantar fascitis (sp?) (the morning pain is suggestive, but I never heard of PF causing pain in this area of the foot.) Any suggestions?"
This sounds like one of two things--either a neuroma or perhaps bruising of one of the metatarsal heads, perhaps a stone bruise. If it hurts just to stand quietly for 10-15 minutes, sounds like a neuroma. I hope not! Does your friend wear thin/lightweight shoes with little cushion in the forefoot? Or do they pronate excessively?

Tim Jantz

It would be very unlikely for your friend to have pf up at the ball of the foot, though not completely unheard of. after all the plantar fascia does terminate by attaching to the base of the toes, and nite splints which are used for pf often come with toe wedges to accentuate the stretch of the pf by dorsiflexing the toes. but as a new runner the possibilities are vast. a neuroma would cause pain if squeezed between the metatarsal heads from top to bottom between the thumb and finger, also possibly shooting pains into the toes. a feeling of numbness of the toes or the feeling like your sock is wrinkled but isn't upon inspection is also a common complaint with the diagnosis of neuroma.

A long metatarsal or excessive pronation can irritate the structures surrounding the joint/metatarsal head.

The usual suggestions apply: nsaid's if tolerated, cushioned shoes, ice or heat, gentle massage, check running shoes for wear, check biomechanics (exessive pronation...), time, cross training.