INJURY: Metatips!

Let this be said, John Murphy of the Carysfort Clinic is the Obi-Wan of chartered physiotherapists, the Force is strong in this one, very strong! I had suspected that my discomfort was related to the metatarsals (basically the non-visible part of the five long fingers that make up your foot) and I proved correct.


I had not described my symptoms in much detail before I could see from the look in John’s eyes that he knew what was plaguing me although he politely let me finish my story. I shall refrain from recapping the story here and instead jump to the conclusion: Inflamed meta-tips (tips of the metatarsals). The 3rd and 4th are affected on my left foot (the 3rd the worst of the bunch) and the 2nd to 4th on my right foot. How quickly and confidently John could diagnose it was proved as he went straight for my right foot after checking the left: This condition rarely occurs in just one leg.

How to find it

He can measure this simply by squeezing above and below the bone in foot that runs into the toes (but before the start of the toes themselves). The soreness seems to be around the bone but particularly pronounced just below the end of the toe (the tip of the foot itself and thus the metatarsals).

To check the condition of each metatarsal you squeeze each one in turn. John asked me to come back at regular intervals over the next weeks to perform “spot checks”. This way it can be tested whether the condition is healing or moving further towards the next stage. But before we turn to that let’s look at the cause:

Why do you get it?

This is a common ailment for forefoot runners and John said he has seen it particularly in Chi-runners in recent times. It’s a normal condition and the inflammation apparently is in the “sheaths” of the meta-tips, whatever exactly that means. He surmised that a scan of the foot would show numerous micro-fractures on the front of both feet: The very early stages of developing stress fractures.

It is an unusual injury for normal runners but common in ultra-runners, ironman athletes and others who do extreme mileage. The direct causes are: loss of flexibility, lack of strength, and distance but only in combination with a forefront running style. But wait, isn’t forefront running better and safer? The answer to that question is “yes” the issue arises because modern men like myself have not develop the natural strength to go hand-in-hand with proper running. Like all things it only becomes an issue when you clock a high mileage. John was heartened by the fact that I could clock 100k before this appeared and can still do 20k runs without aggravating the symptoms noticeable.

John sent me home with one important message: “I don’t want you to think this is a serious injury at this stage. The symptoms are still very mild.” The strangely on/off nature of the symptoms over the last weeks are apparently caused by any slight increase in the size of a blood vessel next to an irritated area being able to annoy the numerous nearby nerves.

Where it can lead?

He was glad to see me early as he said people would normally only appear in the clinic once the condition reaches its next phase: Stress fracture (the treatment for which is generally 3 months off running). The final stage could potentially be nerve damage as there are a plethora of nerves that connect to the meta-tip area. This is hypothetical at this stage but one reason to take the greatest of care.

Contain and Destroy – The Cure

John prescribed a simple plan:

1. Reduce mileage by 60% for the next 10 days

2. Start upping mileage again once symptoms are gone

3. Slowly add gluteal and calf strengthening work into my programme as forefoot strikers need sufficient strength in this area to take pressure of the feet

4. Use running shoes with slightly thicker soles until feet are normal again

5. Possible use a tiny insert for a while to protect the tips of my feet

This is a basic strategy for removing injuries: Remove symptoms with as much running as possible still maintained and then restart advance. John understood that in order to compete at the level I aspire to nothing less than the magical 100 miles will do as a weekly training dose. He’s there to help me move back towards that and this is exactly the sort of attitude an athlete needs from their practitioner. The advice I’ll gain now will direct me towards the physical conditioning necessary for my objectives.

And my objectives for the coming year are highlighted through this: I am at a phase of my running where I am training to train; I’m not training to race. Without the volume of an elite athlete I cannot compete at a level that is personally meaningful to me, so firstly I must train my body to handle the workload that that entails. Only once that is achieved should the focus shift to training to become good at racing, now this is very much a secondary objective.

The Lydiard Experiment?

This of course means the end of my Lydiard Experiment and I’ll talk about what I learned, what I did right and wrong and how I’ll employ the learning in the future in my next article this weekend. In the meantime I’m off to work on some meta-tips!


Tatiana said…
Hi Renny
I had the same symptoms before Jungfrau marathon, which sadly meant close to no training for two months before the run :( Got my feet back just a week before the marathon. I also got to Doctor/PT when I could barely walk after just 15km run, which was not fast enough... Had mild nerve damage as well.

Oh, yes, I am a forefoot runner. And if everything is fine, I run 80->100km per week. Sadly after I overcome this I have new (ITB) issue...

Get well soon,
John L said…
So in some ways your experiment has been a success, despite not getting to the end. You weren't going to stop until you found your body's current limits, and you've mentioned before that it would be impossible to stop before damage begins and not believe deep down you could have gone harder. You've monitored and managed your body and your distance, noticed the early signs of trouble giving you enough information to plan the next phases. So now you'll have to back off the mileage for a while, but in that time you will be able to strengthen your body for a fresh push in the new year. Best of luck.