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The response to the question below was authored by Marc Mitnick DPM

Pain on bottom of foot at the base of 2nd and 3rd toes

by Shannon
(Canada)

I am a marathon runner - I have properly fitting shoes that do not need replacing. I have not had any crazy increases in mileage or speed - just conservative training. I am prone to tendonitis but it usually presents itself along the outside of my foot toward the 5th metatarsal. This week, after a long run, the base of my 2nd and 3rd toes hurt on the bottom of the foot. It's difficult to determine which toe is more affected. It is worst in the morning when I wake up but seems to dissipate throughout the day. I have taken a few days off to rest, trying to stay off the foot. There does not seem to be any bruising or swelling. When I move the toes around, the pain does not worsen unless I pull back on the third toe - then th pain seems to radiate back into the ball of the foot. I need to get back on the road as soon as possible...help!

RESPONSE
Hi Shannon,

The first thought that comes to mind is capsulitis of the second and third metatarsal-phalangeal joint which is the ligament that wraps around the toe and the metatarsal to hold the joint in place. This is a very common injury and is basically a stretching of the ligament on the bottom of the foot.
One cause of this would be a shoe that is too flexibile in the forefoot causing the toes to be forced upwards to an excessive point.
This type of motion would be exacerbated in a situation where you are running up hill as this too forces excessive dorsiflexion of the toes. So in spite of your lack of increase in speed and training this could explain why you injured your foot.
Taking this a step further there is also the chance that you suffered what is known as a plantar plate tear which is where the capsular ligament actually tears. This is a more severe problem that in most cases will respond to rest.
Another consideration would be an inferior metatarsal bursitis where you have inflamed a bursal sac which is lying directly under the metatarsal head.
Because of the fact that you state the area hurts more when you bend your third toe backwards, I would lean more towards capsulitis and the possibility of a tear.
Since you need to be to training as quickly as possible, I would suggest you see a foot specialist as soon as possible because I do not think this is a problem that you are going to be able to fix on your own.

Marc Mitnick DPM
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Columbia University Department of Rehabilitation

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Illinois Bone and Joint Institute

Mount Sinai Hospital

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University of Florida Health

American Family Physician

Cedars-Sinai

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Pain on bottom of foot at the base of 2nd and 3rd toes

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