Top of foot pain above toes??!!

Been running in VFF's for just over 6 weeks and I absolutely love them...Just got over the chronic calf pain... And was great for up to 5 miles at about 8 min mile pace...! Then... Terrible pain the next day over the top of both feet just above my toes!!!
Rest for 4 of 5 days usually takes it off and then when I run again it's back!!

What is it? And how do I get rid of it??

Help?
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Comments

  • I had a slight pain like that last week.  I noticed that it started after I did a very long run (nearly 14 miles) in my KSOs and the pain persisted for about a week after that run.  For me, I think it's due to doing too many miles right after a long run because once I back off the mileage (30 miles per week to 20 miles per week) the pain went away.  You could be doing too many miles at the moment.  Try backing off the mileage and the number of days for about a week and see if it comes back.

    Jay
  • on 1274741814:

    What is it? And how do I get rid of it??

    It sounds like the dreaded (and not-so-originally named) top-of-the-foot pain. This is a typical problem for many runners making the transition to barefoot or minimalist footwear. It does not necessarily mean that your form is off. On the contrary, it may mean that you are getting closer to better form, using muscle and ligaments/tendons in ways they haven't been used in a long time. Jimmy Hart, a fellow forum member, has detailed this problem along with treatment and recovery recommendations in his blog. Check it out here.
  • I have had the dreaded top-of-foot pain for about 8 weeks now (6 off, as I tried to run through it at first), which I believe is the standing record.  ::)  I'd caution you that there can be lots of things going on - muscle, tendon, ligament, bone - and it's not easy to say which one(s) it is at any particular time.  If you're lucky, it's just extensor tendonitis, which should go away in 7-10 days with proper rest, ice, ibuprofen, etc.  If it's a stress fracture (should be easy to tell since it would be very localized and extremely painful with downward pressure), you're looking at like 2 months to heal.

    Personally, I don't know what my pain is from, so I sure can't tell you what yours is.  But whatever exactly it is, the cause is likely the same - too much tightness in your calves and too much strain on the small, underdeveloped foot muscles and surrounding area.  So far as I can tell, only rest helps it.
  • Looks like mine came back with a vengeance yesterday.  I went for what I intended to be a standard five miler and around mile two the pain came on and I had to limp back home.  marko3182, qcassidy352, any news on yours?  Feeling better?

    Jay
  • yes, but not so i can run yet.  however, I'm nearly at the point where pressing on the bone doesn't hurt, which, though it may sound like nothing, would be huge.  I'm also finally getting an MRI, so maybe I'll know what's really going on in there (unless it's too healed to tell now).

    Sorry to hear yours is back.  Just looking at your sig, 130 miles since April 17... I'm assuming this is your first pair?  If so, that's an awful lot.
  • Yeah, it's my first pair of VFFs, but I had been doing Chirunning since the beginning of the year to prepare for the transition to VFFs.  This was definitely an over-use injury because I was training for a half marathon.  I'll end up missing the half marathon, but it's a lesson learned for me.

    Two days later and my foot is feeling a lot better.  Still some pain when I put pressure on it and walk around, but my limping around the house it not as pronounced as it was yesterday or the day before.  I've been icing it and doing the same stretches I did for plantar faciitis.
  • glad to hear you're feeling a little better.  I'd urge you not to rush back in once you think the pain is gone.  I spent a few weeks trying to take a little time off then try running again, and I just kept setting myself back.  It's frustrating to take the time completely off, but I don't see this healing otherwise.
  • I pretty much figured out what it is now...  It's a severe form of plantar fasciitis and a tightening of some tendons.  I'd never had it in my left foot before.  As a shod runner I always had that problem in my right foot until I switched over to the VFFs.

    Tracking back to Saturday, here's a description of the sensations I felt just before the top of the foot pain:  At about mile two I felt a tightening of the superior extensor retinaculum (check out the diagram on Jimmy Hart's page http://gobarefooting.files.wordpress.com/2010/04/foot-muscles.jpg ) in my left foot.  A minute or so later, the pain on the top of the foot started so I had to limp home.  But when I limped home, I had to walk and land first on my heel to take the pressure off of my forefoot.

