Metatarsal Pads and other Foot Woes

[Timothy Reynolds]

Sheesh… Maybe I'm getting old but my feet are in trouble. I wear New Balance trail sneakers with Superfeet insoles, and after a bunch of big hikes over the last year I've been plagued with Plantar Fascitis and since my last outing in March I've a pinched nerve under the toes of my right foot. The podiatrist has recommended generic softer insoles and metatarsal pads.

But, what would YOU recommend, considering weight and comfort, rough trail conditions, rain, and distance? Store-bought Dr. Scholl's ain't gonna cut it.

Is it worth changing my footwear to a heavier, more "shock absorbing" shoe? (Once you got the trail sneaker route, though, you're kinda sold for life).

I'd love some help and or suggestions before my next excursion. My feet will thank you.

Cheers,

Tim

[Travis Leanna]

First of all, I know pretty much nothing about feet. Ok, that being said, I was (still kind of am) having issues with my first metatarsal. I never got a diagnosis, but decided to try insoles first. So far, they've helped quite a bit.

I went to a local shoe store and got my foot mapped by an Aetrex machine, which basically just shows where you're putting pressure. I was surprised to find out that my pressure points weren't were I though they were. The insoles listed below were suggested, and I thought, "oh, what the hell. I'll try them."

http://www.aetrex.com/products/Lynco-Sports-400-Series-%252d-L405.html

[Diane Pinkers]

The muscles of the calves send tendons down into your feet. Problems in the calf muscles can be a cause of foot pain. See a really good massage therapist with a background in sports rehab. My boyfriend was experiencing numbness in his last two toes and metatarsal pain in his left foot. His doctor said "oh, the nerve is just dying" and the podiatrist wanted him to put special inserts in his shoes. A couple of good massage sessions that loosened the muscles in his left side and he has no more problem, although he did ditch the boots that he was wearing when the problem originated. The massage therapist said his left hip was high and his left shoulder was low so that he was pinched together on the left side and unbalanced. Once she got him level he's been fine and been hiking without pain.

I had problems with plantar fascitis that improved with calf stretches/strengthening. Less supportive shoes, not barefoot but shoes that allowed for more flexing of my foot and spreading of my toes helped a lot. If I wear shoes that are stiffer, the problem recurs–even my work shoes have to be more flexible. I stand a lot at work, but those stiff hard shoes that are promoted as "nurse's shoes" make my problems much worse.

[Roger Caffin]

Two likely problems here.
1) the shoes you are wearing are too narrow. Go up a width.
2) the insole has compressed too much under the ball of the foot.

The suggestion for softer insoles may give temporary comfort, but in the long run may exacerbate the problem. Ditch the after-market insoles and metatarsal pads, use the stock insoles as long as they are flat, and be willing to replace shoes with worn-out interiors.

If the stock insoles are all curved and lumpy, replace the shoes with something with a flat interior. Ignore ALL the adverts for arch support, pronation control, gell soles, etc. They are all damaging for outdoor use.

Cheers

[Nick Gatel]

Ignore ALL the adverts for arch support, pronation control, gell soles, etc.

Yep, that should fix things.

[Logan K]

Gotta agree with nick on this one. Perhaps your feet are crying out for freedom (as we're mine). I sunk over$1000 into custom orthotics and rehab with no long term results. Vibrams, soft star mocs, and the NB minimus have cured all of my foot problems except cold sensitivity from too many frost nips.

Good luck,

Logan

[Jennifer Mitol]

First of all, feet are pretty darned complicated. Just because one thing worked for one person (or even a whole mess of people) doesn't mean it will work for you. Before you try things you really and truly need to figure out what your foot is doing and why it's doing it. Don't take anyone's specific advice based on your general description. And frankly, that works for every medical question ever posted online.

Custom orthotics are great for a tiny handful of people, another tiny handful of people can get by with store bought orthotics, then another group does better with barefoot, then another group needs a lot of cushion…then some just need to stretch and exercise. Well we all probably need that last bit.

