Serious Metatarsal issues

[Martin Daly]

Greetings all,

I have been in frequent training for the Camino del Norte which I had planned to start about the end of May. Now I fear I may not be able to achieve this dream as I have developed a severe Metatarsal issue in my right foot.
The pain kicks in at about the four kilometere mark, amd it is so serious that it forces me to stop walking. I am quite devastated by this development, as I can see my chances of walking the Camino disappearing.
I have read widely on the Web about this, and noplace have I found any references to a “cure”
I have good shoes, Merill Moab 11, Ventilator.
Are there better shoes around for someone with this condition?
So, in desparation, I ask: is it possible to walk the Camino del Norte - a difficult Camino, by all accounts - with such a severe case of Metatarsalagia?
Can anything be done to eliminate the pain?
As my physio is away until Februray. I have suspended my training regime - which was not severe or difficult .
With thanks ,
Martin

 

[Deleted member 67185]

Have you looked at metatarsal pads? Discuss this with a foot specialist, especially one that specializes in athletes.

 

[C clearly]

no place have I found any references to a “cure”

Take heart!

I had a metatarsal stress fracture 2 years ago, caused by wearing some stiff heavy boots on hard surfaces on a few very fast walks on city sidewalks. I had pulled these boots out of the closet and decided to "wear them out." They wore out my foot instead. I got a persistent sore foot.

I had several months when I could walk a few km but no more than 6-8 km without significant pain. The pain was never extremely severe but it was clearly going to be a problem on a 800-km walk. I had tried resting it for up to 3 weeks but it didn't really get better. Finally, I got it diagnosed and the doctor said it typically takes 6-8 weeks to heal. He suggested I wear a boot cast or an special insert in my shoe. I decided that the insert increased my discomfort, and the boot was overkill, since I could eliminate any pain by walking extremely gently and wearing cushioned footwear. So I just stayed off my feet as much as possible for the summer. I rarely left the house, wore crocs around the house on the hard floors (quite important), and when I did go out I walked very very slowly so there was virtually no discomfort. It took some real discipline. At 4 weeks, still not healed. At 5 weeks, getting close but not there. At 6 weeks - Yes, I started some regular walking. At 7 weeks, back to proper training with no discomfort ever again. At 10 weeks from diagnosis, I was walking from SJPP. I have walked 3 caminos since.

The lesson... if it is a stress fracture, 6-7 weeks of rest are probably needed. What that "rest" looks like might be variable. I'd suggest that you be really strict, starting right now - no walking; use soft cushioned shoes around the house and when going out. Consider a "boot cast" if your doctor suggests. Forget about even modest walking/training.

What I learned is that until it is healed, it isn't healed. You don't want to set it back. Each day of healing could be undone by a day of walking! So, stay off the foot!

Stress fractures are common and they can be hard to diagnose except with an expensive bone scan. However, the treatment is simple, so if you seem to have one, the conservative and effective treatment is to stay off the foot for 6 weeks. If you don't try to shortcut the treatment, you can be quite confident that it will heal. Plan to stay off it for January and February, then start training in March and you'll be fine for May.

Good luck, and let us know how it goes!

 

[Kanga]

Yes, I've got collapsed metatarsals. Stiff boots are my enemy. Try walking in a pair of flexible soft shoes - something like Skechers. See if that helps.

 

[Former member 49149]

Ok, the end of May. You have lots of time to do what has been suggested, and what you know yourself, will help. Please don’t take this awry, but you might consider another physiotherapist. I had abad case of what you have and with about five visits (and by the way, he is Australian) and being meticulous about doing the exercises, it went. If I ever feel a twinge, a couple of the exercises once or twice, and back to normal. Don’t tear up your tickets just yet! And Buen Camino!

 

[Martin Daly]

Dear all,
I am so grateful for such amazingly prompt and wonderfully solid advice on my metatarsal issue. I am relieved and encouraged. The cloud that enveloped with my thinking I would not be able to walk the 800-plus kilometers was a depressive one: within a short time of my decision to walk El Norte, I became consumed by even the smallest details of the plan.
To everyone, Davebugg, Kirkie, Kanga, and especially to C clearly, solid, detailed, informative and insistant, a profound thanks.
And yes, when it is all over and my injury has healed, and when I have completed my Camino, I will inform you on the forum about how it all went down.

Again, with thanks,
Martin.

 

[Sparrow in Texas]

Martin, you might not think so but learning about your feet now will be so helpful when you get to Spain.

On my first Camino I experienced the full range of foot problems, you name it, I had it. Blisters were the least of my worries.

What made my second Camino pain free was a combination of good socks (Darn Tough light cushion with a liner sock), comfortable and supportive but not stiff boots, consulting a sports medicine specialist, and the right insoles. I use Powerstep Pinnacle Plus insoles that I order online from The Insole Store, they can suggest other possibilities too. These provided comfortable cushioning, good arch support, a built-in metatarsal support pad, and a heal cup for stability. The idea is that a properly aligned and stabilized foot will be less prone to develop problems. Oh, and do not tie your boots too tight across the instep!

No, your dream of walking the Camino is not ending, it is just beginning!

Meanwhile, give your feet a rest and read a good book. Check out The Great Westward Walk by Antxon Gonzalez Gabarian. Outstanding, humbling book...

With much encouragement,

 

[J Willhaus]

Reading this now when my hospitalero duties allow! Thanks to Rebecca Scott for the translation. Great Book!

