Active Community: Message List - Foot pain... stress fracture? See pic...

Re: Foot pain... stress fracture? See pic...

guest — Thu, 18 Aug 2011 22:15:26 GMT

Here's an update. After the half marathon, I took off a few weeks because of this foot issue. Then I had an attack of torticollis, which prevented me from running for another week.

By then, the foot pain was gone... it healed up apparently.

I ran M W F, then again M W, then this last weekend participated in the Spokane To Sand Point Relay (http://www.spokanetosandpoint.com). My three legs of running added up to 12 miles. The foot was fine, no indication whatsoever of any trouble.

So, I think - and hope - this is all resolved.

Re: Foot pain... stress fracture? See pic...

guest — Thu, 18 Aug 2011 21:47:50 GMT

Even though your symptoms in your foot do not qualify as classic stress fracture symptoms, I would still be cautious. The spot you point to is fairly common as far as where a 4th metatarsal stress fracture shows on bone scan.

Re: Foot pain... stress fracture? See pic...

guest — Tue, 26 Jul 2011 00:48:05 GMT

Hi James,

Thanks for the info!

Torticollis is the closest thing I could find to what I experience... this started a few years ago and happens about twice a year. Usually this happens in the morning after getting up and showering. I'll feel something akin to shocks shooting through my neck muscles and through the muscles that run down my back parallel to the spine. This usually takes just a few seconds and will consist of about a half-dozen pulses of shock. These "shocks" seem to cramp up or "spasm" small strips of muscle. These will then be very painful if any stress is put upon them and take a few weeks to heal. For example, right now, just walking upright puts sufficient stress upon the muscles in my neck that I walk with a tilt to my head to compensate - i.e., to lessen the pull on those muscles. It's very painful. Even moving my head in my sleep causes a sharp pain that wakes me up. I suspect that it may have something to do with dopamine, and I'm trying to get in to see an MD specialist for evaluation.

As for the foot thing, it's much better now (about a week since my original post), and I do suspect it may have been a touch of tendonitis or other soft-tissue stress. While this bout of torticollis is a royal pain in the neck - literally - it's given me extra time to rest my foot.

Re: Foot pain... stress fracture? See pic...

guest — Mon, 25 Jul 2011 22:09:06 GMT

First, congrats on your Half, although it appears you have paid a steep price in pain. I want to second Jim's comments above on your foot, but have to ask you about your neck, since it is bothering you enough to stop you from running.

By "torticollis," are you referring to a true "wry neck," or just stiffening of the neck that prevents normal movement. There can be different causes for the condition and different "cures" to match, but stiff or twisted necks are pretty easy to find out there, and often due to postural issues during work (common), sleep (also common), while sitting watching tv or computer (all too common), or the occasional muscular strain while reaching or lifting overhead (less common but can produce a nasty case of it). The rarest forms involve nerve compression or other neurological and spinal causes that may be simple or difficult to treat. If the average chiropractic adjustment does not make it disappear (could make it worse), it is probably more complicated.

A patient of mine in his mid-eighties, who was a hurdler in college, had gotten used to his head being tilted to one side. We often see this in the elderly, and it is often due to accumulated stresses or lifestyle issues that gradually take their toll. In his case, the unequal stress of taking hurdles with the leading leg so many years ago had probably caught up with him. In a few minutes on my table I had straightened his neck again by working on his chronically tight Sternocleidomastoid muscle, which can easily pull the neck to one side. He was greatly relieved.

I've had a case of my own lately that might not be true torticollis, but prevents me from turning my neck from side to side or moving it rearward. I can solve it in seconds my placing my fingers in the groove between my collar bone (clavicle) and upper Trapezius muscle, and probing for tender spots underneath where the Levator Scapula and Posterior Scalene muscles can be found. Instant range of motion, but I hurt this area so bad when I was hoisting a 24' ladder overhead, that the problem returns intermittently. It will eventually go away after the muscles have fully recovered from the strain.

In cross section, you can see how much of the mass of your body is represented by muscle tissue that is rich in sensitive nerve endings. It doesn't take much for a little pain somewhere in all this meat to spread throughout the area, even though the pain is often blamed on comparatively tiny structures like the neck bone (6th cervical) that you see at right center. This is a recurring theme when symptoms are discussed. People are curiously slow to notice the 800 pound gorilla in the room. ..

