pain on top of foot after 5k race

One week ago, I walked a 5K and also did a lot of carrying, lifting and moving things. Developed pain in top of foot, around the 3rd metatarsal. Went to dr and was told nothing showed on the X-ray so ok to keep it wrapped, take Ibuprofen and see if it gets better.

So for a week now I have been walking on it, but putting it up as much as possible as the swelling on top of foot and around the ankle is definitely not minimal. I have also been icing it as much as possible. I have continued to take ibuprofen. The best way to walk is with the forefoot wrapped in ACE bandage.

I still am thinking it could be a stress fracture or tendonitis.
Any recommendations?
Thank you.

RESPONSE

Hi,

Sounds like you have been doing your homework. If you walked into my office after having done a 5k walk the two things that would come to mind would be either a stress fracture or tendonitis of the extensor tendons, the tendons on top of your foot that help bend the toes upward.
This does not mean there might not be something else going on, but in the vast majority of cases it is one of the two aforementioned issues.
So...lets start with the x-ray. In many instances of stress fractures an initial x-ray may appear normal even though there is the possibility of fracture.
I would wait until at least ten days have passed and then either consider another x-ray or even a bone scan. A bone scan will be more sensitive to small fractures that an x-ray may miss.
Lets assume that a stress fracture is finally ruled out, one way or the other. That then leaves you with a probable tendonitis.
The problem with a condition such as tendonitis is that essentially, every time you take a step, you are re-aggravating the tendons and so they seem to take forever to heal. It can become very frustrating.
Even though you can continue to wrap the foot and take Ibuprofen I do not think that is necessarily your best course of action.
I know nothing about you in regards to your medical history, but I will assume you are in good health.
Having made that assumption, if you came into my office and I made the diagnosis of extensor tendonitis that was slow to get better, I would be a little more aggressive in your treatment.
More than likely I would offer you a cortisone injection in the most painful area, as well as some physical therapy, all in an effort to move things along more quickly. (nobody wants to limp around forever).
I have found that treatment option in most cases moves things along a lot quicker.
Now, very important, you have only been bothered by this condition for seven days so there is no real urgency here for more aggressive treatment at this point.
What you need to do is gauge your progress. What I generally tell my patients is that every couple of days compare the amount of pain, or lack thereof, in the foot compared to a few days earlier.
If the foot appears to hurt less and less each time you make that comparison, then it is probably safe to say that you are healing and this problem will not last indefinitely. If you reach a point of progress and it then stops and there is no further improvement, that would be a cause for concern.
One last point. I believe in ice for the first 24 hours after trauma in an effort to decrease swelling and thus minimize pain.
After 24 hours I recommend heat, particularly moist heat. Heat dilates (opens up) arteries and increases blood flow to the affected area. It is this increased blood flow that brings the necessary nutrients to the traumatized area in order for healing to occur.

Marc Mitnick DPM
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