Bottom of 1st metatarsal discomfort

[WoodBow]

I'm 35 years old, 185#s, and fit. I have discomfort on the bottom side of both feet at the base of the big toe. Like there isn't enough cushion there. It is worse on the right but present bilatterally. On a hunt last year, we did not do any crazy mileage, but by the end, I had a "hole" worn in the bottom of my foot at the base of my big toe. Not a blister. It took quite a while to fully heal up. I did run a fair bit last summer leading up to that hunt. Maybe 20 miles a week on average. Normal running shoes. I started wearing xero shoes for everyday wear at the first of this year. Really like them, but the discomfort is slightly worse due to less padding.

Anyone dealt with this? Is it a walking mechanics issue or anatomical issue? I ordered some sheep feet for this year. Hopefully I will get them in time and they help.

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[ztc92]

Do you recall any specific injury? Even if it’s just, “it was fine on this day but then I did this one thing and it started hurting and it’s bothered me ever since.”

Pain in that area in someone your age who is active is often an injury to the plantar plate (“Turf-Toe”), which is usually due to an acute injury involving hyperextension of the first toe. These can take many months to heal even with proper treatment, which is the reason it’s so dreaded in NFL players.

Another consideration for pain in this area is the sesamoid bones, which can be thought of as little kneecaps that live in the flexor tendons for your first toe (you have them other places too) and help provide leverage with flexing the toe. They can become inflamed (sesamoiditis) or even fractured, which would cause pain similar to what you have described.

Treatment of these issues can be complex and often imaging is needed to confirm the diagnosis. I would recommend getting a referral to either a sports medicine physician or an orthopedic surgeon with foot/ankle training. You could also consider seeing a podiatrist of those options aren’t available. Best of luck, foot pain can be a very frustrating thing but almost always gets better with time and proper treatment!

 

[WoodBow]

Do you recall any specific injury? Even if it’s just, “it was fine on this day but then I did this one thing and it started hurting and it’s bothered me ever since.”

Pain in that area in someone your age who is active is often an injury to the plantar plate (“Turf-Toe”), which is usually due to an acute injury involving hyperextension of the first toe. These can take many months to heal even with proper treatment, which is the reason it’s so dreaded in NFL players.

Another consideration for pain in this area is the sesamoid bones, which can be thought of as little kneecaps that live in the flexor tendons for your first toe (you have them other places too) and help provide leverage with flexing the toe. They can become inflamed (sesamoiditis) or even fractured, which would cause pain similar to what you have described.

Treatment of these issues can be complex and often imaging is needed to confirm the diagnosis. I would recommend getting a referral to either a sports medicine physician or an orthopedic surgeon with foot/ankle training. You could also consider seeing a podiatrist of those options aren’t available. Best of luck, foot pain can be a very frustrating thing but almost always gets better with time and proper treatment!

No acute injury to my recollection. No pain in manipulating the joint or when not load bearing. I wouldn't even call it pain ever, just annoying discomfort. I would just carry on if not for the worsening of things I experienced on last years hunt.

I'm actually a rad tech by trade, though I work exclusively in urology now doing eswl. I could image it with my c-arm or have an old co worker do plain films. I'm too hard headed to actually go to a doctor

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[Blackcow]

I’ve had sesamoiditis, a broken and healed sesamoid,turf toe and plantar fasciitis haha. Lucky me. Is the pain in front of the ball of your foot at the base of your toe( turf toe) or the actual ball, slightly to the front ( sesamoiditis)?

 

[rideold]

I've had chronic metatarsalgia for years. I found putting pads in my shoes helped greatly. I put them just behind the painful areas to provide pressure release. They make ones you can buy on Amazon or elsewhere but I just cut up some old insoles and used leukotape. I also never walk around barefoot. Crocks in the house all the time. I saw an orthopedic doc that diagnosed it and showed me where to put the pads. Guess it's a common thing for runners to get.

 

[7mm-08]

I had a significant case of Morton's neuroma a few years ago, which sounds different than your symptoms, but is nonetheless very painful. Ultimately, after seeing a reputable podiatrist, I up-sized my shoes by half a size and started wearing Birkenstock sport blue arch supports in my running shoes and hiking and hunting boots. They've been a godsend. They spread the metatarsals and give (me) tremendous relief. My point is that something this simple could be the key to your issue as well. Good podiatrists are worthwhile, for sure. Best of luck with your situation.

 

[Crusader]

I’ve had sesamoiditis, a broken and healed sesamoid,turf toe and plantar fasciitis haha. Lucky me. Is the pain in front of the ball of your foot at the base of your toe( turf toe) or the actual ball, slightly to the front ( sesamoiditis)?

I had sesamoiditis too, just a few months ago. Very painful, sort of "came out of nowhere," no injury that I could recall. Got x-rays and they showed it was broken. Eventually healed and I'm fine today but doc said it could flare up again at any time. Note that this pain for me, was in the middle of the ball, not farther up near the base of the big toe.