Fall is officially upon us. November is here, and Thanksgiving is right around the corner. But before NYC’s time-honored tradition of parading through the streets of Midtown, New York City spends its first weekend in November hosting the famous NYC Marathon. In honor of the upcoming New York Marathon (Nov 4th) let’s talk about foot pain!!

An oft felt and rarely defined malady of many runners is Metatarsalgia. This ailment is defined by pain and inflammation in the ball of one’s feet. metatarsalgia Is caused by one bone in the foot (the metatarsal) pressing on another bone resulting in a painfully pinched nerve. As you can imagine the respective motion of a foot striking pavement for 26.2 miles can certainly exacerbate this condition. This ailment is not restricted to runners. This condition can be present in anyone and can be aggravated by simply standing up in the wrong way.

This condition is usually brought on by overuse. This, in turn, means that metarsalgia is not a sudden or acute ailment, but rather it is brought on and worsens over time. Before the onset of this condition, there is often a shift in the way a runner or athlete will distribute his or her weight. This may cause some slight discomfort at first, and naturally; our bodies adjust to deal with the pain. Unfortunately, this continues to throw off the weight distribution, irritating the problem further.

Do not fret! We are not left without hope. First and foremost you need the right tools. Any craftsman will tell you he is only as good as his tools. Footwear is a runner’s tool and must be custom fit to your needs. No two feet are alike so a personal assessment is crucial. Take the time to measure each foot, assess the pressure you put on the balls of your feet and think ahead to the type of area you will likely spend the majority of your time.

Common Causes of metatarsalgia

Shoe Size

Shoe size is defined as “The length of a person’s foot is commonly defined as (a) the distance between two parallel lines that are perpendicular to the foot and (b) in contact with the most prominent toe and the most prominent part of the heel. Foot length is measured with the subject standing barefoot and the weight of the body equally distributed between both feet.” (Wikipedia) The second part of this definition is crucial for a runner; size needs to be measured while standing barefoot with weight evenly distributed. As we’ve discussed Metatarsalgia begins with an unequal amount of pressure on one point of the foot. This pressure builds and causes the bones to pinch the nerve. This is more likely if you don’t have a good feel for your weight distribution from the beginning.

Predisposed to Pain

There are a few factors that increase the likelihood of suffering from Metatarsalgia . High arches, Morton’s toe, and Hammertoe are all contains that can lead to pain. Those with high arches have an “excessive fixed flexion”. Flexion is the opposite of extension, so the arch remains static and immobile. This causes excess weight to be distributed to the balls of the feet instead of equally distributing, as you foot normally would. Morton’s toe is a condition concerning the size of the bones in the foot. There are five metatarsal or foot bones in your foot. The metatarsal bones are located in the middle of your foot, starting where your toes end. Morton’s toe occurs when the first metatarsal (your big toe) is shorter in comparison to you second metatarsal (second toe). Weight is normally distributed evenly with the big toe baring much of the load. But Morton’s toe causes this weight to be shifted to the second toe causing pain and callousing in the balls of the feet.  Finally, Hammertoe results from an excessive bending of the second, third, or fourth toe which shortens the muscle and eventually causes the toe to bend permanently. This bending action causes weight to be distributed unevenly, resulting in or aggravating Metatarsalgia .

Surfaces

This is likely the hardest to control. Most runners run outside striking their foot on pavement time and again. With time this repetitive action can cause joint pain back pain knee pain hip pain, and most of all corrections for these pains can cause additional pressure on one’s foot causing foot pain. Running on a track or a treadmill may help, but they are not guaranteed to alleviate the pain.

Treatment

We have come full circle to a runner and his tools. Footwear selections are vast and varied, but there are a few key things to look for if you are suffering from Metatarsalagia.

1. Arch Support- The function of the arch is to provide space for the soft tissue that contains elastic in your foot. These soft tissues act as a spring. It is vital to support the arch or your springs will wear out far more quickly and cause pain as they do.
2. Inner Sole- Whether you choose to have a custom-made orthotic or stick to what’s already in the shoe, the inner sole can provide much-needed support to prevent or comfort to ease Metatarsalgia. If you have a custom inner sole make sure you have it with you to try on with your sneakers. Never guess or decide a half size bigger will adequately accommodate your needs. Wearing a shoe that is too big brings just as much damage as a shoe that is too small.
3. Breathability- A breathable shoe allows for optimal airflow around the feet. This is essential in both combating pains and in protecting the foot from other problems such as fungus.
4. Shock absorption – The goal is to find and alleviate stress put on the balls of the feet. In doing so we must concentrate the shock of a foot hitting the pavement repeatedly in some other place. The rubber on the outsole provides this. Many shoes use the same rubber as tires to ensure both durability and shock absorption.
5. Size (fit)- It is imperative to check your shoe size each time you buy a new pair of shoes. Our bodies change each day and though there may not be a significant change in size over time even an 8th of an inch (a half size) can make the difference between pain and fun.

This may seem like a daunting list but it is worth the extra effort! Shoes like Sketchers and Birkenstock’s are excellent everyday shoes that check all the boxes in getting rid of the pain. Shoes geared towards Health care workers could be the answer you are looking for.  Whichever shoe you are looking for and ultimately decide upon, remember shoes are much more than a simple adornment or even protection. Properly fit shoes can improve your gate, your posture as well as your marathon time. Know your feet. Measure your arch. Try on as many shoes as you need to find the perfect fit for you in your battle against Metatarsalagia.