Dorsal foot pain

by Cierra
(TN)

I am a runner training for a half marathon in April . Here recently I started having general pain in my left foot dorsal side. It started in my big toe and runs up my foot towards my shin I also have a knot on my extensor tendon(it's painful to touch) there was mild swelling after running I also have a bruise above my fourth toe that is practically painless . My shoes are to tight I know that's part of the problem and will fix it. I am worried I could have a stress fracture, I am full weight bearing on my left foot and can hop on my left foot ( the hop test) with no pain, however when I flex my toes towards my head there is increased pain I also have pain when I run . I feel like I'm in a crossroads I don't know if it's a stress fracture or tendonitis. I will rest it for two weeks using the rice protocol . But I would like to know if this sounds like a stress fracture to you or just tendonitis.

RESPONSE

Hi Cierra,

Let me first give you the disclaimer and that is without actually examining you, I have no idea what is wrong with you. Having said that I will offer some insight to your problem based on the narrative that you have supplied.

Although a stress fracture is certainly a possibility as you are a runner, I am leaning more toward tendonitis as the source of your pain, for the following reasons.

The fact that you are wearing shoes that are too tight could very well be a precursor to tendonitis for the simple reason that the tightness of the shoe on the top of the foot, inhibits the free motion of the tendon, in this case the extensor hallucis longus tendon from moving freely back and forth.

Secondly, you mention a painful knot which I think you state is on the tendon. This could be a couple of things but the simplest would be an irritation of the tendon itself which has caused local swelling and pain. If indeed, it is part of the tendon that could affect the whole tendon, which brings me to my next point.

You state that the pain starts on the top of the big toe and travels up to your shin. Well....that follows the course of the extensor hallucis longus tendon.

If bending your big toe back and forth causes pain, then that would also be an indicator that the tendon is giving you pain. Generally moving the big toe back and forth will not cause a stress fracture (of the metatarsal bone) to hurt.

I am not so sure hopping on your foot is of any help in making a diagnosis.

So what should you do? Even though it sounds more like tendonitis than a stress fracture, an x-ray should be taken to rule out the possibility of a stress fracture, simply because this will save you a lot of wasted time if you are treating yourself for tendonitis and in actuality you have a fracture.

Every time someone comes into my office with similar symptoms consistent with tendonitis, I still order an x-ray to make sure there is no fracture for the simple reason the pain can be very similar.

Go have an x-ray and while being examined by the doctor, mention the knot that you feel in the tendon as I think this should be looked at. This knot would also need to be addressed particularly if you want to get back to pain free running as soon as possible.

Marc Mitnick DPM
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