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Stone Bruise

As a high school cross country coach, I have found that some of my runner's describe a "stone bruise" sensation at the ball of the foot, especially when they walk around barefoot.

Answer, provided by Phyllis A. Ragley, DPM, JD President, AAPSM 1997-1998

Q: What is a "Stone Bruise" and how is it treated?

A: What is commonly referred to as a feeling of a "stone bruise" may be metatarsalgia, which is like a "toothache" of the metatarsal head at the bottom of the foot.  Sometimes there is swelling at the area of tenderness but usually there is no discoloration.  Pressing on that metatarsal head at the ball of the foot is tender.  Pulling up on the toes, dorsiflexing them, can also cause symptoms as this stretches the capsule and soft tissue at the bottom of the joint, causing discomfort.

There can be several factors that may contribute to the development of metatarsalgia.  The runner may have a structural problem, such as a long/short metatarsal, plantarflexed, and thought of as a "dropped" metatarsal, a pronatory or supinatory fault. These structural problems had existed prior to the onset of the symptoms.  What often starts the symptoms of the metatarsalgia can be wearing a pair of shoes that are too old or worn where the midsole has bottomed out, a stiff shoe, overstriding, hard surfaces, or overtraining. 

For this reason it is important to review these factors in understanding what may have triggered the onset of symptoms.  Using a cushioning innersole, and sometimes a metatarsal pad, can be useful also in taking the pressure off the area.  It is important to avoid going barefoot or walking around in slippers/socks. Icing the area for 10-15 minutes can help with the acute inflammation as can oral antiinflammatories. X-rays may be needed to rule out a fracture or other osseous problem.   The runner may need a different type of running shoe and some accommodative padding in the spikes.   Most often, metatarsalgia is self-limiting and responds well to the above measures, once the probable contributing factors have been discovered.

As with all injuries, if the simple measures do not alleviate the symptoms, a consultation with a sports physician is in order.

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