Metatarsal pain

[linds]

For a few weeks now I have had pain/altered sensation in the centre of the ball of my right foot, directly behind toes 2 and 3. It feels like there is a stone in my shoe when i walk and also get a burning sensation. It is not resolving. The only thing i can attribute it to is a single spin class that i did with runners on rather than usual mtb shoes but i think it might have pre dated even that by a bit.
Interested in anyones experiences of this kind of thing. Google search seems to suggest it is metatarsalgia...
I now havent ridden for a couple of weeks thinking that rest will help...but not so far.
Thanks

[trailgumby]

Could be a bursa. Get thyself to a physiotherapist and get them to order some ultrasound scans.

[ValleyForge]

If there is a trigger point and the sensation of electric shocks the the classic cause is a Morton's neuroma. Commonly diagnosed,but seldom found... A high resolution soft tissue ultrasound to begin with. Some home made insoles that unload the metatarsal heads are a start.

[grantw]

i had a neuroectomy on my left foot a couple of years ago for morton's neuroma, you'd also be getting shooting pain into your toes if you were unlucky enough to have that condition. Make sure your shoes are wide enough across the ball of your foot. lateral compression in the shoe is a big cause of the pain whether there's a tarsal button or not.

[linds]

I went to a podiatrist who sent me to get an ultrasound.
Apparently I have a bursa between metatarsals 3 and 4.
I have been wearing shoe inserts with padded contouring added to unload the area around the bursa.
I ice it each night and apply topical anti inflammatory.
The perception of the marble in the shoe has gone.
The ball area remains sensitve but gradually improving.
Looks like conservate management will be effective.
The alternative was an ultrsound guided cortisone injection which is apparently very effective..but I declined that.
Now heading off on a few weeks holiday without any cycling....hoping it will be fully resolved by the time i get back.
Already looking fwd to getting back into training and setting goals for the warm season.
Thanks for the helpful replies.

[ColinOldnCranky]

I went to a podiatrist who sent me to get an ultrasound.
Apparently I have a bursa between metatarsals 3 and 4.
I have been wearing shoe inserts with padded contouring added to unload the area around the bursa.
I ice it each night and apply topical anti inflammatory.
The perception of the marble in the shoe has gone.
The ball area remains sensitve but gradually improving.
Looks like conservate management will be effective.
The alternative was an ultrsound guided cortisone injection which is apparently very effective..but I declined that.
Now heading off on a few weeks holiday without any cycling....hoping it will be fully resolved by the time i get back.
Already looking fwd to getting back into training and setting goals for the warm season.
Thanks for the helpful replies.

Glad to see the unknowns are now known. While members here are all willing to offer advice, in matters like this is pays to seek specialist advice. Good luck with it.

Metatarsal pain never made sense anyway. Metatarsals are on the top of the foot. Metatarsal pain has been an almost daily experience for my last 35 years.

[Baalzamon]

A metatarsal bursa forms in the foot due to too much pressure on that area. I had 3 bursa in my left foot and 2 in my right. I was getting shooting pains from nerves being compressed. Root cause of my bursa was my flipping orthotics. They had a roll in them that pushed my natural tracking off my big toe and towards my 2nd toe.... Since gotten other orthotics from a physio partnered with a canadian podiatrist and my problem has since been fixed.

[CKinnard]

A metatarsal bursa forms in the foot due to too much pressure on that area. I had 3 bursa in my left foot and 2 in my right. I was getting shooting pains from nerves being compressed. Root cause of my bursa was my flipping orthotics. They had a roll in them that pushed my natural tracking off my big toe and towards my 2nd toe.... Since gotten other orthotics from a physio partnered with a canadian podiatrist and my problem has since been fixed.

that would have to be gaitscan. can you tell what model you got, and any additional custom additions they included. and price?
podiatrists in my neck of the woods are charging anything from $400 to $800, and often prescribe hard stiff orthotics when more flexible are required.
We charge $395 for gaitscan orthotics.
My issue with gaitscan orthotics is if the customer isn't happy with them for whatever reason, the administrative overhead is a pain (sending them back to Canada for modification, and associated cost).

[CKinnard]

I went to a podiatrist who sent me to get an ultrasound.
Apparently I have a bursa between metatarsals 3 and 4.
I have been wearing shoe inserts with padded contouring added to unload the area around the bursa.
I ice it each night and apply topical anti inflammatory.
The perception of the marble in the shoe has gone.
The ball area remains sensitve but gradually improving.
Looks like conservate management will be effective.
The alternative was an ultrsound guided cortisone injection which is apparently very effective..but I declined that.
Now heading off on a few weeks holiday without any cycling....hoping it will be fully resolved by the time i get back.
Already looking fwd to getting back into training and setting goals for the warm season.
Thanks for the helpful replies.

because you are doing several therapeutic interventions at once, it's not a certainty the bursa are causing your pain.
bursa rarely feel like a stone.
It's more likely metatarsalgia.
Ice helps this significantly as does wearing shoes with broader softer toe boxes.
Also get some solid massage into your calf muscles, plantar fascia, and upper and lower foot tendons to take load off the metatarsophalangeal joints.
Low Dye taping with padding under the tender area can also help.

