Intermetatarsal bursitis

I hate to say it, but wow is that an awfully difficult condition to treat. You need a clinician who will spend a lot of time looking at her foot, the pad underneath, the muscles in between, etc, particularly how all the bones and joints of the foot move. Frequently we find something is too loose right next to something that is too tight (relatively speaking, of course) and that is what perpetuates the issue. In her case, given the onset of barefoot shoes and increased weight through the lower extremities (wearing a pack), I'd worry about bone contusion and overall irritation. Heck, she might do well with a little non-weight bearing for a while just to let things settle down.

Basically, I would advise you to find a GOOD PT. If she is not getting a decent response in 5-6 visits, go somewhere else. An orthopedic surgeon is just going to send her PT anyway, so not sure what more they are going to offer.

I agree to stay away from steroid injections…even if they offer short term relief the studies are very clear that after about 6 months they cause way more problems then you had initially.

Anyway, good luck. This is a tough one and no clinician is going to have good answers for you.

After all I have been through with my feet I will second Jen's advice. First healing and rest. It takes time to do that, maybe even a year with no extra weight bearing and some therapy for healing purposes only, not anything that would add stress to the area. Our bodies are amazing, and given time do heal, but they must be given that time, otherwise it's more insult to injury on top of the initial damage.
My problems also started with going too fast with the VFF and then an accident, which was then compounded by working conditions. It took me three years to get back and a lot of doubt, frustration and pain, but once I gave my feet the time to heal, and found the right exercises and routinely applied them, I started to heal and now am well again. I still have to watch it, but I'm not young any more!
Best wishes for her recovery.

Technical! I am mostly out of my depth here.

I agree with Jennifer and Drusilla, especially about the value of just resting the foot for a while. Something needs time to heal.

And I would stay a very long way from anyone with needles or knives …

Cheers

I don't have anything to add to the discussion with this specific condition, but I hurt the top of my foot running barefoot (very common) after running too far after taking a week off ….. I was surprised that it took 4 straight months of no activity to get back to normal …. the only other injury I've ever experienced that took so long to heal was a rotator cuff / shoulder that I hurt bench pressing, it took about 6 months to heal …. the point is, I was shocked that feet can take such a long time to heal when most things seem to take a few weeks…. such a bummer … hope her recovery goes well and you find a good PT.

This type of problems sadly is not unusual when making transition to minimalist shoes.
I managed to (mostly) avoid any problems thanks to Minimalist Runner forum https://groups.google.com/forum/#!forum/huaraches . Search for TMTS – too much too soon and "top of the foot pain".

Paradoxically jumping into FiveFingers and "going everywhere" seems to be the worst choice. In my opinion (and probably other minimalist/barefoot guys) you should either go straight barefoot or slowly lighten your shoes. When going barefoot your soles will naturally prevent too high mileage and your foot will have time too adapt.

In FiveFingers you remove all arch support instantly but can go for miles right from the beginning. The stress is slowly accumulating and when pain starts it is usually too late. Barefoot obviously is not possible in technical terrain, but once your soles toughen up you can do more than most imagine – it just takes not months but years.

Warning – most people on mentioned forum have strong opinions on current shoe industry and knowledge of some podiatrists.

Walking barefoot when conditions allow is amazing – it's like gaining sixth sense. Imagine wearing thick rubber gloves whole life and removing them. At first it will hurt to touch wood, sand etc. then you train yourself to feel properly and the new possibilities open up.

I hope your girlfriend feet will heal soon and then she may consider starting once again slower, definitely without backpack, but that depends on doctor's opinions.

When I started walking as part of a fitness/weight loss effort, I immediately started having metatarsal numbness/pain. I took two corrective steps, following which the problem went away and has not returned. What worked for me:

1) Ensure that all of my sports shoes and hiking boots are very wide in the toe box, so that there is zero pressure squeezing the toes together.

2) Wear SuperFeet insoles in all my shoes and boots. The location of the arch support with these insoles forces weight to the outer length of my foot and probably helps take pressure off the metatarsal area.

Of course, everyone is different, but these are two steps that are easy to try. If they work, great. You can try SuperFeet demos as almost any running or hiking/outdoors shop. So, maybe you end up with a pair of wide shoes as the only cost. The fact that she started having the pain after switching to minimalist shoes and also while walking barefoot around the house suggests that her foot doesn't respond well to no arch support. If that is the case, the SuperFeet may be terrific for her. For my entire life, I suffered brutal arch pain after hours in ski boots, ice skates, soccer shoes, tennis shoes, etc. Low arches, pronating the foot inwards with all the pressure on the arch. The SuperFeet completely cured this.

So she went to the orthopod, who did have some insight into the issue. She does have intermetatarsal bursitis between her first and second toe, but she also has capsulitis in the joint of her second toe ("turf toe") which is likely due to it being longer than her first toe, which is pretty common (they call it "Morton's toe"). I began reading as much as I could about this condition, which led me to a great resource online by a these two men who go by the "Gait Guys." They discuss normal gait and common issues with abnormal gait. After studying that for a week or so, I applied some of my knowledge to her gait. She had several obvious defects. First, she has a "dropped" second metatarsal, which means she was walking mostly on her second toe, which was grinding her second toe into the ground. Secondly, she was pronating her foot allowing her arch to completely collapse too early in her stride. Thirdly, she was not engaging her hips and allowing her knees to bow in. Finally, she has pretty weak intrinsic muscles of her feet, especially her toe flexors.

Based on this, I've been working with her to correct the abnormalities. The Gait Guys talk about the "foot tripod" in which the weight of the foot is carried on the heel, the first metatarsal, and the fifth metatarsal. We've been working on standing to keep that position. We've been working on walking barefoot on grass and sand. Yesterday, we went on a longer walk on sand, and her turf toe started acting up. She started walking in a way to stop it from hurting, which off-loaded her second metatarsal onto her first metatarsal. She said it felt weird because it felt like her bone was driven into the sand. I remarked that was probably pretty normal. Walked the rest of the day pain free.

All of this stuff is fascinating, but I am not a kinesiologist, so off to the PT she goes. I've come to the conclusion that avoiding barefoot walking is terrible advice for her. She should avoid it until the pain dies down (it has), and then do it slowly and allow the pain to guide her on what not to do, thus relearn how to walk pain free.

Adam, that's good news. Yes, keep the walking pain free…but if she can walk without pain then by all means do it!

Given what you've said about what you've observed in her gait, make sure the PT really assesses the mobility of all the bones in her foot, watches her walk many times, and works her whole lower kinetic chain – meaning don't just have her sit there and do towel crunches with her toes. She needs to work those hips, her buttocks, her hamstrings (but probably not so much her quads). The PT also needs to be working on the individual joints of her foot….

As I love to go on and on about ad nauseum, there is a crap ton of bad PT (and orthos, and chiros, and podiatrists, and MDs, etc etc) so be super critical about her clinician. I don't care how nice he or she is, if the PT is not looking at the motion (both quantity and quality) of the joint segments of her foot you need to find a different PT.

Sorry for being so critical of my colleagues, but so many of those PTs just make the whole profession look like crap. Make sure she is working with the PT, NOT some teenage aide, either.

Ok, done with my soap box. I hope things work out!!!!!

(And feel free to PM me any questions you have…I'm more than happy to help when I can)