Injury: Top-of-the-Foot Pain April 21, 2010
Posted by gobarefooting in Injuries, Uncategorized.trackback
I am active in a couple of barefoot running forums, and I am linked in on a number of barefoot sites. I love the opportunity to share and learn from fellow barefoot folks like myself. Having an extensive background in running and training, I tend to get a lot of questions, which I also enjoy. It seems that a majority of the questions I get are about injuries. This has kind of always been the case even before I became a full-time barefooter, and I was a little surprised to see that it also translates to the barefoot community. There is however a big difference in injuries between the two worlds, barefoot and shod. That difference is that barefooters are getting injured because they are not transitioning properly, and my shod runners are dealing with injuries from poor form, improper shoes, or overuse. With that said I decided to create a section on the site that will address common injuries for all types of runners from beginners to pros, both barefoot and shod.
My first injury to address is one that a lot of barefoot runners face:
Top-of-the-Foot Pain
There seems to be a lack of talk online about why runners get this injury, and I believe that is because a shod runner will rarely have to deal with it. Barefoot running is considered a new running fad so a lot of the issues surrounding it are not yet well studied or explained.
We all know that the foot is an extremely complex mechanism that gets seriously underused while wearing conventional shoes. It is made up of a lot of muscles, connective tissues, and nerves that are constantly handicapped by the stiff and cushy soles of most shoes. When a person decides to let his feet out of those shoes he is essentially taking his foot out of a supportive structure. I won’t say “cast,” but it is close. So there has to be some adjusting done to the way you approach your feet in terms of how much they can take and how to alleviate pain issues. I have outlined a beginners’ transition period in other posts, and I recommend you read them if you are making the switch. I also recommend you go there if you are suffering from pains or injuries in your barefoot running quest. Injuries are signs of doing something wrong, and learning to correct those issues will make the switch easier.
When running in a conventional shoe, the foot comes down on the heel, which means the toe is up, and the calf muscles are lengthened. That lengthening of the calf muscle puts it in its weakest range, and other muscles will have to make up the difference. One effect of this calf lengthening is the shortening of the muscles and tendons in the top of the foot and front of the lower leg or shin. You might not notice any of this, but over time it is happening, and switching to a barefoot or minimalist shoe will reverse it. When landing on the fore- or mid-foot, the foot is pointing down as it approaches the ground. This will lengthen the foot muscles and flex the calf muscles. You have essentially changed the muscles that are being engaged at foot strike and every joint has a balancing act that it goes through to work and stabilize the joint. The difference in foot strike will make a change in the joint’s balance and start using the muscles in a different way.
The typical runner making the switch will usually complain of sore and tight calves after the initial barefoot runs. This is because the calf muscles are now being tightened and flexed. After that initial shock is gone and the calves begin to adapt, the same runners typically complain of pains in the tops of their feet. These pains are usually coming from two muscles and/or three tendons that run the length of the top of the foot, one of which actually starts along the tibia.
The two main foot extensor muscles are the Extensor Hallucis Longus muscle (EHL) and the Extensor Digitorum Longus muscle (EDL). The tendons from these muscles cross the front of the ankle, pass across the top of the foot, and attach into the big toe and lesser toes. These are the muscles that run along the top of the foot. There is also the Extensor Digitorum Brevis muscle, but it is more along the upper/outer part of the foot and not typically associated with this issue. Three tendons cover these muscles: the Extensor Digitorum Longus Tendons. These muscles and tendons all function to pull the foot upward and work with resistance from the Achilles tendon and the calf muscles (flexor muscle group) that pull the foot downward.
When these tendons are over-stressed they become inflamed and painful. Swelling may come with the inflammation but not always. Most commonly it is the extensor tendon to the big toe (EHL) that is affected. In other cases the extensor tendons to the lesser toes (EDL) are affected.
Top-of-the-foot pain is typically considered to be a form of tendonitis but can also just be a muscle strain. The most common factors that cause extensor tendonitis are excessive tightness of the calf muscles, over-exertion during exercise, and falling of the foot arch. A barefoot runner will not have to concern himself so much with the falling of arches as the forefoot strike most commonly strengthens and builds the arches. That would mean the barefoot runner would typically be dealing with calf tightness since he is now using the calf muscles more than before. So if you switch to a forefoot landing after years of heel striking, then you are suddenly activating the weak muscles opposite the strong muscles you have been using your entire life. The pain in the top of the foot is usually going to be some form of tendonitis as these tendons are not used to being pulled on and stretched. The other problem is that in switching to the fore/mid-foot strike you are also contracting the calves more than before, which will then cause stress on the opposing muscles and tendons in the top of the foot.
All of you who started out with calf pain transitioned to top-of-the-foot pain for that very reason. Your calves got extremely tight and sore. A lack of proper stretching and relaxing caused a counter balance problem, which manifested itself in the connective tissues in the top of the foot. Remember that every joint in the body is a balancing act between muscles, and the pain you feel is rarely coming from the spot you are feeling where you feel it.
With top-of-the-foot pain you should stretch the calves and arches as well as taking anti-inflammatory meds. Getting the calves to relax and loosen up should be the main focus, as this will allow the release of the muscles and tendons in the top of the foot. Icing the top of the affected foot will also help in the recovery process. As with any injury the main prescription is rest. This may be the toughest of all pills to swallow, especially for someone who has just learned the pure joy of running bare, but rest and time, stretching, and ice will heal this issue, allowing you to get back out there and do what you love.