[linds]

Back from a 3 week holiday - unfortunately the problem has not resolved. I slacked off with the interventions part way into the trip as the padded contouring lost its effectiveness and I ran out of tape. Wearing a good supportive show like my Keens certainly feels better that shoes with less support and lots of space around the toes. Not sure how to proceed now. The podiatrist showed me how to tape the foot and this seemed to help - perhaps I will start this again, go see her again I suppose p may also get the opinoin of a local osteopath who is a keen cyclist and does professional bike fits. I went for a ride a few days ago - first for about 9 weeks - didnt feel too bad in the bike shoes actually. Thanks everyone for the replies so far.

[linds]

About 2 weeks ago I went to a local natropath/masseur for a massage and happened to ask him his opinion on my bursa. Interestingly he gave me the exact opposite opinion to the podiatrist and physiotherapist. After a physical examination pushing firmly into tissue, pushing and twisting toes to locate pain and therefore the extent of the inflammation site he gave the following advice. There is no sign of trauma, no skin break, no external injury. Therefore it is a minor inflamation. Generally with minor inflamation of joints and flexible areas, according to him, it is best to keep them moving and used - quite the opposite to the podiatrist who wanted to protect the area by unloading the site and putting my foot in new shoes with very think inflexible soles. He recommended walking around in soft soled shoes and / or bare feet, squats that put weight through the ball of the foot in a stretched position and continued icing but not heat. Given that the inflammation had not improved on the podiatrists plan at all I decided to take his advice. Result - in a few days the foot felt better than it had for months and now it is almost fully resolved. I am not limping, am not avoiding any activity at all. So I can avoid the whole expensive guided steroid injection path and everything that would have led to - ie repeats of the same every few months. Now it may be that the injury was ready to sort itself out, but my opinion is that his suggestions triggered the recovery. In any case - very happy!

[foo on patrol]

Foo

[silentC]

Interestingly he gave me the exact opposite opinion to the podiatrist and physiotherapist

Not really any surprise there, since Naturopaths are typically anti-mainstream medicine.

However in my own experience, he is probably right in that restricting movement often seems to either not help or make things take longer to heal. In my case, my metatarsal pain is further back towards the arch of my foot, around the bony protuberance on top of the foot. I went to a physio and he diagnosed a lefranc fracture, which is damage to the hard tissues around the joint. He put me in a moon boot and gave me some exercises, which included hopping on one foot, but that I simply could not, still cannot do.

I happened to go to a GP while wearing it and of course she asked me about it. When I told her, she said that restricting that type of injury is pretty much outdated treatment these days and allowing the joint to move is the best way. So it's not just the quacks saying it

My next option is to try the podiatrist, which I will do soon. I don't have much faith in alternative medicines I'm afraid. Especially things like naturopathy and homeopathy. But if they work for you, that's great.

[CKinnard]

You have to take into consideration the naturopath/masseur's clinical experience.

I could list a dozen conditions I see every week where his advice would be absolutely wrong.
i.e.
subacromial or trochanteric bursitis. Both need to be rested, and often the only thing that settles them are cortisone shots.

The guy is presumably talking from his own experience, however extensive that is....and not that of any of hundreds of medical and pathology texts.
Further, inflammatory conditions should ALWAYS be immobilized in the acute phase. This is no doubt the reason naturopathic advice isn't given by ambulance.

If you got relief from moving it, then the inflammation has probably settled, and it may have been irritated adhesions perpetuating pain.

[grantw]

That's interesting advice from the naturopath and conforms to my experience. My neuroma and bursitis was a direct result of restricting and compressing my foot (mostly super tight rockclimbing slippers and some other poor shoe choices along the way). I had to have surgery on the neuroma but the bursitis is still there and much relieved by walking about barefoot or in soft and loose footwear.

[CKinnard]

The other pertinent point re the conflicting advice from the naturopath/masseur is that he didn't assess or treat it at the same time as the physio and podiatrist. Inflammation is worst when acute, and settles over time. In the early stage, ice and rest are the defacto standard. As inflammation settles, movement becomes more appropriate, as long as it is gradually ramped so as not to kick off more inflammation.

Ignorance about how therapy changes over the course of a disease drives a lot of patient criticism and misunderstanding. Further, clinicians invariably have to deal with poorly articulated and inconsistent explanations from patients, which often leads to variable advice between clinicians.

[Baalzamon]

A metatarsal bursa forms in the foot due to too much pressure on that area. I had 3 bursa in my left foot and 2 in my right. I was getting shooting pains from nerves being compressed. Root cause of my bursa was my flipping orthotics. They had a roll in them that pushed my natural tracking off my big toe and towards my 2nd toe.... Since gotten other orthotics from a physio partnered with a canadian podiatrist and my problem has since been fixed.

that would have to be gaitscan. can you tell what model you got, and any additional custom additions they included. and price?
podiatrists in my neck of the woods are charging anything from $400 to $800, and often prescribe hard stiff orthotics when more flexible are required.
We charge $395 for gaitscan orthotics.
My issue with gaitscan orthotics is if the customer isn't happy with them for whatever reason, the administrative overhead is a pain (sending them back to Canada for modification, and associated cost).

yep gaitscan. Phsyio then sent 3d model off to canadian podiatrist mob who then form the orthotic. Was with Activate Phsyiotherapy and I was charged think $380 but got most of that back with Medibank PVT
Funny tho, my previous podiatrist gait scanned me and didn't pick up on the issue! Looked at my history of scans and sure enough you could see the tracking moving off the big toe onto the 2nd metatarsal head which caused all my issues. I still get the odd twinge in my foot, nothing tho like the nerve pain I was getting where sometimes I would jump from the searing pain.