    So today I did some stretching and walking around barefoot at home.  I have no pain in the metatarsals (whew!).  The superior extensor retinaculum seems a little tight, but my plantar fasciia is also tender.  I tested this by doriflecting my toes and walking around that way and the pain lessened.  Without the dorsiflection stretching the plantar fasciia, I started limping again. 
  • your plantar tissue is getting sore for reasons different than when you run in shoes.  one reason is the counter balance issue of muscles and bones.  each muscle has a counter muscle to stabilize joints.  so when the tissue in the upper layer of the foot gets tight it can effect the plantar tissues by forcing them to be overworked in stabilizing the many joints of the foot.  they can also be sore based on the other tissues of the arch getting tight due to compensation for the upper layer which will then cause the soreness. 

    the toughest part is to be able to determine the difference between plantar tissue soreness and plantar faciitis. i would do ice and heat treatments as well as rolling the foot with a tennis ball.  make sure when you're rolling the plantar tissues that you actually roll the heel as well.  coming from the front of the foot, roll back through the arch and plantar tissue, and roll to the center of the heel.  roll all over the heel and then roll back forward.  this pattern will promote blood flow as well as release the tissue. 
  • I'm glad you've figured out what it is and that you don't have metatarsal pain.  That's a *****, let me tell you.
  • Confirmed by my doctor today.  It is definitely the tendons and not a stress fracture.  For a moment there, he thought it might have been gout, which I've had before.  Ouch!

    He said I could tape it up if I was crazy enough to try to run.  For about a half a second I was tempted because I had already paid my entry fee for the Lake Chabot Half Marathon this coming Sunday.  I figure if I was young, crazy, and trying to impress a few ladies I'd go for it.  Unfortunately, I'm not young, just young at heart.  I'm not crazy, just foolish on occasion.  And any ladies I'd try to impress would record my silly antics and probably post the video on YouTube so that images of me hobbling around in pain would serve as a warning to others.  ;D

    It's been three days since my last run in VFFs and I'm already going through withdrawal symptoms.  But I've learned my lesson and once I can run again in my VFFs, I'll remind myself to take baby steps.  I want to be able to run for a lifetime, not just a season.
  • so r u running shod for the time being?
  • on 1275445638:

    so r u running shod for the time being?


    Probably not. I'm going to hold off running until late next week and try doing one mile in my KSOs.  If it hurts, then I'll stick with my Mizunos until I can do three miles without pain.  If I can do those three miles, then I'll try one mile in the KSOs again.
  • on 1275440146:

    Confirmed by my doctor today.  It is definitely the tendons and not a stress fracture.  For a moment there, he thought it might have been gout, which I've had before.  Ouch!


    good, glad to hear it.  But I'm curious - did he take images (x-ray, MRI, bone scan)?  I ask because i had an "expert" podiatrist tell me mine is a strained ligament when there are about half a dozen reasons to think that can't be it (or can't be the only thing).

    If it's a true tendonitis, it should disappear in 7-10 days with full rest, ice, ibuprofen, etc.  If you do all that (full rest meaning Full. Rest.) and the pain persists or comes back, it's almost certainly more than just tendons.
  • on 1275449632:

    on 1275445638:

    so r u running shod for the time being?


    Probably not. I'm going to hold off running until late next week and try doing one mile in my KSOs.  If it hurts, then I'll stick with my Mizunos until I can do three miles without pain.  If I can do those three miles, then I'll try one mile in the KSOs again.


    yah, that sounds like a good plan... the slow transition is killing me!
  • on 1275492409:

    on 1275440146:

    Confirmed by my doctor today.  It is definitely the tendons and not a stress fracture.  For a moment there, he thought it might have been gout, which I've had before.  Ouch!

    good, glad to hear it.  But I'm curious - did he take images (x-ray, MRI, bone scan)?  I ask because i had an "expert" podiatrist tell me mine is a strained ligament when there are about half a dozen reasons to think that can't be it (or can't be the only thing). If it's a true tendonitis, it should disappear in 7-10 days with full rest, ice, ibuprofen, etc.  If you do all that (full rest meaning Full. Rest.) and the pain persists or comes back, it's almost certainly more than just tendons.