I'm going to get into a bit of hot water here I bet, but I have been terribly disappointed with the practice of podiatry. GENERALLY speaking, and referring to most of the ones i work with, they inject everything despite a rather substantial and established body of evidence that steroid injections are bad bad bad bad for just about every bit of soft tissue. They give everyone orthotics (really? No one has a foot that can contact the ground adequately?) and they seem to believe all the great advances of the 1980s are still the best ways to address tendon and joint problems of the foot and ankle.

So what do you do?

Basically someone needs to look at your foot: how it moves, where is it stiff, where is it weak, etc. Someone needs to watch you walk, look at the whole leg: how does your hip move? Your knee? Do your arches fall or are they stiff and high? Do you have no arches to begin with?

The cheapest and easiest way to start, especially if you aren't too far down the road to injury, is to be fitted for shoes at a good running store. The best ones watch you walk, maybe even videotape you, then tell you what kind of shoe to get.

All due respect to Roger, sometimes the inserts from the drug store are actually a good thing. I frequently get patients with atrophied fat pads of the heel and the best thing they can do is put a gel insert into the heel. And sometimes, for difficult metatarsal pain, met pads are actually a great way to temporarily relieve pressure while the underlying tissue heals.

Anyway…

As a physical therapist I am certainly biased towards PT as an effective intervention…but with a HUGE caveat. There is some seriously bad PT out there, and it might be just as hard to find a good PT as it is to find a good podiatrist.

So the bottom line is that someone needs to look at the biomechanics of YOUR foot and ankle. Don't let anyone inject you with anything, don't waste money on electrical stimulation or ultrasound or iontophoresis or any of that bogus crap.

That was a whole lot of negativity…sorry. Feel free to PM me if you want some specific suggestions…I'd need to ask you a lot of questions first tho.

Good luck

[Nick Gatel]

"The cheapest and easiest way to start, especially if you aren't too far down the road to injury, is to be fitted for shoes at a good running store. The best ones watch you walk, maybe even videotape you, then tell you what kind of shoe to get."

Jennifer,

You have expertise; I don't, other than I have been running injury free since 1965.

A few years ago I had shoes fitted at a well known running store. My intent was to get the correct size. They had me walk and then run. They determined I pronate. Don't most people? Anyway, they recommended shoes to correct this deficiency. After a few weeks I realized the shoes were forcing my feet into an unnatural position and I started to develop pain. Threw the shoes away went back to minimal shoes, flip flops, and barefeet and all has been fine.

BTW, they did an excellent job on the sizing.

[W I S N E R !]

On the flip side, I think plenty of people here can attest to having completely underwhelming, frustrating, and downright incorrect diagnoses and experiences with medical professionals in addition to simply not having access to sports medicine specialists.

I've met countless athletes, myself included, that have been involved in multi-year quests to fix what ails them due to eventually giving up on the professionals.
A close surfing friend has invented an elaborate stretching and strengthening routine that completely cured a back injury after 3 years of various medical professionals and PTs told him the only option left was "pain management" (AKA strong drugs) and possibly giving up surfing. I personally ended a nearly 1.5 year bout of tendonitis in my foot by giving up shoes and focusing on barefoot strengthening for over 6 months…certainly not something any doctor or specialist was recommending. I did it because nothing they suggested (short of no longer running) worked for me. In fact, their suggestions made life worse for me.

Understand that many people are turning to forums for ideas because they've already exhausted options available through their insurance plans to absolutely no avail. While there are certainly plenty of kooks on the internet, I certainly do not equate the presence of an MD next to someone's name as an indication that they know much about working through something like ITBS when a seasoned marathon runner could rattle off a dozen different stretches and strengthening exercises. I know many coaches and elite athletes- a few that are purely online acquaintances- that I would turn to for advice on an injury long before I'd walk through the doors of a Kaiser or seek a professional.

