Swollen metatarsal area - below and slightly ontop

by Cecilia
(Bonita, CA)

I have been running long distance for years. (About 14 miles on Saturdays; keeping the weekday runs to just about 3 miles, four days a week.) I recently purchased a sportsband which inspired me to work on my speed. During these speed runs I ended up using my forefoot a lot to propel faster. About two weeks ago I began feeling pain on the pad below my third and fourth toe on my left foot. When I manipulate it almost feels like there could be some build up of fluid or something there. My foot is also slightly swollen on the top. No bruising though. I have been icing after runs and taking anti-inflammatories. It's not extremely painful, just irritating and feels like there's a bump beneath my foot when I walk. Can I rule out a stress fracture or break, since there's no bruising and the pain is not extreme? Going to pick up some metatarsal pads tonight and see if that helps.

RESPONSE

Hi Cecilia,

Unfortunately, you cannot rule out a stress fracture in that portion of your foot simply because there is no bruising or severe pain. Pain is a relative term to most people and the amount of pain that might experience from a stress fracture would be predicated on the degree of the break. In other words there may be a small "crack" in the bone, all the way to a much more severe fracture. Only an x-ray will tell and I would be remiss if I did not mention the fact that sometimes a small break in a bone may not even show up on an initial x-ray and that an MRI or bone scan might even be required.
The fact that you changed your gait by running more on your forefoot would certainly strengthen the argument for a possible stress fracture.
Having said that, there are other conditions that will also cause pain in the specific area of the foot that you are complaining about.
Whenever anyone mentions pain behind the third and fourth toe, the word Morton's neuroma jumps to mind. This is a pinched nerve that occurs between the third and fourth metatarsal bone heads and will cause pain in the area that you mention.
There nerve is on the bottom of the foot and although not impossible, generally does not cause swelling or pain on top of the foot, but rather a shooting sensation into the third and fourth toes as well as possibly a pain that shoots back into the foot. Symptoms are generally of the tingling, burning, numb nature at that are typical nerve pains.
Another issue that might be causing pain could be a capsulitis, which is essentially a stretching of the ligaments that attach the metatarsal bones to the toes. This too generally causes pain on the bottom of the foot but because the ligament surrounds the whole joint, theoretically, it could cause pain on the top of the foot as well.
In addition there is always the issues of metatarsalgia which is just pain on the metatarsal heads as well a possible submetatarsal bursitis which is an inflamed bursal sac that may be present under the metatarsal head.
So, as you can see, your pain may be coming from a number of different sources.
Even though you are not in severe pain, if you are concerned about doing further damage to your foot, why not make an appointment with a local foot specialist and have your foot examined? That is the best way to approach this issue.

Marc Mitnick DPM
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