    He didn't take x-rays, but he did move my foot around in different directions and start pressing down on my metatarsals and all over my foot with the standard "Does that hurt?"  I had no problem telling him where it hurt.  He also had me stand on my toes and move my foot around while standing.  The pain was mostly along the top of the foot roughly around where I felt the tightness prior to the pain on Saturday.  Things are getting better though.  I still limp, but the pain is fading.  However, it will still be over a week before I'll be able to even try running again.
  • I started to get a bit of top of the foot pain a few days ago, although if I press down on the top of my foot, furthest from the toes then I feel a slight sensation along my second toe, it feels really weird, anyone else get this?
  • I think I'm the latest victim.  Funny thing is, I had actually been running in shoes for the week before it happened (trying to do more miles than I could do in VFF's).  I've also been concentrating on correcting my form, which may have been what gave me this pain.  It's only in my right foot and strangely seems to be worse in the morning when I first start walking around.  I've had it for about a week now and it seems like it gets less painful over the course of the day.  In the morning, if I baby it and limp, it hurts...if I take a step or two, through the pain, then it starts to get less painfull (but is still a dull ache all day).  Does this sound normal?  I'm trying to rest it (by not running) but I can't exactly take off work and stay in bed all day.  Any ideas for "resting" the foot while maintaining mobility?  Thanks.
  • If it gets less painful throughout the day, then you should consider more stretching in the morning because the muscles and tendons need a little warming-up.

    I had to put Spenco Insoles in my shoes to alleviate the pain.  It takes some of it away.  I dread using the insoles though because that's what helped promote my heel striking and led to my runners knee, plantar fasciitis, etc back in the day...  Yesterday when I was at Big 5, I tried on a pair of casual shoes by Doctor Scholl's which had nice cushioned insoles built it.  I felt no pain when I walked around, unfortunately they didn't have it in my exact size and I didn't want to go to work with oversized shoes.  I'd look like a clown!

    I'm not ready to run just yet, but did a little test yesterday.  I put some silicone metatarsal pads in my KSOs and did some light jogging back and forth in my living room.  It seemed to take a little bit of the pain away.  So eventually I'm going to have to invest in a pair of Bikilas because I may not have enough of a fat pad in the ball of my foot to absorb the shock of VFF running.
  • the tough thing here is that the "top of foot pain" is not just one thing.  It can refer to extensor tendonitis, a metatarsal stress fracture, a strained ligament, over-stressed muscles, a combination of the above, and probably several more that I'm missing.  These deal with (obviously) different parts of the foot and have (obviously) very different recovery times.  Unfortunately, it can be hard to tell them apart, especially if there's more than one thing at play (for example, it's very likely that there's at least some tendon inflammation whatever else is going on, so until that calms down, it would be harder to isolate any other problem).  I've been hurt for over two months and still don't know exactly what happened to begin with.

    I do agree with jmijares that if it's worse in the morning, that suggests extreme tightness rather than soreness/inflammation, which one would expect to get worse with more walking.

    The other tough thing is that, as you say, there's no "complete rest" for this type of injury unless you're willing to boot your foot and be on crutches (though if it's both feet, you're kinda sunk).  So that definitely slows the healing process.

    I'm afraid I don't have much advice except complete rest (don't try to cheat and run "just a little"), ice, and ibuprofen.  If possible, you might want to think about a scan (x-ray, MRI, bone scan?) to really zero in on what's going on.
  • It's 17 days since the dreaded top-of-the-foot pain hit me with a vengeance.  I was hoping to run in my KSOs today, but couldn't do it.  Just walking around barefoot at home convinced me that I couldn't run in my KSOs.  However, I did throw on my Mizunos and put in my old arch support insoles and was able to go for a 2 mile jog.  I had to consciously prevent my left ankle from rolling outward, which was my secondary injury as a result of the top of the foot pain.  I'll try again in a week's time to run in my KSOs...
  • If I were you, I'd get an x-ray. Two docs told me my pain was not a stress fracture, and when it didn't heal after 2 months, I had it scanned and whattya know, stress fracture. If you can get someone to order it, why not? They're cheap and very fast. An MRI not so much, but there's no reason not to get an x-ray. Just my opinion. I wish I'd gotten one months ago - I'd probably be running by now. 
  • qcassidy- wow after reading your bad luck I think I will demand an xray if this "normal" transition pain continues for more than another week, been 5 days already, without running at all. 
    And like everyones said.... I already miss my bikilas.  I only started running again recently, got up to around 5 mi x 3 day/week in shods, before even trying the vffs.  I thought I was doing a slow transition been about 6 weeks running progressively more often in vffs.  I thought the worst was the intense calf pain that followed my first 2mi+ vff run.... but this TOTFP has been absolutely debilitating, to the point where I can hardly walk to the bus stop in the morning.  Should I be spending more time back in my shods? because I've started hated even walking in shoes, it exacerbates an existing knee injury, and was really looking forward to being able to run in vffs for at least 8mi a week 

    any advice on adjusting my transitioning?
  • on 1276712172:

    If I were you, I'd get an x-ray.