If you have more questions check out the article on Treatment and Recovery
Timely and helpful posting once again! It seems the greatest risk incurred in barefoot/minimalist running involves the occasional consequence of enjoying too much of a good thing.
I seem to have done that and am trying to “moderate my fun” a little to allow some minor TOFP to go away. Again, thanks – great work!
Duncan I’m sorry to hear about the injury. It’s always tough to deal with and tougher sometimes to come back from. I hope it all goes well and I’m glad the article was of some use.
Great article! This is a good explanation of a common complaint.
thanks Jason I appreciate the feedback. I keep getting asked about it so I thought I would try and answer some questions
Great post on TOFP, with a diagram to boot for honing in on the problem area! I was worried I had gotten a stress fracture, where the top of my foot felt slightly bruised, but after jogging on it for a few minutes the pain would go away, only to return pretty much the day after running. I have taken almost a full week off and the pain is going away! But I was still unsure about the stress fracture vs tendonitis or the like. Reading your post has me leaning towards an irritated tendon. Any advice on how long to rest, or how long to wait once I don’t notice the irritation any longer? Thanks for the article!
Same here Andy! My left foot is “slightly bruised”. The pain diminishes with rest, so I guess I’ll give it another day or two to go away completely. I also have felt a deep horizontal stretching mid left foot twice during my last 2 runs which eventually relax after the first 1/2 mile.
Yea, great article. I have the same question, how long do I need to rest it? I hate not being able to run, an I know this is going to be hard.
Due to the many questions i have gotten on recovery times i am going to add to the article so that it covers that area. I appreciate all the great feedback that I am getting on this and see that it is much more of an issue that I originally thought.
Great post! I had the same issue with top of foot pain… it was definitely tendonitis as after a few days I could trace the pain directly along the tendon path. I could also trigger the pain by squeezing my foot from the sides. I was able to get rid of the pain quickly by icing and putting some cottonballs in between all of my toes (I saw this online somewhere) and it pretty much instantly removed the pain so I left them in for a day and no more pain. I still stayed off of it for another few days to make sure it wasn’t coming back.
Great post and great additional information in the comments, too. This is the best explanation of the pain I’m dealing with, and a good source of encouragement in terms of how to deal.
what about side of the foot pain? under the ankle bone and extending toward the big toe? I am afraid that I have a stress fracture. I have been wrapping it but have had the pain since July.
Jill I would say it’s time to have it checked out. At the very least get it x-rayed and see. You’ve had the pain more than long enough for a stress fracture to show on an x-ray. Having a pain for that long in the place you say it is is not a great thing to have. Your description also sounds slightly like the pain is in the plantar fasciitis area but I’d say have it checked either way to try and rule things out and point you in a direction for recovery.
I have injury waling playing football back side of left leg above ancle from last two month i am suffering i am used TFT & Ultra sound,Massages and exceises i am not geting out this paing i am unable to walk properly & running and i am unable take waight on front foot of left leg any budy sugess me a good excises or medicine
[...] learned about TOFP on the web, realized my overzealousness and went back to my running shoes. While I healed, I again walked [...]
It is a very awesome information. Thanks for sharing. St. Petersburg FL back pain
I’ve been having TOFP for over a month. The majority of the pain has subsided but there is still slight swelling and pain even when not running, although after and during a run the pain goes away. Should I have it checked out or keep working on stretching?
At this point I think you need to shut it down and let it actually heal. If you can use phrases like “during and after a run the pain goes away” then I typically consider that not letting the issue heal. In your case it sounds like you need to try and stay off of it for a while and let the irritation actually subside. Stretching is great but sometimes you just have to stop and let stuff sit still. You are having pains and swelling when you are not running which is a big indicator that it’s time to do some serious resting and healing; like time in a boot healing. If a couple of weeks don’t do the trick then it would be time to seek medical opinions for sure.
Thank you! Great post and needed as i go down the barefoot transition.
Fantastic post! I am not a runner, I am however almost always barefoot
I have a bulging muscle on the top outer side of my foot and have been searching for some answers, this is very helpful tx
[...] Which leads to my next problem. My inability to fully toe off on my left foot. I have a severe pain on the top of the foot where the shoe laces tie and after looking for some answers, stumbled across this blog post by gobarefooting. [...]
Pain sucks.
Ah! Thank you SO MUCH for your post! You described the exact thing I am experiencing, including the calf soreness, which went away several months ago. The doctors did not seem to know what was going on (as they probably don’t know much about barefoot running), so I was so glad to find your post. I will let it rest and heal. I was running on it, because I noticed that once it warmed up, I could run really fast and the pain was at bay, but it would come back twice as badly once I finished my runs and sprints. Thank you again!
This is just what I needed, thank you!
Thank you so much, for this post. I walked 12 miles in my five fingers the other daY, and I was puzzled by the pain on the top of my foot. I’ve been in ‘barefooting” it for 2 years now. My question is, my pain gets worse ,whenever I wear “normal” shoes/slippers, is this normal?
Yes it can be worse when put in conventional shoes. The reason is typically the heel to toe differential. That drop from the heel stretches the tissues on the top of the foot which can cause it to hurt a bit. I’ve gotten to a point where I cannot wear a pair of shoes with more than a 3mm toe drop without pain issues. I also posted an article I wrote on how to recover from TOFP so if you haven’t read that yet I would recommend it
Lovely and informative post! All the more reason not to freak out.
