Bottom/Outside of left foot Pain after NYC Marathon

by Blake
(Charleston, SC, USA)

After running the NYC Marathon in early November, 2011 I suffered severe pain on the bottom of my foot along the entire outside from heel to toe. It essentially felt like a burning sensation and I could barely walk (definitely could not run) until mid January. I started lightly running again in mid January with no pain (3-4 times a week, about 12 total miles per week). Fast forward to February 9, 2012 and after a light 3 mile run the pain returned almost as severely as if I had just run the marathon. I have no clue what this may be, aside from an aggravated lateral plantar fascia....any help is appreciated. I am back to Ice, compression, rest and elevation....I have signed up to run Chicago in Oct. 2012 and am terrified this injury will prevent me from participating...

Thank you,
Blake

RESPONSE

Hi Blake,

The best advice I could give you is to see a foot specialist in your area who can actually examine you and arrive at a proper diagnosis so that appropriate care may be initiated.
Having said that I think we can probably rule out a fracture as the source of your pain as more than likely the pain from a fracture would not resolve itself as quickly from a couple of weeks of rest, only to return again. If you sustained a stress fracture I would have assumed the pain would have been continuous. But crazier things have happened, so the possibility of a stress fracture and re-fracture would have to be ruled out.
The next thing that comes to mind is a subluxed cuboid. As the name implies, the cuboid bone becomes displaced generally in athletes and will cause a fair amount of pain. Once the bone pops back into place the pain usually subsides but the potential for another subluxation certainly exists.
Next is the possibility of damage to the peroneus longus tendon as it passes under the cuboid groove. This tendon comes down to the foot, travels along the side of the foot and then makes a sharp turn under the foot to go to the first metatarsal bone. Because of the nature of its course, this tendon is subject to irritation and thus pain.
These are the more common causes of pain along the side of the foot.
Less common causes might include damage to the abductor digiti quinti muscle which is the muscle that allows people, in theory at least, to bend their small toe outwards.
Lastly, you may have done damage to what is known as the lateral plantar nerve which is a nerve that travels on the bottom outside portion of the foot. Irritation to the nerve could give you the burning sensation you mention.
The obvious problem here is that I do not know which one of these conditions you may be suffering from. There is also the issue as to why it has happened twice.
Is it the result of the terrain you run on? Is there a problem in your gait cycle and thus running stride? Is there an issue with your particular brand of running shoes?
So, since your concern is being ready for your next marathon and because you have now suffered the same problem twice, I think you need to get some medical advice up close and personal. The reason why this problem has occurred twice and the means to address it can only be done by a foot specialist who can examine you.

Marc Mitnick DPM
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