    I'll have to check with my doctor when he's back from vacation, which is - I think - next week.  Though I did go for a three mile run today in shoes.  No pain, other than the soreness that comes from getting back into running after a two week break.  Inclines did make my anterior tibia tendon feel a little tight, so I made sure to run on as level a surface as I could.  I didn't feel the tightness though when running on a downward slope.

    I have noticed though that I'm running shod like I do in my KSOs.  My stride is a lot shorter, probably a few inches longer than my walking stride.  I can feel a slight discomfort when my stride gets a little too long, but then I correct it.  When my feet land under my center of gravity and my ankles allow my feet to pronate like they should, I feel no pain.  I could have actually run another mile, but I'll save the four mile run for this Saturday.

    I'll wait another three or four weeks before re-introducing myself to VFF running, and I'll keep the VFF running to one short distance per week.  I've mapped out my mileage on an Excel spreadsheet for the next eight months and will be sticking to just a 5% increase in mileage every week.  My goal for this week is to come in at or under 10 miles.

    I'll have to remind myself over the next few weeks to stick with the program I have scheduled and not to give in to the enthusiasm and freedom that I feel when I run in VFFs...  For some people, as the old USMC saying goes, "Pain is weakness leaving the body."  Though for those of us who like to run, and especially for those of us who like to run in VFFs and don't have the discipline to keep the mileage low, pain is enthusiasm leaving the body and reality setting in....
  • Dr.Ninja,

    Well, I'm not sure I'm one to give advice, since I clearly didn't know what I was doing.  But I can serve as a cautionary tale.

    I tried to keep running through the TOFP for about a week.  Like you, I was practically limping walking around.  Like you, I wanted to get away from shoes as fast as possible because they caused knee pain that went away in VFFs.  Even after I accepted that I had to take time off, I kept trying to run a few miles here and there and kept walking around in the VFFs.  It was only after a month that I gave up the running entirely and another 3 weeks until I accepted that even walking in the VFFs was not helping.

    As it stands now, we are pushing 3 months since the pain started and almost 2 months since I stopped trying to do any running of any kind.  And I only just got in a boot 2 days ago with a minimum expected time wearing it of two weeks (apparently, I did heal somewhat during my time not running.  not nearly as fast as I would have in a boot, but since I wasn't doing anything but walking in regular shoes, that was enough to allow some slow healing).  Meaning an absolute best case scenario will be that I'm running again about 13 weeks after the pain first appeared.  Even with a stress fracture, that's a horrible timeline - 8 weeks is usually the upper limit.  If I could do it over again, I'd have gotten an x-ray the day after the pain started and been in a boot that day.  And I will never, ever again try to run through TOFP or try to "cheat" by getting in a few miles here or there during recovery time.

    So if you want my advice, and again, take it for what it's worth: 1) Really, really rest, meaning no running at all, no walking in VFFs, no exercise that involves impact until the pain is gone.  Cheating on this is only going to drag this out.  2) Stretch your calves - it can help with several kinds of TOFP, and it can't really hurt.  3) get an x-ray.  If it is a stress fracture (and your description is a lot like how I felt about 6 weeks ago) you need to get that foot immobilized ASAP.  Even walking in regular shoes - let alone running, let alone running in VFFs - is going to drag this out enormously.  Just look at me - a minimum of 5 weeks longer than the typical worst-case scenario, and longer if the 2 weeks in the boot doesn't get it done.

    Good luck man.  Believe me, I feel for you.

    I should also just say that there are lots of things it could be other than a stress fracture that are not as bad: a stress reaction, tendonitis, sprained ligament, or just beat up muscle and tissue.  But if you rule out a stress fracture with an x-ray, you can be a little more aggressive in getting back in to it.  I'm not saying go wild, but you can start light running again on tissue that is still healing (as long as you don't set yourself back), but if it's a bone, you absolutely can't run until it's 100%.
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