Addressing Ball Of Foot Pain In A Runner With Pes Cavus

A patient, who I had diagnosed previously as developing a hammertoe, contacted me after noting that one side of her foot was “inflamed” in comparison to the other side. She notes the inflammation is in the metatarsal pad area. The patient notes she has a high arch and longer second metatarsal, and wonders if she is at risk for developing metatarsalgia.

The pes cavus places a lot of force on the metatarsals over a flatter foot. This patient could be in an overload situation, may be forefoot running, wearing shoes with a high heel pitched forward, running on hills or may be sprinting.

The patient did acknowledge running on hills. She considered not running due to the metatarsal pain but rationalized running again due to an improvement in the pain. The patient noted that it did not hurt when she ran and she tried to alter her landing when she did notice pain. She is also trying Altra shoes. The patient says these shoes offer more room in the toe box. She adds that the shoes are neutral and flat, and believes these qualities will reduce the impact on the forefoot.

When a toe runner begins to get ball of the foot pain, he or she can take several steps. These include temporarily avoiding hills, icing for 10 minutes twice daily, trying to run more on the midfoot, lowering the heel drop (Altra shoes are all zero drop), and cutting the mileage in half to see if that can lead to 0-2 pain levels on a visual analogue scale. This patient should stay at that mileage for a short period and then gradually increase it by 10 percent or 1/2 mile every fourth day.

Toe running with pes cavus on hills can be painful at times so shoe changes, gait changes and avoidance of hills are all helpful measures to alleviate pain.

Editor’s note: This blog originally appeared at https://www.drblakeshealingsole.com/2018/01/painful-metatarsals-in-runner-common.html . It is reprinted with permission from the author.