I have experienced this too. I have always enjoyed going barefoot, and started barefoot running about two months ago. I was out of shape generally, so it was easy to take it slow, from one mile, then to one and a half miles, then two miles, until, after about a month, I tried three miles, and got Top-of-the-Foot Pain, on my left foot, for the first time. However, on that same run my ‘index’ toe got caught underneath my foot twice towards the end of the run, when I was tiring and not picking up my foot sufficiently. Could that have caused the pain, or do you think it’s a coincidence?
Erik I think it could be a bit of both. I would probably lean toward the toe getting caught as the main culprit though. Consindering you had no pain till that run where you had that happen I would say it probably came from those toe drags. The key will be to let it heal to a point of no pain and then see how your foot feels after a short run of a mile or so. The next thing I would pay attention to is the fact that you were getting to a fatigue point where you were not able to maintain your form. That is a solid sign that you were doing more than you needed to be so when you do get back at it I would say to add the mileage a little slower so you have a better adaptation phase.
Thank you for your timely reply, and the great advice. I forgot to mention that for the last three weeks I have reduced my runs to one or two one-mile runs per day, along with about two miles walking barefoot with my daughter on my shoulders, to and from daycare. The pain had been gradually lessening, but then today it seemed greater, after three days of no walking or running barefoot. So perhaps I’ll try a full week of rest, or to the point of absolutely no pain, as you recommend. Thanks again.
Great article. It describes the pain I have in my left foot. I train in both lightweight neutral shoes and Vibram 5 Fingers. Three weeks ago, I did 1.5 miles of hill training in racing flats and several days later noticed discomfort in the top of my left foot. I thought it was from too tight laces and shifted more to the Vibrams. I am training for a marathon in 9 weeks and was hoping to get in an 18 mile run today but stopped at 10 as I felt that the foot pain, while not severe, was a sign to give it a rest. Do you recommend I lay off running for a while? If so, how long? Also, should I keep training in the Vibrams or do more running in neutrals? Finally, what about Advil? Thanks!
Taking it easy would be a good idea but you don’t have a lot of time left to get ready for your race so there is a conflict there. I would advise you to lay off the Vibrams for now and possibly for the rest of your training for this race. A less flexible shoe will help you keep those irritated muscles relaxed even while running. Yes running minimal and bare is all about working those muscles but if they get over worked then you are left sitting. I recommend icing the foot as well as massaging it to help work out the irritation. You may try taking a week off as that won’t cost you very much in terms of training and just adjust your taper period the weeks before the race. Advil is good for helping to get rid of inflammation so I do recommend it but not while running. You should avoid all pain relievers other than Tylenol 24 hours before and 6 hours after racing. Good luck
I’m happy to say that after laying off a week I saw my doctor (former runner) who initially thought I had a stress fracture. X-Rays and lack of pain changed his mind. He recommended I layoff Vibrams and X train for another week while gradually building up mileage to former levels. I’m happy to say that, after two weeks, I’m just about back to former mileage albeit at reduced pace. I’m taking Hammer Recovery pills and skipping Advil since I no longer have swelling. I’m also much more mindful of Chi Running technique of NOT pushing against feet and toes and landing with midfoot strike. I’ve also adjusted expectations for the race and, instead, focused on how good it feels to run pain free again!
I took on barefooting (slowly) a couple months ago and I started getting top of the foot pain a few weeks ago, so I stretched, relaxed, iced, and took it slow. It seemed to go away mostly after 2 weeks and I figured I was healthy enough to compete in a 4 mile race this weekend. Not even a mile into the race my TOFP came back, and it was 1000x worse. I finished the race walking because that didn’t hurt as bad. Turns out I broke a metatarsal, the one of my second toe (one next to my big toe).
So I have a theory that perhaps some TOFP could be from small fractures from muscles and tendons not being strong enough to support body weight properly and putting too much stress on the bones.
Since this happened to me and I thought it was just sore muscles and tendons based on everything I read online about TOFP, I would advise anyone with TOFP to be a bit more cautious, take time off, do more stretching and strength training for your lower legs, and be sure your form is correct before even taking on distances of a mile or more.
Hope someone can learn from my mistakes!!!
This is such a great post! Thank you!!
I am dealing with this issue now and am having a very hard time finding information on the web that I feel I could trust.
Just a few questions…
1) What are the risks of continuing running on a foot with this kind of pain? Fracture?
2) are there any particular stretching and strengthing exercises you could recommend? I read on KenBobs site that lying on a bed on your stomach with feet hanging off mattress, flex feet and toes up, hold for 30-60 second, repeat. Thoughts??
3) is there any good way to distinguish between muscle pain/ tendinitis and fracture??
Again, thank you so much for this post and this site!!
Chris (aspiring barefoot runner that can’t get past 9mi without getting hurt)
Hi Chris I hope things are going better for you and I will try to help as much as I can. 1) Running on a foot that is suffering from tightness or connective tissue irritation can cause stress fractures so you need to be careful. 2) I think Ken Bob’s exercise is perfectly fine but I recommend curling your toes into carpet, picking up a towel with your toes, and doing barefoot calf raises for strengthening. Between those three movements you basically hit all the muscles in your foot. For stretching you just need to flex and stretch your toes both forward and backwards as well as apart. 3) It is difficult to determine if soreness is a fracture or not. This biggest indicators are typically the sharpness and acuteness of the pain. If it’s sharp and in a specific spot then it may be a break. If it’s more dull and spread out then it might not be broken but you are at risk. I hope that helps and I would also tell you to stop trying get past nine miles. People get too caught up in trying to increase distance when what they need to be doing is building a base. Doing more 4-5 mile runs will build your strength and allow you a better opportunity to adapt which will allow you to get those longer distances in.
