In this video, I'm going to answer questions about metatarsalgia,
or pain that you feel in the ball of your foot, that have been asked in reaction to
my other video that I did about it, where I discussed in detail what causes it and what
treatments work well and how to apply the treatments for metatarsalgia. So,
if you want to watch that video, I'll put a link to that in the Description of this one.
For those of you who don't know me, my name is Maryke. I'm one of the physiotherapists from
sports-injury-physio.com, where you can get online physiotherapy assessment as well as treatment of
your injuries. Have a look at the Description of this video if you want a link to our website.
So, the first question relates to, how can you tell if the activities you're currently
doing is okay for you to do? Because the person who wrote in said that they are
currently cycling and swimming, running in the pool, riding a bike, even rock climbing,
and they don't feel pain while they're doing it, but they're not sure if it's okay or not. So,
to understand how to interpret that - because I struggled with this myself as well - one has to
understand how your body creates pain. Now, if you've had metatarsalgia for a while, you can
know that … or you will know that this condition can really drag on. When I had it, it lasted for
about a year before I could properly get back to my things again. And I'll tell you my journey at the
end of this; I'll lay it all out for you as well. And what happens is, you start obsessing about every single
thing that you feel in your foot, and every time you feel a little ping there, you think,
“Is it worse? Is it going to get worse? Am I going to be worse off tomorrow? Have I now delayed
my rehab?” But it doesn't work that way. So, if we think about pain: When we get an injury,
your body creates pain to warn you about that part and so that you can look after it to protect it.
But what we used to think was that, as your injury heals, your pain naturally goes away and that the
amount of pain you feel equals the severity of the injury. Now, we now know, because we've got MRI scans
or all these fancy things, that actually sometimes injuries can have no pain or excessive pain compared
to the damage that there is. Sometimes the injury can even heal, but the pain remains. So,
pain isn't a good indication of the severity of the injury or whether it's still there.
How does this bit work? Well, it's because you don't actually have pain receptors in your
foot or any part of your body. What you do have is, you have you have sensors that
tell your brain about the amount of pressure, the temperature, the chemicals in that area, stretch,
all of those things; and they're forever sending messages up to the brain. Now, the brain ignores
most of these messages because it's at a level that it doesn't think that it's dangerous. So,
for instance, if I squeeze my thumb really hard, I can feel I'm applying strong pressure, but it's
not painful because the brain goes, “Yeah, that's not dangerous for us. We don't care about it. You
can press it as much as you like.” But now, if I whack my finger with a hammer and I injure it,
it's super painful. And you'll … because the brain goes, "That amount causes damage, that's
a problem for us!" But now, two days later, I just press it gently, it really super hurts still. Now,
you can agree that that gentle pressure is not actually injuring it. But what it is doing is,
it's causing pressure in an area where the brain is very sensitive and worried about at the moment.
So, it goes, “Hoy! What are you doing there? We can cause that injury to be worse. Stop doing that!”
So, it's causing pain long before there is new injury happening. So, it's the brain's job to decide how
it interprets all of these signals. And what we now know from the research also is that the brain
doesn't have a set level for what is safe, what is not. It uses your past experiences, and it
uses what the impact might be, what it thinks the impact might be, on your future. So, for instance,
if I have an injury that I think, “Uff! Man, this is going to stop me from running an important
race”, or “If this carries on, I might lose my job." Immediately, that can actually increase
the amount of pain we feel because the brain interprets it as a super dangerous thing for my
survival, although it's just my enjoyment, or even my finances. But then, if I go to the doctor's office and the
doctor tells me, “Oh no, this is actually not what you thought it was, it's something simple. It
will be better in two weeks.” What they've shown with studies is when those people come out of the
doctor's office, their pain has already decreased by at least 50%. And you can agree with me,
there's no healing that took place in the doctor's office. It's literally your alarm system that just
went, “Oh, okay, we don't have to worry that much!" and the pain or the threat has decreased. So,
I am not by any means saying that all pain is in the mind. I'm just saying that the amount of
pain is decided by the brain ... or the severity of the pain. And when you've got ongoing conditions
like metatarsalgia, your brain can play a big part in making you too afraid to move and too
afraid to do things. So, what the research is showing for these types of conditions,
usually having a bit of pain or discomfort while you're doing an activity is absolutely
fine. Because remember, the brain's trying to protect you before more injury happens.
