The best way to commence the Athletic and Repetitive Stress Injury (RSI) series is from the ground-up. In clinical practice, patients frequent the office with foot related pain and often lead to frustration and critical missed training time if issues are not addressed in a timely manner. Overuse conditions of the foot include problems related to the active insertion of muscle, tendon or ligament as well as static problems associated with weight-bearing load transmission.
The initial RSI is a condition that is frequently discovered due to increased training volume without a proper ramp-up phase. Metatarsalgia is a term used to describe pain to the forefoot, specifically at the metatarsal heads. Symptoms associated with this pathology include pain and tenderness under the plantar surface of the metatarsal heads or the fat pad of the foot.
Causes of Metatarsalgia:
- Equinus Type Foot – this occurs when there is not enough “dorsi-flexion” or enough movement of the foot toward the front of the leg when running due to short or tight calf and/or Achilles tendon.
- Pronation – this foot fault causes excessive foot mobility and inhibits the great toe and first metatarsal shaft from accepting weight during push-off phase of gait and this shifts excessive load stress to the metatarsal heads in the middle of the foot.
- High-Impact Too Quickly – beginning of a new season brings enthusiasm, high impact and quick ramp-up training leading to excessive stress. Basketballers, field athletes, running, cutting, jumping athletes, ballet dancers and gymnasts all place too much stress on the ball of the foot and too much pressure over this small contact area.
- Cavus Foot (High Arch) – this foot fault leads to excessive load stress at the front of the foot and consequently the metatarsal heads cannot distribute the impact leading to inflammation and even stress fractures.
Management of Metatarsalgia:
- Address biomechanical factors that contribute to foot, ankle, knee and pelvic faults – this can be done with corrective adjustments in many cases
- Address training techniques, warm-up and cool-down procedures
- Address flexibility of foot-ankle-knee, hip and lower back
- Address foot wear and encourage stabilizing or motion control shoe
- Address foot fault and consider adding corrective, custom orthotic to support biomechanics and for shock absorption
- Add metatarsal bar/pad to running shoes and/or orthotics to decompress metatarsal heads (ball of foot)
- Support over pronation with Kinesiotape for proper foot mechanics and tissue support
- Perform a Gait Analysis for total kinetic chain assessment and for corrective measures
- Enhance length and stretch capacity of Achilles tendon, Soleus and Gastocnemius
- Foam Roller and “Stick” calf group, plantar arch muscles/fascia and Tibialis group (front of leg muscles)
- With resistant cases, avoidance is best medicine and cross train with pool/swimming, recumbent bike, elliptical and rowing ergs for maintenance of cardiovascular fitness while “actively resting” injured area
- Add natural proteolytic enzymes in elevated doses for 30 days for anti-inflammatory and fibrinolytic benefits
- Radiology for resistant cases to rule out stress fracture(s) and/or occult pathology for best treatment direction
As one can attest from the above information, lower extremity injuries are very difficult to manage as we are always “on our feet” so extreme prudence with training, nutrition and biomechanical support is the best, preventive medicine. Check in for an evaluation if this condition is keeping you out of your game!