About your foot, there is a muscle in the region highlighted in your photo, called the Extensor Digitorum Brevis, that can produce cramps in the toes and pain in that area because of its sensitivity. Activate the muscle by extending your toes upwards with your foot flat on the floor as depicted. If you place a finger on the area in your photo, you can feel it flex when you do this...

While the pic from Gray's partially obscures the Extensor Digitorum Brevis with the superficial Cruciate Ligament, the muscle begins way back at the heel bone, extending underneath the Peroneal tendon sheaths, on its way to the toes. Because of this, its pain symptoms range from the toes to the area you describe. Swelling in these muscles can actually widen the foot so shoes seem tighter than they really are. Restrictive shoes (based on your photo, I think yours may be too tight) stifle circulation in these muscles and irritate them. They also prevent the natural motion of the muscle to lift the toes with every footstrike. Look for a longer, wider shoe with a roomier toe box and better flex in the sole (it should have special "flex grooves" to promote this movement).

Another muscle underneath the EDB that travels from the heel along the base of the foot to the little toe, is called the Abductor Digiti Minimi. You can activate this muscle by spreading your toes outward, where its action to "abduct" the little toe to stabilize lateral motion of the foot comes into play. One important symptom of strain in this muscle is feelings of ankle sprain that show nothing on x-ray or mri. The pain pattern even more closely matches your description, even extending rear to the heel. Pressure from the muscle may cause some of the discomfort that begs "popping."

Be careful, when massaging these muscles, not to irritate them further. Avoid wearing elevated shoes or notoriously unstable shoes like flip flops, although there are probably a number of well-constructed, supportive exercise sandals that may give them relief.

Re: Foot pain... stress fracture? See pic...

guest — Mon, 25 Jul 2011 16:01:13 GMT

Thanks for the feedback. By bruising, I mean discoloration.... it was kinda reddish brown, then kinda green, but the discoloration is gone now.

I haven't run now for 2 weeks (since the half).... and think this is probably healed up now.... probably just a flesh wound. Another medical issue is keeping me from running now, so this has kinda gone to the back-burner as far as ailments go.

New problem is torticollis... not running-related, but any movement causes great pain, so I won't be able to run probably until later this week at the earliest. Oh well, at least it's forcing me to stay off the foot!

Re: Foot pain... stress fracture? See pic...

guest — Mon, 25 Jul 2011 13:57:03 GMT

I'm going to guess (I don't have any medical training) it's not a stress fracture. From what I understand stress fractures tend to have increasing pain as an activity goes on. So if you said it feels fine when I get up but hurts more as time goes by - then I might think stress fracture. Pain upon initial movement after long periods of non-movement (i.e. sleeping) which then feels better sounds more like a tendonitis or other soft-tissue problem. The area where you're having issues is generally where the Peroneal tendons run. Maybe you've got some tendonitis. It's a little hard for me to tell from the pic but when you say "bruising" is there discoloration or just swelling? If just swelling that points even more, in my opinion, to tendonitis. If there's discoloration - that would lead me to believe something more like a sprain, but I assume you didn't have any sort of traumatic event, especially since it felt OK right after the race.

Rest and ice seems in order. If it doesn't improve over a few days I'd probably go to a podiatrist and see what a pro has to say.

Good luck.

Jim

Foot pain... stress fracture? See pic...

guest — Thu, 21 Jul 2011 17:17:18 GMT

A few weeks ago I ran my first half marathon. The rest of that day, and all the next day, my foot felt fine. However, that 2nd night after, my foot started feeling like it needed to be "popped" or "cracked" like a knuckle.

So I started wrenching on it, trying to pop it, but no, no pop. It started to hurt though. The days after that, it was fairly painful to walk on. Even now... 11 days after the half, when I get up in the morning it's a sharp pain when I walk, but the pain goes away after a short time, maybe 10, 15 minutes after first walking on it.

After about a week, I noticed that I had bruising on the side of my foot. In the picture below, I've indicated the bruising - not very heavy bruising, but enough to notice. The purple X indicates the focal point of the pain. When this first started, if I pressed there, it would hurt, but now it doesn't. When the pain was the worst, it felt fine to walk tippy-toe, and I'd do that to get up stairs. The pain comes mostly when I stride, flexing the foot while bearing my body weight.

So..... could this be a stress fracture? If not, what else? I'm thinking I'll stay off of it a few more days, to make it 2 weeks since the half before running on it again, and see how that feels.

And yes, the left half of my big-toe nail is black and has been for a few months from something else entirely.

Thanks in advance for any tips, etc.