Foot injury (longstanding)

[DuncanM]

Almost 3 years ago I managed to fall over a football in such a way that I landed on the end of my right big toe with the foot pointed vertically downwards and all my weight going through it. I was wearing super flexy shoes, so there was no support there, and the foot bent in a way it's definitely not supposed to. X rays of the metatarsals at A&E were negative, and they suggested it was "just a soft tissue injury". After the swelling refused to go down I went to my usual physio, who said he thought I might have done some ligament damage. With exercises and massage, it got to the point where I could walk properly, and eventually do my daily activities and ride my bike again, so I moved on and left it at 90% function thinking that was going to be as good as it got. The joint at the base of my big toe has never regained it's full range of movement, and the arch on this foot is significantly lower than that on my left.

Recently, I've been doing weighted lunges in the gym as part of a program to try to make my right hip work properly. This has irritated the big toe joint significantly, to the point where it hurts to walk, so yesterday I went to a podiatrist. He said my right ankle was over flexible, and that the calf muscles had tightened up to compensate.  This was tightening the plantar fascia, resulting in tension throughout the foot, causing my symptoms (I also have pain around where the plantar fascia is, and he said he could feel the inflammation in there). The treatment is to ice the sole of the foot for 5 minutes, and then do "heel drop" calf stretches to lengthen everything out and reduce the tension and inflammation. He also said there were early signs of arthritis in the big toe joint.

Does anyone have experience of similar issues with feet? I've never had any problems with my feet prior to this injury, and it seems so complex I'm out of my depth!  Also, is it worth going down the GP referral route, or will that just end up with me at a podiatrist after a huge wait?
I'm also wondering if the lingering foot issue is what has caused my hip problems, and whether they can be resolved without fixing the foot, but I don't think anyone can answer that.

[hellymedic]

The conservative advice I would suggest is experimenting with fairly rigid shoes, with or without arch supports, offering varying degrees of extension at the base of the big toe and seeing what seems comfortable.

[ravenbait]

Does anyone have experience of similar issues with feet? I've never had any problems with my feet prior to this injury, and it seems so complex I'm out of my depth!  Also, is it worth going down the GP referral route, or will that just end up with me at a podiatrist after a huge wait?
I'm also wondering if the lingering foot issue is what has caused my hip problems, and whether they can be resolved without fixing the foot, but I don't think anyone can answer that.

I am not a medic but have suffered similarly. I tore the plantar fascia (do NOT recommend) in a triathlon. It meant I couldn't walk for nine months. I now have arthritis in the big toe and a bunion on that foot. I tried the standard advice of rigid shoes and insoles etc, but the only thing I have found that helped was moving away from shoes to Vibram fivefingers and retraining my biomechanics. I can't recommend it as it goes against every bit of medical advice I ever received, but it worked. I was able to go back to competing having been told I couldn't run again. I suppose if you find you are able to move better barefoot (which is what persuaded me to give it a go despite the advice), it might be worth a try?

Sam

[DuncanM]

Thanks - I guess I'll have to experiment.
My current trainers are quite sturdy, and I've got (of the shelf) inserts in them and my bike shoes. I can definitely feel the lack of arch in my gym shoes, but I don't think they were a problem until I was putting significant weight through my flexed (back) foot when lunging. That foot feels less stable when not in shoes, though that might just be my perception.

[ravenbait]

I was less stable for ages, but I was pain free, and that made the difference between being able to work on it and not.

As I said, though, it might just be that I'm peculiar.

Sam

[mrcharly-YHT]

<just responding to subject>

Recommend you stop standing on foot and give it a break.

[CrazyEnglishTriathlete]

I didn't do anything as dramatic as bend the toe like that, however, in November 2018, I came up lame after running a half-marathon in training.  I assumed things would pass - but over the winter it didn't settle down - more than a few miles walking the middle toes on my left foot would swell up.  I'd already got arthritic damage to the big toe joints on both feet.  My physio had a look and recommended an x-ray for a stress fracture - which required a visit to the local GP, who couldn't have been less interested if they'd tried. 

I gave upon my entry to Race to the Stones, where I was going to stretch myself to running 100km, and assumed my running days were over.   At the end of 2019 a specialist podiatrist franchise occupied the old doctor's surgery in our local centre and I decided to give them a go.   I'm now equipped with a pair of custom insoles that position my feet correctly to accommodate for the historical damage, and running shoes that give the right kind of support and padding (based on their recommendation).  It wasn't cheap, but I ran a marathon at the weekend, in pretty much the same time as I would have done at my best.  I really enjoyed the event and am looking forward to doing more long runs to complement my cycling adventures.

If it matters to you I would recommend seeing a specialist.  I might be unlucky with my local GP practice - but they have too many genuinely sick people to look after to worry about keeping a fit person on the road.

[davelodwig]

I turned my foot while flying a kite, A&E told me it was soft tissue.

