2nd Metatarsal Overload Syndrome

Wondering about the calluses I have had behind my second toe balls on both feet (though very rarely do I get any pain/tenderness from these - if I do it's after wearing my KSOs all day) I have had the calluses for as long as I can remember - long before any barefoot shoe wearing, perhaps since my teen years.

Doing some searching about I came across something called 2nd Metatarsal Overload Syndrome. It's very specific and seems to be caused by the first metatarsal/big toe being hyper-mobile and lifting upwards as the foot touches down, leaving all the pressure of walking and running to fall onto the 2nd, 3rd and 4th toe balls. Though of course the 2nd metatarsal gets the greatest amount of impact.

This sounds kind of familiar to me - my big toes have always felt kind of weak somehow - and if they are not bearing much weight then this would explain it. (FYI both big toes are straight, I have no bunions, and have very rarely worn heels in my life. My arches are low to flat though, and people have observed in the past that I 'run funny' - or flat footed.

The possibilities/cause of my big toes not bearing weight are more complicated though - anything from me having shorter first ray bones in my big toes, to just my joints being over flexible. It's all a big guess.

The problem is explained a third of the way down this page here -http://www.northcoastfootcare.com/pages/Ball-of-Foot-Pain.html

It's also looked at in detail in this podiatry website - http://www.podiatrytoday.com/article/4733?page=1

And I've just found this which explains the cause of flat feet or fallen arches is an instability in the first ray of the big toe - leading to flat feet and weight transfer on the second toes. http://books.google.co.uk/books?id=OcHq05vQGDwC&pg=PA7&lpg=PA7&dq=2nd+metatarsal+overload+strengthening&source=bl&ots=mQOK1-uWmX&sig=8Leh3W-TWYsQxGQ26yHKUWxuRfg&hl=en&ei=2y3JTeyCEdSy8QP586HoBg&sa=X&oi=book_result&ct=result&resnum=9&ved=0CEUQ6AEwCA#v=onepage&q&f=false

Anyone else thinks this sounds familiar to them too? Has anyone else always had calluses behind their second toes, with or without pain - or big toes that feel weaker than the other toes, or unsupportive of the foot?

Any advice....?  The good news I guess is that they rarely cause discomfort for me, and never in my Vivo Barefoot shoes, but the bad news it can while wearing KSOs...  I also worry if it might flare up as I age.... :-\

Comments

  • I see this all the time in my practice. A lady came in yesterday with this issue while hiking, she had a short 1st met and slightly elevated causing pain at the 2-3rd mets. She opted for orthotics but there are other options if you want to stay away from support. An easy way to alleviate the pressure is put a layer or two of mole skin under the 1st met head in the VFF or you can stick it directly to the foot for a trial, this will transfer pressure away from the 2nd without the use of orthotics
  • An easy way to alleviate the pressure is put a layer or two of mole skin under the 1st met head in the VFF or you can stick it directly to the foot for a trial, this will transfer pressure away from the 2nd without the use of orthotics


    That sounds brilliant - thank you kindly for your reply - I found similar advice on this website
    http://www.triggerpointbook.com/mortons.htm

    I didn't realise that Morton's toe doesn't necessarily mean the second toes look visibly longer than the big toe - which they don't with mine. But all the other signs of Mortons are there - from calluses to wear in the centre of my shoe treads under my second toes, to flat feet. I suspect if I take my socks off now and bend my toes down and look for the metatarsals I suspect my second toe metatarsals are both longer than my first.

    Sounds daft but it's actually made me very excited at the thought of being able to help this with small pads, rather than stop wearing my beloved barefoot shoes. It's quite an Eureka moment!  ;D

    I wouldn't be completely sure where to stick the padding though - directly behind the 1st metatarsal ball, or on the ball of the foot? Or more trail and error?
  • Put the mole skin just on the plantar (bottom) surface of the 1st metatarsal where the sesamoid bones are
    http://www.mortonsfoot.com/mortonsfoot.html
  • Further to my question earlier I've examined the soles of several pairs of my shoes for tell-tale wear - these are shoes I used to wear before getting barefoot shoes -

    DSCF4299_1.JPG

    Hmm....  ::) I've examined my feet and second toe bone is markedly longer inside both feet. (When I curl my toes down the second toe collides with my big toe, and if I pull it up out of the way, it bends right underneath it. Not sure what that's all about....  :-\ My Vivo Barefoots also have noticeable wear at a small patch in the centre of the soles. around 1 inch square.

    I've bought a basic replacement pair of 3mm Scholl insoles for my Vivo Barefoots, (The original insole is 3mm) trimmed them to size and used the cutoff pieces to make toe-pads for my first/ big toe metatarsal, which I attached to the bottom of the insoles with duct tape. I then attached an additional little bit of foam padding on the top of the insole - to make a total of 6mm raise for the big toes only.

    DSCF4305_1.JPG

    I've kept the original soles also, because these ones feel a bit strange! I'll assess them over a few days getting used to them, and see how walking and running compares. If it's too high I'll pull the duct tape bit off the bottom, or if it feels too spongy I may look to put something like a small bit of cork on the bottom instead.