I’d also like to ask for some information on distinguishing a stress fracture from tendonitus. I ran a tough trail marathon a little over a week ago in minimalist shoes and felt fine during the race. However, a few days afterwards I went on an easy run on some flat trails and there it was–TOFP on my right foot. It seemed to fade the next day so a few days later I tried again and it was bad enough that I had to stop and limp home. It was swollen and stiff for a few days. I’ve been crosstraining and icing and while it doesn’t really hurt anymore, it is still swollen and stiff. I tried running on a treadmill yesterday and stopped immediately because I was limping. The weird thing was that it didn’t hurt. I was limping because I didn’t have the full range of motion in my foot to push off properly. At first I feared I had a metatarsal stress fracture, but since I can’t find any particular location of sharp pain, I’m leaning more toward tendon issues… Any guidance or advice?
Sadly Rachael my advice is to have your foot looked at by a doctor. The swelling not going away is something I would say is a concern. If it had swollen and gone away in a day or two I might have said you had some inflammation but since it’s sticking around I fear it’s more than that. I like that you were able to go run without pain but the limping and lack of motion is a big concern. I would definitely recommend you not run on it and try to avoid doing things that will have you putting excess pressure on it until you can have it looked at.
I just wanted to follow up on this and thank you for your advice and great article. You were definitely right. I’m usually wary of heading to the doctor right away, especially since many are not supportive of the minimalist thing, but it turns out that this time I needed to. I was also lucky to get a great podiatrist who diagnosed me within minutes before even the x-rays confirmed it. I had a stress fracture in my third metatarsal. It’s amazing how quickly it happened. I felt like there wasn’t much warning, but now that I’ve experienced it, I think I understand the symptoms better. The sharpness of the pain and the way it throbbed even when I wasn’t moving my foot should have been a tell-tale sign. Thankfully, it healed very well and quickly, and I was given the go-ahead to start running again almost a month ago. I’m gradually increasing mileage and am still running in minimalist shoes (Merrill Barefoots). Ironically, I’ve actually been having very slight TOFP that feels markedly different than the stress fracture, more like what you describe in this article. The biggest difference? How diffuse it is and how related to movement. When I flex my toes I can feel the tightness.
Anyway, thanks again for putting me on the right track!
Just a follow-up to add to the info already given: I found that stretching my foot really helped with my top-of-the-foot pain in my left foot, as per gobarefooting’s advice. I now stretch both my feet before and after running as well as periodically throughout the day. I stretch them both toes up and toes down, the latter by holding the top of the foot to the inside of my thigh, sole facing me, knee pointing away at a 45-degree angle (a stretch I Iearned in karate). I’ve also become more vigilante about stretching my calves and hamstrings, but I think stretching the foot has been key to my recovery. Thanks again.
Thanks to all for the information on TOFP. I have been suffering with this for over a month and all of this info makes so much sense. I will try stretching more and strengthening my lower legs. I am more of a walker and mountain biker and it is strange because when I am exercising I don’t notice the pain as much as when I am laying in bed trying to sleep or just going about my business during the day. I am a hairstylist so I am on my feet a lot of the day and I am sure it does not help that I wear flip flops much of the time. I live in the desert.
Yup, this sounds like my problem too. I walk about 3 miles a day, 5-6 days a week. I started wearing VFFs mid-summer-ish. The top of my right foot towards my ankle has been bothering me for at least 3 weeks. It is most bothersome during non-walking times and having the weight of winter blankets pressing down on it at night seems to aggravate it. Right now it is tender to the touch and hurts if I have my ankle at anything but a right angle.
Thanks for you article! I had been experiencing tight calves for a couple of weeks, but it gradually got better and was gone. I then developed TOTFP, and wasn’t sure what was going on. I am training for a half marathon in two weeks. I did the first six miles today, and my foot was hurting, so I came back and changed from my five fingers to my nike frees, and it felt much better! I was encouraged to find your article to tell me what was going on. Now I am off to ice my foot!
Thank you so much for this informative article! I’ve been experiencing tendonitis in my foot and ankle for way too long! Your article not only explains what’s going on, but also gives helpful suggestions on how to solve the problem! It’s hard to stay off my feet long enough for the tendons to truly heal, but I’m hoping that stretching my calves will help.
Thanks again!
You’re welcome Sara and I hope you heal up fast!
[...] run the length of the top of the foot, one of which actually starts along the tibia.” (from http://gobarefooting.wordpress.com/2010/04/21/injury-top-of-the-foot-pain/) That sounds about right! GA_googleAddAttr("AdOpt", "1"); GA_googleAddAttr("Origin", "other"); [...]
Thanks for the article. I’ve spent hours researching the injury online since getting the pain on Sunday night (now Tuesday). Great to know it’s not as serious as I thought. Am resting now but have a half marathon booked for Sunday night (White Night, Brighton) and really want to take part. That said it will be the furthest I’ve run in minimalist shoes (Trail Glove) even though I’ve been running in them since July. Will ice again tonight and not do any training at all until the race is upon me, my question… do you think I’ll be fit enough for it or am I kidding myself?