Some 5 years later I end up loosing the ability to run / walk / stand without pain.

After seeing a physio and paying for an MRI turns out I broke my foot and now have arthritis in my cuboid, my GP and the local MSK unit seem interested about doing anything though they did give me a boot to wear which reduced the swelling.

I'm finding that a combination of exercises to build strength in the foot and ankle muscles and wearing wide barefoot shoes helps a great deal (vivobarefoot), normal supportive shoes make it worse because they stop the foot from functioning correctly.

I can't imagine I'm going to run anymore marathons, 5k would be nice.

D.

[T42]

"Just" soft tissue injury is like "just" a bit dead.  I've "just" had ankle-cartilage problems for the last 30 years - since 13th May 1991 to be precise. Oh, not to worry!

[Asterix, the former Gaul.]

Be very careful doing 'weighted lunges'.  We know someone who bust their knee doing that sort of thing.  A broken knee is very nasty and evidence suggests full recovery is not a thing unless you are very young.

I've also had an ankle pain that was caused by catching it at an awkward ankle.  It lasted two or three years on and off. Using it but not overdoing it seemed to work best; if I forgot to be careful it soon reminded me. It's OK now but I am still careful with it.  Cycling did it good if anything.
 

[DuncanM]

I have had many knee issues in the past, and lunges with dumbells has worked well for them. The physio has recommended them because I'm not able to squat properly (or cycle) due to my hip. I was hoping that lunges were a good compromise - my (lack of) grip strength stops me getting too heavy, but clearly it's bad for my toe/foot!

I think the common factor in all the experiences listed here are that A&E didn't find anything on the X-Ray and sent us all away with a "not emergency medicine" conclusion. Unfortunately, the next step is utterly absent, resulting in missing follow ups, no real diagnosis, and slow recovery at best. GPs being utterly useless at musculoskeletal issues don't help. From my experience, the only reason it's worth going to the GP for this sort of thing is to get referred to someone who knows what they are talking about (usually many months down the line). I might have to do that if I don't get results from working with the podatrist, but a couple of extra weeks to see how that works out is probably not going to harm things one way or another. The foot isn't bad enough to stop me doing things, but the ROM restrictions are almost certainly affecting my biomechanics (and I'm getting more and more convinced that I won't be able to "solve" my hip without sorting the biomechanics).

It's interesting that some people found "barefoot" shoes help, and others tailored support. I'll have to think about whether barefoot or shoes feel better...

[Ruthie]

Not injury-related, but my calves are too short and I walk funny. My toes and mid-foot do the work that my ankle is supposed to do. The resultant pain was unbearable.

Orthotics made by the podiatrist, after thorough gait analysis, helped a lot. The pain came back last year and I now have heel raises under my orthotics and daily calf lengthening exercises. I choose my work shoes very carefully and use Hoka one one sandals as house slippers.

https://www.sportsshoes.com/product/hok1343/hoka-ora-recovery-women%27s-slide-~-ss21/#sku-hok1343

 I never walk barefoot.

All this has helped enormously but I still get pain. I think that’s partly me forgetting the exercises, and partly me wearing my high heels sometimes because I love them.

[Peter]

Yeah, I love high heels, too!

[DuncanM]

Return appointment today. I've basically been icing my foot and stretching my calf twice a day for 4 weeks. The angle measuring stick says I have gone from 67 degrees flexion to 86 degrees, which he was really pleased with (normal is 90-100, my left is 93). So I'm going to repeat the 4 weeks stretching, but resume any "normal" activity I like, and then have 4 weeks of no prescribed stretching, and see how much it has reverted.

8 weeks takes me very close to the bikefit appointment I have booked - I'm kinda wondering if I should set it before or after. The bikefitter is one who is pernickety about shoes and insoles, so I figure it's probably best to do bikefit first and then take those shoes/insoles with me to the podatrist after.

[Jakob]

I've had plantar fasciitis caused by too tight calf muscles before, but I went through quite a few other treatments before figuring out it was the calf muscles, so at least your podiatrist spotted that early on.
Foam rollers and/or rolling on a squash ball can also be really helpful in loosening up the calf muscles, albeit rather uncomfortable.

FWIW, when I tore my calf muscle (a rather major tear), my physio was furious that A&E didn't put me in a walking boot straight away and didn't refer me to a sports doctor. I did (on my physios recommendation) get my GP to refer me for an ultrasound scan. He was reluctant as 'that's kinda too late now', but both me and the physio wanted to know the extent of the damage.

[jaymack]

I have arthritis in my first metatarsal joint of my left big toe. You need to get some expert advice, see a podiatrist and consider having some bespoke orthotics made. You shouldn't underestimate how effective they can be, you may also want to see advice about orthotics for cycling. In my experience Sidi cycling shoes cope best with bespoke orthotics.