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A young female runner of mine complains of pain between 2nd & 3rd metatarsal. 2 different x-rays show no stress fracture. MRI showed nothing. Neuroma ruled out. She has normal to high arch, slight pronation with excessive wear on the heels of her running shoes. Burning also occurs on the bottom of her foot. Mom(also a runner) reports that shoes are replaced every 400 -450 miles. Cushioned & stability shoes have both been tried. The kid is a good runnner with scholarship potential, but the pain completely changes her stride. Time off doesn't help as pain returns when she starts running again. Is anything obvious standing out to anyone?

 

Where between the 2nd & 3rd? Proximal or distal? Dorsal or plantar?

See:
Presenting Patients for Clinical Advice

 

Where exactly does the burning occur? When you palpate the foot, where is it tender? Is it dorsal or plantar? Is it on the medial or lateral or dorsal aspect of the metatarsals or in the interspace? Does the pain improve or get worse during running and what type of shoes and activities make it better? Does she have any pain during walking? What is her age? Does she have normal periods?

The pain could be a intermetarsal neuritis which would not show up on MRI but most commonly pain in this area is due to a 2nd or 3rd metatarsal stress reaction in a young female runner.

 

Hi Justrun,

A technique I have used (with a non-athlete) to aid diagnosis is strapping the digit involved at its base into a plantarflexed position for a week. Relief of symptoms suggests plantar plate tear or capsulitis. Originally suggested in 'Podiatry Today' and useful for my patient.

 

it can be Köhler 2