Swollen, lumpy sensation and click under smallest toes

by James
(Wirral, UK)

I recently (3 weeks or so ago) started running for the first time and, in retropspect, had probably purchased ill-fitting shoes.

After a week of running (too much too soon), the ball of the left foot under the smallest toes had a squishy, swollen
feeling when walking and felt less elastic than the same area on the other foot.

After a week or so of this sensation I partially addressed the problem by shoe widening at the laces, and alternative
sock choice. This minimises perception of the problem when walking, but the swelling remains. When compared
to the 'good' side, this swollen area (photo A) feels slightly 'inflated' and more springy.

There is also a 'click' that I can usually produce between the third and fourth toes by manipluation. Occasionally, this click
will be noticeable when walking. The third and fourth toes also seem slightly splayed apart (photo B). This can be made
more pronounced by raising the ball of the foot from underneath (photo C).

Stricly speaking, there is no real 'pain' as such at the moment, just a very unpleasant sensation of the ball flexing/toe joints
rubbing/pad crinkling. The situation has now been more or less the same for 3-4 weeks.

What might also be relevant is that I suffered a fractured calcaneous in the foot in question and have always noticed that this
overloads the smaller toes somewhat compared to the other foot. Also, after my recent running spree, the area was
obviously overloaded with the smallest toe blistered.

Whilst I am not yet getting any severe pain, the area is obviously traumatised and I am growing increasingly concerened
by the persistence of the symptoms.

RESPONSE

Hi James,

Poor running shoes, or any athletic shoe for that matter is the number one cause of foot problems in the athlete.
Based on your narrative, it sounds as if that is what set this whole problem in motion.
The squishy feeling in your foot sounds as if it may be nothing more than inflammation from whatever structures you damaged.
Additionally, the clicking feeling you are experiencing as well as the area that you point to in your photo is highly suggestive of a nerve irritation. The nerve involved is the one that passes between the third and fourth metatarsal bones, then divides, and sends sensation to the third and fourth toes.
You can read my section on "Morton's neuroma" for more information.
The good news is that you are not yet having any severe pain, but of course, you do not want to see your situation deteriorate into that.
My first suggestion would be to see a foot specialist in your area, short of that you can try a couple of things.
Get yourself a good pair of running shoes, consider adding an orthotic to the shoes to give you better support and balance. If you are able to tolerate them, you can try a regimen of anti-inflammatory medication for perhaps two weeks, to see if you can reduce the inflammation.
The message to take away from here is that right now you are not having any substantial pain but you do not want it to see the problem get worse. Obviously, the worse the problem gets, the harder it is to alleviate.

Marc Mitnick DPM
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