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Jogging & Running/Shooting pain in 2nd toe at tip

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Question
Hello Sir and thank you for your time.

I am an experienced runner averaging around 50 miles per week.

On Tuesday evening I was running with my local club doing hill work. I was running down a hill when I misjudged the speed of some on the slower runners which caused me to brake - this brought me up on my toes (I am a forefoot runner by the way). No big deal, I carried on running, but about half a mile later I felt I had a stone in my shoe so stopped to take it out, but there was no stone inside. Ran again and had the same symptoms. I decided to call it a day and went home thinking all would be good the next day - it wasn't! Still the same feeling.

I haven't been able to run since as the shooting pain in uncomfortable.

I went to my Doctor for an x-ray and have been told there is no stress fracture.

To explain the shooting pain: If I put my full body weight of my right foot on the ball of my foot (over the big toe) the shooting pain goes to the tip of my second toe, but no other toes. If I push my fingers into the ball of my feet between the 1st & 2nd toe the pain, once again goes to the tip of 2nd toe. There is no pain in the ball of my foot.

I did a short video: http://www.youtube.com/watch?v=036KI2buxCU

What could be causing this and is there a remedy?

The Doctor suggested a cortisone injection. Should I?

I am quite down about this as I have two big races coming up in 3 weeks.

Thank you for your valuable time.

Regards,
Karl

Answer
Karl, admittedly I have never seen this before. I appreciate the video to understand better what is happening. I recommend 1 or 2 of 4 options.

1) An MRI will show more than an x-ray. X-rays are good with bones, but not with soft tissue.Further, an x-ray early on in a stress fracture, especially in a little bone like the foot may result in what we call a "false negative". That means it may read "negative" (no fracture), but that is "false" (there is a fracture).  

2) Rest for 2 weeks and see if it is any better after the 2 weeks. The drawback here is that you have 2 races coming up.

3) Get a cortisone injection. The drawback with cortisone injections is that they numb the pain and you may be causing worse damage. Maybe you're not, but maybe you are.

4) Ice and take an anti-inflammatory and see if it's any better the next day. (My guess is it won't be a lot better, but if it is then that is a sign that you possibly would be ready for your races.)

I highly recommend getting an MRI because it can't hurt in this situation. There is likely either a nerve impingement near the base of your 2nd toe or possibly a ligament sprain.

Good luck. Please let me know if I can be of further assistance. I'm sorry I couldn't be of more help,.  

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Nick Rainey

Expertise

I can answer questions about pain and training program. If there is a question about running that I don't know then I'll do some research and make sure I provide you with an answer.

Experience

I'm a Doctor of Physical Therapy. I'm a track and cross country coach. I train clients throughout the year. I've helped prepare athletes for their NFL Pro Days. I've written articles on running. Finally, those that I work with have less pain and run faster.

Organizations
American Physical Therapy Association- Sports Section

Publications
The 6 Week Workout Program- I'm the author of this book Research Made Simple for Physical Therapists- I'm the author of this Kindle book

Education/Credentials
Board Certified Clinical Specialist in Orthopaedic Physical Therapy Doctor of Physical Therapy BS in Exercise Science NSCA- CSCS and CPT USA Weightlifting Level I NPI- Certified Posture Specialist Total Motion Release Level II Certified Dry Needling

Awards and Honors
National Posture Institute's International Perfect Posture of the Year Award 2011 Clinical Excellence Award- Rocky Mountain University of Health Professions Aegis Therapies Scholarship recipient

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