You’ve got a week or so before the race so you could be okay to run the race. The other key is how long you have been able to run in your Trail Gloves up to this point. If your long distance is near the race distance then you should probably be alright to go after resting this week. At this point I would say if your prior training is up to par and the foot feels healed and without pain on race day then go for it. If your long run isn’t 8 or more miles up to this point and/or the foot still hurts then you might need to sit it out. I wish you good luck and think you’ll probably be okay to go after resting.
Thanks gb. I’ve run 9 miles in my Merrells without any problems at all. I run 3 times a week in them two 3 milers and a 6 miler and have done for the last month, as well as running 10k trail races for the last 3 months (1 a month). Pre this injury I was feeling like I was getting to the next level with the new barefoot technique. Perhaps in the excitement I’ve been overstretching my stride and that’s led to this. Or it could be that my last run came after playing soccer for 90 minutes in the morning and it was too much. I don’t know. However I will do as you say and rest until the day of the race and see how I get on. Until then I will keep icing and taking anti-inflammatory tabs. Thanks for all the help and advice.
Hi again, Just thought I’d let you know I completed the Half Marathon race in the end. Not fast as was difficult course half of it uphill, 1hr 52m. All went absolutely fine, no pain in my foot… apart from fatigue. Thanks again for all the advice, it really helped.
Thank you for the information about barefoot running and pain. About nine months ago I began running half-time with Vibram Five Finger shoes. And in the past five months or so I’ve been running exclusively running in these “shoes,” to alleviate the knee pain I have suffered for years, knee pain that I believe was initially caused by being a heel-striker. Running with Vibram’s has allowed me to continue running by runningon the balls of my feet, taking strain off my knees. However, in the past couple days I’ve had severe pain at the pain of my big toe. So much pain that I’ve hobbled around in to work today like an old man. I wonder: Is this related to the TOF pain you describe here, in which case “RICE” is the best antidtoe. Or is it something else?
Sadly the answer is that it could be both. It could just be TOFP and it could be more. It could be soft tissue damage or it could be a stress fracture. In these cases I tend to take a wait and see approach. If it’s just TOFP you’ll notice it getting better each day as you rest. If it’s more than that the pain will stay at the same level as you rest and you should have it looked at.
I just googled my injury because it has been 5 days since I ran last and I am freaking out. Then I find your post here that describes what happened to me perfectly from start to now. I am so impressed!!! I just started running 3 months ago barefoot on the beach down by the waters edge and I for sure don’t want to give this up! I am dissappointed about the rest part, very difficult for me. I went for a 1 mile walk on the beach today to see how it (the injury) is doing and of course I am in pain again. I usually run 5-6 miles so this is a shocker! I actually couldn’t walk at all on my right foot for 2 days when it first happened. I now can walk but still have pain. I have been icing it as well. YES, I had major tightness and pain in my calves after every run but I started spending much more time stretching afterwards and my calves felt better THEN this top of the foot pain which is way worse. So here is my question finally…..What can I do to get back to running sooner than later. I am a big eater and running is the only way I equal out. Help!
again thank you for having this blog!
this happened to me, and then i rested and massaged my foot. but i think i might have made a bigger problem. one day i was massaging my foot with a golfball and accidentally put all of my weight on it. i heard a snap and felt a lot of similar pain. now my bone feels higher compared to my other foot. i’m referring to the bone that leads to my second largest toe. for about two months now the swelling has reduced but not gone away completely, given i still occasionally tried to run. please recommend a course of action. i’m in highschool and feel like i have a lot of potential. but my xc seasons have been riddled with injuries and now i only have senior year left.
The only answer I can give you is that you need to see a doctor and do not run on the foot until then. When you have things like “pops” and bones that feel out of place you have to take it seriously because it usually is. Injuries come from a lot of reasons but most of them are from improper training or care of the body. A lot of injuries also come from things like muscular imbalances that go unnoticed or untreated and they build up until the body breaks. Once you’re healthy and cleared by a doctor your best course of action is to adopt a well rounded routine that focuses on base ability, good flexibility, overall strength training, and functional stability training. All of that will help you become a better runner but more importantly keep you healthy. You also need to make sure your form isn’t an issue that’s working against you. Study running form inside and out. Look at different running types of runners as well as the history of running technique and then analyze your own form and technique. If you want to be good at a sport you have to know the mechanics of the sport and I also encrouage you to learn the history as well. To excell at something you have to know it inside and out. Go see a doctor and good luck.
ok. Thanks. I do do a lot of cross training and balance training and all the years I’ve been injured I’ve wanted nothing more than to just be able to run so I had been looking into everything I could do. and for two years people convinced me out of running barefoot and to get a shoe with good stability. and I can’t tell you how many crazy shoes I have about 20 miles on now. Finally my brother’s friend kurt showed me how to fix my shin splints by running with the pose and evolution methods of running, and my shin never hurts when I feel like I’m doing it the right way, but my foot does. Now I have one of the most recommended wide barefoot flat shoes with a little stability for transitioning, (altra instinct) and I tried to not blow out my calves, and then my foot hurt really bad about two miles in one day out of nowhere. So I think I’m doing everything you said was the problem in the article. The only difference is the possible bone and swelling that won’t go away. So I’ll be sure to get it checked out. Thanks for the advice.
