top of foot pain accompanied by pain on side of foot

by frank
(Berlin, Germany)

About 6 months ago i developed what assume was a cyst on the top of my right foot between my fourth toe and ankle. This area was sensitive to the touch and became progressively more painful. Eventually this problem was exacerbated by an additional pain that was centered on the side of my foot between my big toe and ankle that felt like a tendon or a ligament had tightened up to the point where it felt like a constant painful cramp. The pain in these two areas became so intense that I couldn't put any pressure on my foot when I first got out of bed until I limped around for a couple of minutes. I believe the problem originated as a result of beginning long (300 mile +) drives 4-6 times/month with my foot in constant pressure against the gas pedal. Additionally I increased my running routine from about 10 miles/week to 20 during this time . I tried all the home remedies (rest, ice, heat, elevation, wraps, ibuprophin), but nothing worked. I finally stopped running all together about a month ago and began using cruise control on my long drives which continue to this day. i went to see an orthopedic specialist who confirmed no bone fracture via x-ray. He prescribed an orthodic insert for my shoe, but that only made the pain on the side of my foot so intense that I could barely walk after a week. I went to another Orthopedic specialist who had an MRI done, and that confirmed no existing or prior fracture. But he saw some evidence of a bone bruise on the op of my foot. He prescribed a carbon orthodic insert and a wrap for my ankle to stabilize my foot. After a week, the cyst is gone and I feel some relief, but soreness and discomfort to both areas persists. Pain is duller, but increases if my shoes are too tight and/or I walk for more than 30 minutes. Any alternative thoughts on what my problems are and/or other cures I should be considering. I need to start running again...I've gained 10 pounds and going stir crazy.

RESPONSE
Hi Frank,

It sounds like your problem is on its way to resolving itself through the use of an orthotic. Based on your description and the fact that the orthotics have seemed to eliminate or improve the situation, it sounds like you have a midtarsal fault. This is caused by a foot that flattens out too much and creates a jamming effect on the top of the foot which will then lead to inflammation and pain.
Use of an orthotic will prevent the foot from over flattening out and thus eliminate the jamming on top of the foot and over time the swelling and pain diminish.
If you are feeling at least 75 percent better you might try some light running, making sure you have an orthotic in your running shoe. Perhaps start in a controlled environment like on a treadmill and see what happens.
If you do alright, then you can try increasing your mileage. I would do this in conjunction with advice from your doctor.

Marc Mitnick DPM
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