So, it's like that analogy of pressing the thumb after I've hit it with a hammer. It really hurts,
but it's not causing damage because the brain's creating the pain before it gets to the level
where it actually produces damage. So, the research shows that if you do activities and
you experience a little bit of discomfort, that's just the brain telling you, “I want
you to be careful here.” It's not telling you that you're actually causing damage. So, if you
keep the pain levels or the discomfort you feel below about a 3 out of 10 and you don't
see a day-on-day increase in that pain – so, by tomorrow morning, your pain is back to normal,
the discomfort hasn't increased – then usually that's okay. So, to get back to this question,
if you're doing … if you're riding your bike, they can feel it a bit while they’re
cycling - to be honest, while I was cycling, I could also feel my foot a little bit -
that's usually okay if the next morning is not more painful and later in the day it feels fine;
it's just while you're doing it that you're feeling a little bit. Rock climbing, you're
telling me that you feel nothing while you're climbing, and it actually feels good afterwards,
but you're worried because it places stress on the froot. Don't worry about it. The pain is telling
you that it's okay because you're not feeling worse the next day. So, go on with it if that's
the case. Pool running, that can be really good. The only thing with pool running is, I find if you
run in the pool that you actually push yourself away in the water; that can sometimes irritate
it … Doesn't have to, but it can sometimes irritate it. Whereas if you just run in the deep
water without actually making contact with the floor, that can sometimes be a better option.
But yeah, your cross-training activities sound absolutely fine to me. Then the question is often,
should you change the way that you walk? Should you walk in a different way to not
put so much stress on the ball of your foot? No! Because it's not possible to control your walking
with your mind the whole time. Walking is a super complex movement, and our brain
calculates the whole time different little things about what's the perfect optimal step to give in
different situations. Just walk in a normal way. If you're going to try and control it too heavily,
you're going to cause overuse injuries in other parts. This injury didn't happen because you had
a faulty gait. It most of the time happens because you just changed something and how much pressure
is through that foot too quickly. And I think in your case, you mentioned later on that you think
it may have been about barefoot shoes and things like that. That would have been the cause. So,
don't go messing with things that weren't part of the cause. What's my opinion about barefoot
running or walking? Is it good for you? Is it bad for you? Well, if you have got metatarsalgia,
I would advise that you don't go into minimalist shoes or barefoot walking, because actually that
has been shown to cause metatarsalgia, because it increases the pressure on the ball of foot. So,
what the research is showing is, when you go into minimalist shoes that don't have a heel and have
a flatter sole, it takes the strain away from your knees, but it actually places
it more into the Achilles tendon as well as the ball of the foot. So, you're more predisposed
to stress fractures and metatarsalgia in the ball of the foot then. So, I wouldn't use it
if you've already got this condition. Can calf and Achilles stretches help to prevent metatarsalgia?
Not really. In most cases it is not because things are excessively tight that it's caused.
It's caused because of overload, because of the shoes you wore or the type of activity you did
or the change that was just too quick that you made between those ... the types
of activities. There are some cases where it might be an issue that it's over-tight, but
it's usually people who have changes in muscle tone like cerebral palsy or something like that,
that can cause it, or if you've got severe arthritis or something in your foot, that causes a change with
that. But in most adults that don't have any issue with that, it's not really going to prevent
it. How about exercises for the feet? Can it make it worse? Will it help it? The only exercise
that I would be careful with is when you're doing calf raises. So, going up and down on your toes,
especially during the early stages. I'm currently doing calf raises and I did them ... several months
into my recovery I could start them, but I had to start very low load because that really loads the
metatarsal heads. So, whether you can do them or not will depend on where you are in your recovery,
but just use the pain response again and check how you feel the next day or several days later.