Do you think that extensor tendonitis could result from a stress injury from running? i was diagnosed a couple years ago with a “stress reaction of bone” in the 4th metatarsal on my left foot. xray never showed an actual fracture, but the pain was definitely right on the metatarsal and it hurt really bad…so doc treated it as a fracture. i was put into a boot for almost eight weeks (while 7 months pregnant) and since then i’ve had on and off (mostly on) TOFP. For a long time we thought maybe the metatarsal hadn’t healed…even went into the boot for another few weeks…but as time went on, and after lots of internet browsing, i began to think that maybe i had developed tendonitis in that same area. i lost a lot of muscle, strength and flexibility in the ankle/calf from being immobilized for so long. this past summer the doc sent me to PT which confirmed some strength and flexibility problems. i’ve managed to get up to 2-3 times a week running, but no more than 3-4 miles…and never on consecutive days…without horrible pain. but anytime i push it, in terms of distance, speed or frequency, i end up on the sidelines again…and back in the pool. i’ve noticed that when i walk barefoot my foot usually feels pretty good, but as soon as i put on my running shoes i feel the pain…which leads me to believe that the angle of my foot in the shoe is stretching and irritating the tendon…before i’ve even started running. (i do try to soak my foot in warm water before runs to loosen up/warm up the tendons, but with three little ones, let’s just say that doesn’t always happen.) so anyway all of this is leading me to consider trying a minimalist shoe (not sure i’m brave enough for barefoot! especially with a cold snowy Cleveland winter approaching!) wondering what thoughts you or any of the other readers might have. i’m getting really close to asking for a cortisone shot in hopes that it will wipe out the inflammation (and associated pain) for good!
Yes I do think that your problems could have been caused from running but not just running itself. It was probably the shoes in combination with your mechanics on some level. It sounds like you’ve done all the right things medically which is great and I’m glad you have. At this point I would make two recommendations. 1. Strengthen your feet. Treat them the same way you would your core or your biceps and do exercises that specifically strengthen the muscles in the feet. I listed some in both articles I wrote about TOFP. 2. Change the shoes. You don’t have to go all the way to a minimal shoe. A lot of barefoot purists will tell you that you need to just run barefoot but you don’t have to go that far in order to obtain improvement. For people who want a conventional running shoe and the same cushioned feeling I highly recommend Altra footwear. For the women the shoe is called the Intuition and I just don’t think it gets any better in the world of cushioned running shoes. It has a foot shaped toe box, Zero Drop (perfectly level) sole, and they are gender specific in the design to fit a woman’s foot. If you want to go minimal Altra also has a really great minimal shoe offering as well. There is always of course our old friends the “Toe Shoes” known as the Vibram Five Fingers. I think with the right footwear and getting the foot stronger you can alleviate your pain issues and avoid the cortisone which may help but won’t be a permanent solution if the cause of the problem isn’t fixed.
Wow!! Great stuff here….I’m glad I found this….trying to help myself here. I had a brief consult with a podiatrist who wasn’t familiar with this type of pain. (“Only see this when someone has dropped something on their foot”). He ordered X-rays which were negative. He padded up my arch which helped and also placed a pad with a hole in it on the top of my foot and told me to make sure my laces dont hit there.I’m a nurse and on my feet all day and I’ve been limping around and my foot has been swelling at the end of the day!
I have a life dream of running a marathon and recently started running (or jogging I’m slow!) and the tops of my feet have been hurting but also my calves! I stopped and went on vacation but was walking in sandals – they are flats with a supportive bed but also did a lot of barefoot walking in the sand. Anyway, when I returned home the TOFP in my left foot is severe! This article has given me hope – every time I have started to train it seems that some pain stops me. I have to do run this next year – I just have to…..I can’t imagine running barefoot as I wasn’t doing that so it had to be the improper stretching of the calves? Thanks for the article and what type of shoe to buy. I will stretch, Motrin and ice and rest till the pain subsides and find those shoes!! I’m going to strengthen my feel too which makes complete sense. Wish me luck as I go for accomplishing a lifelong goal!
Do you have any advice for me? I know in my head I can do this but will my body agree? I feel like I don’t care how much or what hurts – I have to do this even if I crawl past the finish line. Date of race is 10-21-2012!
I like your drive but don’t let it take you to a dangerous place. If your pains keep coming back then there is either something wrong in your mechanics or in your gear (shoes). For someone who has a lot of foot swelling and/or mechanics issues I’ve found that shoes can make a world of difference. I’ve recently spent a lot of time running in and working with the Altra line of footwear and I have never been more impressed with a shoe. For women the shoe is the Altra Intuition and the benefits it brings are huge. By having a level sole it offers a lot of help in overcoming heavy heel striking as well as decreasing impact forces at landing. All this is done by something very simple and that is what I like. It’s also foot shaped which gives the toes room to spread out and give you better balance through the ankles (pronation). I hope you reach your goal and keep me posted on the progress. I always love a good success story. Also if I can help in any way please let me know.
You’re the best!! Foot feels better with rest and stretching!! I’m going to find those shoes and start again. I have to do this….lifelong goal and dream!! I will keep you posted!
I think I fell victim of the “too much too soon” syndrome. Yesterday my third actual “minimalist” outdoors run went fine aside from the to-be-expected tired-out calves, but a couple of hours afterwards my left foot started showing… well, symptoms.
