Question
Two months ago, I began having pain in the top of my left foot- near the 4th-3rd metatarsal area. Pain is more midfoot than towards the toes and there is no point tenderness and if there is swelling, it's minimal.  It occurs after rest- particularly after I have been exercising. I was relatively active until mid-March when I got really annoyed with the issue and gave up everything except for 2-3x weekly soccer games (subbing out as much as possible) in an effort to get it to go away. I iced and took some anti-inflammitories as well. I managed to get it to mostly dissipate for about 2 days... then went snowboarding for about an hour one day and it was back with a vengeance. I finally went to a podiatrist last week, convinced that it was an old injury (fractured metatarsals 2-4, requiring k-wire fix) turning arthritic and preparing to start an entirely new workout of nothing but biking and swimming. I'm 31 so I was kind of bummed at that prospect, but wanted to make sure that was the issue before I completely gave up activities on my feet. Pod surprised me by saying there didn't appear to be any relation to the old injury. Instead, he thinks it's the way my heel turns when walking that is putting pressure on the midfoot joint. He recommended orthotics. I was skeptical (I usually am...)  I've never had this sort of foot pain other than breaking it. A PT friend of mine says I should try that route first- though I know my calves/achilles are tight and I stretch constantly because of it. I guess I don't understand exactly why the way my heel turns makes my foot hurt. And if that's the case, why doesn't the right foot hurt? If I go the orthotics route, how long does it take to get adjusted to them and to get this issue to go away so I can start running without fearing the after-effects?

Answer
Hi CP,

Foot orthotics help to realign the foot and support the weakened foot structure.  When the heel turns in this causes pronation which is an inward position of the foot.  This leads to unlocking and instability of the joints causing increased metatarsal and midfoot stress.  So in this case an orthotic would help.  Usually this pain would come on gradually and over several months will improve with the orthotic device.  However, if you are having significant pain and some swelling there may be more happening.  I would seek another opinion and consider an MRI if x-rays are negative.



Sincerely,

Marc Katz, DPM
Tampa, FL
Advanced Podiatry
http://www.thetampapodiatrist.com
http://www.tampacryosurgery.com
http://www.notoenailfungus.com

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