Sharp, Specific Foot Pain

Dear Dr.,

I have an acute, sharp foot pain near the base of the first metatarsal, maybe slightly towards the medial side but primarily underneath the bone.

It came on after strong, repeated pressure across the arch and that area from walking on a very taut piece of webbing (like flat rope, slacklining it’s called). The onset was acute, not gradual. I kept using it because the pain while notable was not intense, but a couple hours later it had become much more painful and acute.

The pain is sharp, almost splinter-like, if the specific area is pressed (the area of pain is no bigger than a dime). On superficial palpation of the foot there, i.e. without pressing down to the bone a bit, there’s little or no superfical tenderness or apparent swelling. It was intensely sharp the next morning, then slightly mellowed out in the afternoon. Now, a few days later, the pain is still fairly sharp and specific, but I feel it from just slight touch to the tissue in the area, I think it’s at the level of the soft tissue there rather than the bone.

Also there is no way (that I’ve found) to make the pain come on with just passive or even weighted movement of the foot through range of motion. It’s really only on direct pressure to the area. Walking does not bother it, though stepping on something raised in that area is very painful. When the foot is totally passive, there’s no pain or sensation that is notable. And there is no visible sign of bruising or swelling.

It’s almost hard to find the place to press to make it hurt, it’s that specific. But again, only direct pressure hurts. Pressing on any other part of the metatarsal produces no pain, such as pressing from the top of the foot, etc.

Any ideas are much appreciated!

One Response

  1. Foot-com

    Hello and thank you for your question.

    You gave a very good summation of your symptoms which helps a lot. Some things that I would want to rule out include a stress fracture, peroneus longus tendonitis and contusion abductor hallucis muscle. Although stress fractures do not always show up on X-ray it might be beneficial to have a baseline X-ray done.

    Otherwise if the pain persists after resting, icing, anti-inflammatory I would see a Podiatrist who can better evaluate you and determine the diagnosis.

    For peroneus longus tendonitis and abductor hallucis contusion / strain rest, massage, stretching and anti-inflammatories typically will alleviate these. I’m suspecting it’s related to the direct pressure from the line.

    I hope this helps!

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    Dr. Emily Splichal
    Please be advised: we do not provide medical advice, diagnosis or treatment.
    By law, we cannot give specific medical advice over the Internet.

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