I learned this lesson the expensive way.

[Jennifer Mitol]

Actually you guys, I totally agree with you. As a medical professional I am sometimes literally horrified at what other medical professionals have told – and done to – patients. Sometimes i think the best advice I can give people is telling them what to stay far, far away from. This makes me seem like a negative nancy I think, but at least it's a good way to protect yourself against bad medicine. But, for example the previous post about stretching calves and strengthening lower leg muscles is a great piece of advice simply because it isn't going to hurt..

As I was writing that post last night, after a rather frustrating work day, I felt it was too negative and whatnot, but couldn't stop myself ;)

So sorry about that…and I am fully aware how hard it is to find a medical professional (regardless of letters after their name) who is worth your time and money. Part of my frustration at work yesterday was literally that…undoing crappy, horrible interventions by a surgeon and trying to convince the patient that we should try something different….

[Ken Thompson]

Called a medical practice for a reason.

Someday I hope to see medical perfect.

[Kelly G]

Now I have found that a stiff sole helps my right foot quite a bit. Significant foot pain that I experienced with my nice comfy Keens, which allowed my feet to "twist" on uneven ground, was much reduced when I switched to North Face Syncline boots that have a much stiffer sole. They are reasonably light for boots but the stiff sole also helps with foot fatigue after a rocky day in the mountains. I should have bought a second pair.
Kelly

[Brian Lewis]

No doubt that feet are complicated and that what works for one person doesn't work for another.

I've had the same conversation with my foot doctor; he wanted me to get a boot, but I pointed out that the (heavy) boots he was recommending had toebox too narrow for another problem he had diagnosed.

If money isn't a factor I definitely would go the custom orthodic route, with no expectations that it will fix things — but hope that it possibly might, and/or reduce the odds of other problems.

My foot doctor actually had a metatarsil pad basically build into the top of the soft rubber part of one set of orthodics for me, FWIW. The stick-on pads are okay, but you want to take care to get it in just the right spot (!).

I wish there were easy and certain answers to this stuff.

[Mike In Socal]

Tim-

Buy a foam roller (<$20) and roll out your calves to start. Tight calves can translate into foot pain on the bottom of your foot. It may or may not solve your problem but it's an inexpensive start and will benefit you if you roll out the rest of your legs as well.

You should also find a good physical therapist, sports med doc, or chiropractor. A good one is worth his or her weight in gold. They understand biomechanics and can help you without medicine, injections, etc.

My chiropractor specializes in sports med and is a runner so he understands when I describe certain problems. Along the way, I have learned a few things: Everthing is connected. If you have tight hip flexors, your gait changes which can cause problems in your feet. Pain in your foot might be caused by tight calves. Pain just below the knee might mean your IT band is tight.

So, start stretching every day and find a good PT/Chiro that will work with you.

[Roger Caffin]

Hi Jennifer

> All due respect to Roger, sometimes the inserts from the drug store are actually a
> good thing. I frequently get patients with atrophied fat pads of the heel and the
> best thing they can do is put a gel insert into the heel. And sometimes, for
> difficult metatarsal pain, met pads are actually a great way to temporarily relieve
> pressure while the underlying tissue heals.
No argument!
Both are genuine medical problems which are beyond my experience and skills – but within yours.

Cheers
PS: as I am sure you know, I agree with your other comments as well!

[Jason Elsworth]

I spent two years working with professionals trying to fix a back injury. I was waking up every night in pain and it was becoming very wearing. my sister in law, who is a gp, showed me 6 simple stretches and within 2 weeks i was fixed. I have also been amazed at just how much stronger I feel after 2 years of barefoot and minimalist shoes. I know this is a controversial area for some but for me it has just plain worked. the web is awash with forums for various conditions where sufferers have been unable to get help via the drs they have seen so far. the advice on these forums is often not about alternative medicine but how to educate your traditional dr.as craig points out there is plenty of kooky stuff out there, but there patient experience can be very valuable.

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