If you have a feeling that an exercise is making stuff worse, leave it out; check how it
feels without it. Put it back in; check how it feels with it. That will tell you whether it's
helping or not. Then, something people often ask me is will they get better and how long did it
take me to recover? So, I went and I looked back at my Garmin stats, actually, to see how exactly did
this work, because it was three years ago that I had it. And what it showed was that
during the early stages of my recovery, I was really limited to just very short walks and
not too much time on my feet. And then, as I recovered, about two or three months later,
I could start little run-walks and I kind of did run-walks on and off, on and off up
until the December. So, we're looking at … It started around the April time, I think,
and then December, I kind of overdid it a bit and I thought, “You know what, you're being
silly. Just concentrate on cycling and swimming and walking; don't do any more running.” So,
I left it for three months and then, when I started again – so, about a year after it
first started – then I could start with run-walks and consistently increase that until I got to
5 Ks by the end of that year, and that was fine. So, it took me a proper year and a half to get to
running 5 Ks where I wasn't actually thinking about it. And also, at the beginning I had to
keep it really slow, because the faster you run, the more you push off. I also had to avoid really
going up hills, because when you go uphill, you go on your toes more; and you run up a hill on your toes more.
These days, you'll also be happy to know that I'm pretty much wearing the shoes that I used to
wear most of the time. So, I can walk barefoot on tiled floors now. But if I do it excessively or
too much, then I can feel some sensitivity coming back. How do I fix it? I literally just wear my
lovely blue plastic, very dirty Birkenstocks inside the house for a couple of days
and, boom! then the sensitivity goes away. Most of the time I walk in these. I can walk about
4 kilometres in these without any issue. They’re pretty thin at the moment because they're old,
and I haven't been in a country with big enough feet that I can actually get new ones. So, most of the
time I'm happy in these. If I do longer walks, I do wear - or I go for my runs - I wear my
Hokas. I absolutely swear by these; they're really comfortable. If I annoy my foot because I walk too
much in my flip-flops, especially on gravel where there's stones, then sometimes my foot can get a
bit sensitive again, and I just wear these for short walks then as well for a couple
of days and, boom! – sensitivity goes away. So, to answer the question about whether you'll always
have an issue with it, I don't know. My feet are just inclined to it. I've known for years
that I had a grumbling thing there. It was only three years ago that I properly overdid it and flared it up
properly. So, for me, I think it's always going to be an issue if I go too wild. But, because I
know what footwear to wear and what situations to adapt, it's not limiting me at all. I can now do
hikes of 14 kilometres; just haven't done longer ones because I haven't had to. I’m mostly running
between 2 and 3 miles. That's not because of my feet; that's because I'm being lazy at the moment.
I can walk miles and miles barefoot on the beach, which I couldn't do it at one point.
And I remember, even, when it was really painful, just jumping in the ocean, that was hurting it
and causing it to be worse. And now I can do all those things without even thinking about it. So,
the journey was that the first year was the worst. The next six months was annoying because it kept
on coming back if I wanted to push too hard. But then the following six months - so, getting
up to two years - it really, really got to the point where I didn't think about it much. And
this last year I really didn't think about it much. It's just every now and again that I get
a "ting!" from it. And I won't be surprised if in two years from now, I'm sitting and going,
“I can't remember that I had it”, because that's how the body works. These things are sometimes
slow in healing, but they do eventually heal. Excellent! It feels a bit like that was just a
bit of a rambling from my side. Apologies if it's longer than what I thought it would be. Remember,
if you need help with an injury, you're welcome to consult one of the team via video call,
and the link to the website is in the Description of this video. Take care!