Understanding and Addressing Forefoot Pain in Runners

Question
Hi Orlando,

hope you can hep me, I am a LMT in australia but have recently started... I have a client who cross country runs approx 50-70klms per week and has done so for the past 12 years... he had recently developed pain upon rising in the morning and when applied pressure and also after running, found that his soleus/gastroc/ant tib were all very tight so went away at offloading these muscles and gave calf/soleus/anttib stretches fo him to do at home and also rolling his foot over a tennis ball... and iceing the plantar....
Then he comes back a week later, has still been running and the pain in the underfoot has now gone and he feels the pain between 3rd and 4th metatarsal when palpate and also when i take his foot into inversion and create a mild stretch... What is his problem do you think? What can i do for treatment and suggest for him to do?

thanks
melany  

Answer
Good morning Melany.  Thank you for your question.  Sorry to have taken so long to answer your question.  I did not realise that I had two pages of mail in the last 24 hours.  Your question was on the second page.

Beware:  you mention one side only.  This is very serious.  Do not treat the patient any more.  If this condition is acute-why?  If this condition is on one side only and not the other-why?  A doctor warned me about this years ago.  Always ask why is it in one side only and not the other.

If he has been doing this routine for 12 years and this condition is acute-my advice is not to treat him any further-send him to a sports doctor or physiotherapist.  His condition could be medical-all you are seeing is the symptoms.  

I don't want to freighten you-you have done the right thing by your patient.  You got a second opinion.  Mine.  If your patient sees a sports doctor or physiotherapist only continue to treat him once the doctor/physio has given the patient clearance to see you.

It is always the old story-when you are wrong-nobody forgets.  When you are right-nobody remembers.

I am not sure that I answered your question as well as I could.  But, I am not sure what more I could tell you.  

Please keep in touch and let me know how you get on.  I have every confidence that your patient will remember your good advice to him and continue with your services once finished with the medical team.

Looking forward to hearing from you Melany.

Cheers