    Initial impression is that it now feels as if the entire foot is on the ground when I walk, instead of just the four outer toes. This may take some getting used to....!!
  • Exactly my problem! Especially on my right foot, I have morton's toe and...a big ball under 2nd metatarsal. Today I went running in my kso, everything was great, but right now I feel a slight pain in my second toe. Beside that, I noticed that when I put force on the foot when barefoot, i.e. during the gait, my second toe (right foot) tend to curve toward right. Turns slightly right, rotating on itself (so that the nail is closer to the big toe) of 2 mm. Nothing contortionist-style, but enough to see that foot isn't working at its maximum.
    The self-help tip of putting a pad under big toe ball sounds ok, just some question for those who tried:
    1) how thin the pad should be?
    2) which material is better?
    3) how do you stick it to the footbed of the VFF without damaging it forever?
  • Wow this is EXACTLY what I have "2nd Metatarsal Overload Syndrome" on BOTH feet. It is worse on my left foot and I actually have an appointment with a podiatrist tomorrow about it. I noticed it two weeks ago after running in my Speeds. I recently started running in VFF's a month and a half ago. I have NEVER had this problem before running in my New Balance. I assume I did too much too soon? I am scared to run because I don't want to make it worse. It's starting to hurt more and more as I run where it didn't bother me for a week or so..I just thought it was a callus. But on Monday I tried to run a 5k (in My old New Balance because I thought I needed a break from my Speeds) and it felt like I was running on a marble...Has anybody had this heal up ok and what did you do? I don't want to stop running or exercising! I am afraid the doc is going to tell me I can't run in VFF's anymore and that I have to get orthodics or something..I just started in the VFF's and don't want to stop :-[ 
  • I would try with padding, but I'm waiting from Kitol the answers for my question. I hope he/she will read this topic again.
    Gunner let me know what the doc will say.
  • corvo,
    1) how thin the pad should be? start with one layer, then two and so on till you feel pressure relief

    2) which material is better? Use adhesive mole skin or thin adhesive felt

    3) how do you stick it to the footbed of the VFF without damaging it forever? stick it to your foot under the 1st metatarsal head and extend up to the joint of the big toe but not on the toe itself

    This is a temporary modification, once you're pain free for 1month you wean away from the padding. If the pain comes back you weaned too soon

    gunner,
    Try the same padding technique as above. Also check your foot strike and toe off while running, make sure you're landing flat and try not roll up on the toes to push off. It's usually the propulsive (push off) phase which causes the problem. Have someone look at the bottom of your feet while elevated and relaxed, is your 2nd metatarsal more prominent that the rest? Calluses are like icebergs, there is what you see on the surface but there is also much thickening below adding more pressure giving you the "marble" feeling

  • on 1314883271:

    This is a temporary modification, once you're pain free for 1month you wean away from the padding. If the pain comes back you weaned too soon


    I think this is VERY important.  Much like using arch support, the idea is a temporary fix to help pain and promote proper form.  The last thing you want is to become dependent.
  • on 1314883878:

    on 1314883271:

    This is a temporary modification, once you're pain free for 1month you wean away from the padding. If the pain comes back you weaned too soon


    I think this is VERY important.  Much like using arch support, the idea is a temporary fix to help pain and promote proper form.  The last thing you want is to become dependent.


    Great advice thanks everyone! My second toe is longer then my big toe...from what I have been reading this might be part of the problem? I also was running in my VFF's mainly on the treadmill because of the weather outside, could this have been the problem to? Maybe I had the speed up to high which was MAKING me push off my toes? I was running at 6.0 speed with one incline, sometimes ramping it up to 6.5. After I started doing this is when I noticed the lumps on the bottom of my pads after a week or so. Does anyone else run on treadmills with VFFs when they have to? Do you keep the speed lower to try and keep the right form? I will update what the podiatrist says today...also where do you get moleskin from? Thanks again all! Can't wait to get back in my VFF'S!
  • also where do you get moleskin from?


    Medical supply, pharmacy or drug store in the foot care isle.

    Maybe I had the speed up to high which was MAKING me push off my toes? I was running at 6.0 speed with one incline,


    It's probably the combination of speed and incline. Going up hill is the worst for morton's toe
  • So I went to the foot doc yesterday. Turns out I have thin forefoot pads. So the bump on the bottom of both feet below my 2nd big toes are my metatarsal bones. I had calusses built up on those spots which he trimmed down with a scalpel and it definitely feels better. But it is still super sore in those spots. He wasn't too against vibrams or running in them, he said he was pretty open minded about it. But he said if the pain persists I should not run in them. He said it could turn into worse problems. He did suggest padding my forefeet with a horseshoe shaped padding so there would be padding all around my forefeet except for the 2nd metatarsal area below my 2nd toes. It just sounds like a royal pain to have to do that everytime I want to run. Anyone else out there have thin forefoot pads and have to pad them in their VFF's? Kind of defeats the whole purpose I suppose huh? I run in speeds, maybe there are better options of VFF's with better forefoot padding? I don't want to give them up but I don't want to run in pain either...The doctor kept saying I COULD get orthodics but then I would have to go back to big squishy heavy a** running shoes and I don't wanna! Not sure what to do...
  • I've been suffering from turf toe for a while, and finally bought the Orthofeet BioSole-Gel orthotics. They helped with discomfort immediately, and easily fit into most of my shoes--I just remove the footbeds that come with the shoe before inserting the orthotics. I wore them yesterday to walk my dog, and they were very comfortable.
  • The Biosole-Gel insoles shoes have really given me pain relief from my year long battle with plantar fasciitis. I have are so comfortable and really helps my planter fastidious. Able to walk now even long distances without much pain. Will definitely be buying another pair from orthofeet! I would recommend them to anyone with any kind of foot pain. Wonderful support all the way around.
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