First, I felt a sort of ache, yet also a kind of numbness at the ball of the foot. Then, it seemed to move to the top of the foot. And now I can’t even really locate it anymore, though it’s definitely more to the top and also outer edge of the foot, even perhaps including near the ankle. Go figure!
There’s no sharp pain at any given location or such, so I assume it’s not bone-related. Nerves, tendons… who knows. I’ve tried poking places, like the “knuckles” etc, but still can’t locate what is wrong exactly. Putting ice on it doesn’t seem to make a difference, except for a brief period it actually aches more all around. My feet don’t seem to like the cold much!
I can walk with the foot ok, heck I could probably even run (which I obviously will not), but despite the lack of any sharp pain it’s not entirely comfortable to even walk. And if I’m not thinking about what I’m doing I notice I sometimes start to slightly limp to keep weight off of it.
I suppose I’ll just keep monitoring the situation and try to figure what, if anything, I can do about it. Visiting a doctor around here is useless, they seriously know less about sports injuries and such than most non-doctors
It sounds like you have the right plan. The most frustrating thing about TOFP is that it’s not always pressure sensitive because there are multiple layers of muscle in the foot so not all of them are reachable through the skin. You can only feel the pains during movements because of that. A great indicator is movement and whether or not you can feel the pain then.
Hmm, for the last couple of days I’ve thought the foot has swelled somehow, somewhere, but couldn’t pinpoint it. But it seems to be at the ball of the foot where the numbness and ache began. If I don’t put any weight on the foot and lay it on the floor, the ball is swelled enough that that the two smallest toes on the left don’t actually touch the floor all the time. This also explains why now it feels that the foot tends to land “side-heavy” towards the left, with the outer edge taking a lot of the weight. Should I just try applying ice on the ball of the foot and hope the swelling subsides? The foot does feel slightly better now, but definitely not normal yet. Anything else I should look for in the swollen area?
Meh, on further thought these symptoms lead be back to the “condition” that I first read about before ending up here – metatarsalgia. Darn it.
Or possibly even worse, Morton’s neuroma. Sigh, further investigation warranted.
I’m curious where you wound up? Did you ever have it diagnosed?
Haven’t had it diagnosed… and rest hasn’t really fixed it yet either. It’s still strange in that the symptoms seem to shift, with sometimes the ball of the feet being problematic, other times the outer edge of the foot, etc. Still no sharp pains, but not entirely comfortable to walk/stand for long periods of time even in padded shoes either.
I did go on a short (about 2,5km) run a few weeks back with “normal” shoes and heel-striking. It didn’t make the foot any worse, but damn did it immediately kill my back once again. Other than this, haven’t done any running since the foot issues first exhibited.
After having recovered, after a while I went on a 5.5-mile run, and got some TOFP pain again in my left foot. So I finally got the foot xrayed. Turns out I have a tiny stress fracture on the third metatarsal. But the doc said it was already healing. So I started running every other day, three miles max, and adopted a mid-foot strike instead of a forefoot strike. This helped a lot, but I did feel it a bit more in my knees. So perhaps other folks might want to try a midfoot strike while they’re working through their TOFP.. It seems to help take some of the stress off the metatarsals.
I like your thoughts and think you are on the right track with moving to a mid foot strike. A forefoot strike is not very natural unless you’ve been doing it your whole life. Forefoot striking is a big misconception among those just starting in minimal/barefoot running. A mid foot landing is by far the best in my opinion.
As for working through TOFP I don’t recommend it. Rest and rest properly is my advice. Let it heal and you won’t have to “work through” it.
I was so glad to find this article. I’ve been running in regular shoes, but once a week I run low mileage (5-6 miles) in Vibrams. Last week during my run,the pain started on the bottom outside of my foot; after my run, I ended up with TOTF pain. I have to start training for Boston in a couple weeks but can’t find your article addition on how long to lay off with TOTF pain. If I stretch and ice, what’s your opinion? Also is it bad to switch back and forth between regular and Vibram shoes?
Sorry for the long time to respond but hopefully your problems have subsided. Resting time for something like TOFP is extremely variant. It’s completely different for nearly everyone. It shouldn’t be a problem to switch between shoes if your form is good. If your form cannot hold itself across different types of shoes then it could cause problems. I personally could go run just about any distance in nearly any shoe but not everyone could do that without problems. Starting something like minimal running is not something I advise during marathon prep because it requires a lot of monitoring and sometimes rest which is not something you can do during long distance training. My advice would be to limit the VFF running to 3 miles or so; forget what you think short distance is because 5-6 miles is not short for someone new to minimal footwear; and see if that helps. I would also only do it for the one day like you said. If it’s still causing problems I would leave the VFFs alone until you are in a downtime with your running so that you can give your feet the rest they need to make that transition.
I have bought a pair of VFF two months ago and I absolutely love the feeling of liberation from this new way of running. Besides the odd blisters I can cope, but recently the top of my foot started aching along the smaller toes. Your article was very helpful in identifying the problem! I did go a little crazy with my new shoes and ran a LOT, and I guess the best thing to do now is rest, which I’m not going to enjoy at all! I already rested for two weeks but tonight it came back and I struggled to reach 5k, it’s not swollen or painful unless it’s in mid-stride. *sigh, I just want to run
Part of your problem could be the blisters. Blisters hurt and pain causes things like your stride to be altered to try and avoid the pain. If you’re getting blisters often then you need to look at your form or the fit of the footwear and see either of those is causing the blisters. It’s a small thing but it becomes a cumulative problem that can cause a lot of issues. Other than that it might just take you longer to recover than you would like. No one likes being limited and having to rest injuries is never fun but you have to let the body heal or you’ll just be fighting this battler forever.
