Burning feet in a triathlete

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Hello this is the first time I've posted here. I'm looking for a bit of advice with a Pt.
Triathlete, very fit has burning pain in both 2-5 met heads for 3 months afte 3km of running.
Has tried various shoes, double socks, Vaseline but nothing changed. The area is thickened and very tender to touch. U/S showed nothing significant except slightly thickened met plates on 2nd and 3rd mtpj but no hyperaemia.
Mechanically very heavy on f/f running. No heel strike. Yesterday he ran barefoot along a track and no pain. Wouldn't have him as a candidate for barefoot running. Can anyone help? Thanks

 

Rule out medical reasons (peripheral neuropathy)
Consider transient parathesia from feet swelling and compression from shoes.

Best guess --> plantar plate dysfunction

 

Thanks for your reply Craig. Would an MRI diagnose plantar plate dysfunction and what's the best Rx?
Thanks

 

Hi Gilldun,

I've had a similar a patient that was a long distance runner that ended up being just capsular thickening and irritation.

If the ultrasound was negative for neuroma, intermetatarsal bursitis and plantar plate tear I would assume it was capsulitis as U/S suggested. Trial taping the affected toes plantar flexed (use thin strips of fiximul) to offload the met heads and increase cushioning with proon to see if you can give relief purely through pressure reduction.

If that's doesn't work send for an MRI and I'm sure there would be something like Craig suggested.

good Luck