I’ve been wearing minimal shoes for about 1 1/2 years. I stopped having calf pain a long time ago, but I have transitioned to the top of the foot pain for about 4 months. It started when I wore out my evos and decided to try NB minumus road. The pain would come and go. So I transitioned to nike free runs. Now I have more pain. The only shoe that brings slight relief is my merrell moabs. I went to the doctor and had them x-rayed and found no breaks. He noted the bone spurs on my halux on the left and right foot, which I already knew about. Your article makes sense. I will try stretching. I will have trouble resting though. My job requires me literally to walk 50 miles weekly(meter reader). What can I do? I love minimal shoes they help my halux limitus and knee pain. Can wearing stiffer soles help my feet rest? I’m also doing a barefoot near midfoot strike when I’m walking. Should go back to long strides until my foot can recover? Any help would be majorly appreciated, thanks!
I apologize for the delay in response but I have some thoughts. First I’ll ask if a midfoot strike is normal for you when walking or is it a change you made? If it’s not natural then it could be part of the problem as it’s fairly taxing to walk with a midfoot strike. Most people walk heel to toe which is perfectly ok when walking. Stride length when walking won’t make much difference as long as it’s your natural motion so I wouldn’t worry about that part much.
A stiffer shoe when walking will definitely help the foot relax. That’s sort of the whole point with this minimal/barefoot movement. Less under the foot means the foot is allowed to move more freely which works it more. A stiff shoe will hold it still and keep it from moving as if it were in a brace. While trying to let it heal it would be good to try a stiffer shoe and see if that helps.
Thank you for addressing this as a barefoot runner. Websites who are against minimalist and natural running all just assume top-of-the-foot pain is a stress fracture. My routine would suggest that my injury is NOT a stress fracture, so I’m glad your article was here for me to get another opinion.
great article. I have been experiencing top of the foot pain after barefoot skipping. I would be interested to hear you thoughts on whether this is a good form of cardio? I’m not a runner.
I’m assuming that by skipping you mean jumping rope? My answer is yes. Jumping rope is a great form of cardio because it uses a lot of muscles and really gets your heart rate going. You can vary the speeds and ways you do the exercise to keep the body guessing as well. Doing this barefoot gives you more strain and strengthens the feet a lot. It also will help you develop better balance and coordination. This has long been one of my favorite exercises that I feel really is underutilized. If you meant actual skipping, like across a field of daisies, then yes that is also a good form of exercise that will give you similar benefits to jumping rope.
I was recently introduced to barefoot running. Unfortunately for my feet & bank account, I approached this like a science experiment; I went out & bought 4 different types of minimalist shoes, from Five Finger Vibrams, Nike’s Free Run, Merrell and Newtons, and at first only my calves hurt but as I changed to different shoes every run TOFP increased. Can changing shoe type/technology actually make my injury worse, or even more horrifying , ” can wearing different minimalist shoes make my transition from heel striker to mid foot stricker longer & more painful!?!
Orphelia, there is a lot of anecdotal evidence that it’s best to start off barefoot, for very short distances. Once you got the form down, and you no longer feel any pain, you can use minimalist shoes if that’s your preference and/or if temps and/or terrain demand it. If you’re running on dry asphalt above freezing, there’s probably no reason to wear shoes at all. You may find it’s possible to run down to 20F or so.
Yes it could be coming from your constant switching of shoes. When you look at all four types of shoes and how they are approaching the same goal it could be too much of a shock to your under strengthened feet. The purpose of the shoes you bought is to change the way you run and they all do it differently. Five Fingers are super thin and super flexible. Nike Free is super flexible but the same thickness as any other shoe on the market. Merrell is an in between not being as flexible as either of them but not as thin or thick as them as well. Newton is similar to most shoes except that they have more weight and materials (the lugs) under the fore foot to force a fore foot landing (my least liked shoe here). My advice would be to go with one pair for now and out of those four I’d recommend either the Free or the Merrell’s to start with. The Free is good because it’s more flexible than you are used to but offers you a similar feel to your norm. The Merrell’s are your collection’s in between shoe so you wont have the same cushion but you also wont have a thick heel to land on either so they could be a good choice. Once you settle on a pair of shoes you need to go out for very short mileage focusing on two things. 1. Take shorter and more frequent steps. Don’t shuffle but don’t worry about having a long stride. 2. Don’t worry about the landing so much. I personally think it’s more ideal to land flat footed. The fore foot can put you too far up on your toes and we already know about landing on the heel being bad so try to land more flat footed and under your center of gravity. Most of the time just trying to take shorter strides will accomplish this. Beyond all that your focus also needs to be on making sure the sore and tired muscles of your feet recover and stop hurting or you’ll be dealing with more severe issues like stress fractures. I hope this helps and please let me know how it goes.
Thank you, I appreciate the the advice, it was hard picking which one to use, since I kept getting different views on each one. I’ll try to stick with one for now and see how far I can go. & will definately watch my form… I’ll keep you posted!