 

[Rick of Rick and Peg]

I'm wondering if the Norte is the best camino for you. I've gotten the impression (maybe incorrectly) that there was a lot of road walking on the Norte. Walking on pavement can be very hard on the feet. Any opinions from veterans of multiple caminos?

 

[gittiharre]

Take heart!

I had a metatarsal stress fracture 2 years ago, caused by wearing some stiff heavy boots on hard surfaces on a few very fast walks on city sidewalks. I had pulled these boots out of the closet and decided to "wear them out." They wore out my foot instead. I got a persistent sore foot.

I had several months when I could walk a few km but no more than 6-8 km without significant pain. The pain was never extremely severe but it was clearly going to be a problem on a 800-km walk. I had tried resting it for up to 3 weeks but it didn't really get better. Finally, I got it diagnosed and the doctor said it typically takes 6-8 weeks to heal. He suggested I wear a boot cast or an special insert in my shoe. I decided that the insert increased my discomfort, and the boot was overkill, since I could eliminate any pain by walking extremely gently and wearing cushioned footwear. So I just stayed off my feet as much as possible for the summer. I rarely left the house, wore crocs around the house on the hard floors (quite important), and when I did go out I walked very very slowly so there was virtually no discomfort. It took some real discipline. At 4 weeks, still not healed. At 5 weeks, getting close but not there. At 6 weeks - Yes, I started some regular walking. At 7 weeks, back to proper training with no discomfort ever again. At 10 weeks from diagnosis, I was walking from SJPP. I have walked 3 caminos since.

The lesson... if it is a stress fracture, 6-7 weeks of rest are probably needed. What that "rest" looks like might be variable. I'd suggest that you be really strict, starting right now - no walking; use soft cushioned shoes around the house and when going out. Consider a "boot cast" if your doctor suggests. Forget about even modest walking/training.

What I learned is that until it is healed, it isn't healed. You don't want to set it back. Each day of healing could be undone by a day of walking! So, stay off the foot!

Stress fractures are common and they can be hard to diagnose except with an expensive bone scan. However, the treatment is simple, so if you seem to have one, the conservative and effective treatment is to stay off the foot for 6 weeks. If you don't try to shortcut the treatment, you can be quite confident that it will heal. Plan to stay off it for January and February, then start training in March and you'll be fine for May.

Good luck, and let us know how it goes!

I got a stress fracture in my 2nd metatarsal and a lisframc joint sprain ( didn't know that that were the injuries until weeks later) I slightly tripped and knocked front and side of my foot taking a step down onto a verandah at the end of an exhausting day 1 out of Geneva. I wore Adidas walking shoes.
I continued to walk to Le Puy in excruciating pain. Hitchhiked 2 days.
It took many months to come right. 95% recovered. In the end what fixed it was wearing extremely stiff hiking boots all day every day at home and at work right through the summer. 6 months later I was able to walk the first week of the Le Puy route.
Overall the foot issue was a miserable experience and I put on 5 kg too.. .weight of my pack. Now my knee hurts. Hard to shift the kgs in your sixties.
Looking forward to my next camino in 2018 though.

 

[Sparrow in Texas]

We all are such great "doctors"! We all would agree that the metatarsal needs rest while it heals and that some cushioning, whether on the foot or on the bottom, feels good.

Gittiharre, was the reason for wearing the stiff hiking boots during your healing process to keep the bone stable sort of like a splint or an orthopedic boot?

 

[susanawee]

Greetings all,

I have been in frequent training for the Camino del Norte which I had planned to start about the end of May. Now I fear I may not be able to achieve this dream as I have developed a severe Metatarsal issue in my right foot.
The pain kicks in at about the four kilometere mark, amd it is so serious that it forces me to stop walking. I am quite devastated by this development, as I can see my chances of walking the Camino disappearing.
I have read widely on the Web about this, and noplace have I found any references to a “cure”
I have good shoes, Merill Moab 11, Ventilator.
Are there better shoes around for someone with this condition?
So, in desparation, I ask: is it possible to walk the Camino del Norte - a difficult Camino, by all accounts - with such a severe case of Metatarsalagia?
Can anything be done to eliminate the pain?
As my physio is away until Februray. I have suspended my training regime - which was not severe or difficult .
With thanks ,
Martin

Martin, I would definitely recommend that you go, in the first instance, to see a Podiatrist and, then, if needed, get a referal on to a Podiatric Specialist or someone who deals with foot issues.....you have enough time before your walk to get your foot issue sorted out properly. We here on the forum, can only give you information and hints as to how to manage this, but we are not professionals - it may be an issue with your shoes, but it may well be a structural issue with you foot. Much better to go to the people who really do know feet and who can help you properly. Kind regards and I hope that you can sort this out sooner rather than later.

 

[TaraWalks]

Hi Martin,
Physio here. It sounds painful and I'm sorry it's causing you such distress.

Because I can't look/feel/move your foot, I can't give you a definitive answer on what may be your issue. It doesn't sound like a stress fracture but to be on the safe side, it may be a good idea to rule one out.

First stop - GP referral and get an X-ray. If you do indeed have a stress fracture, then your physio/podiatrist/orthotist/GP will need to know and having at least the accompanying report will be beneficial in this case.

So go chat to your GP, they'll send you in the right direction and make the appropriate referrals if they're indicated. Lastly, your Physio is not the only Physio in the world. You can find another good one (ask your athletic friends) and get into it when you've seen your GP.

Hope it all works out,

Cheers,
Tara

 

[C clearly]

It doesn't sound like a stress fracture

I am curious what is not consistent with a stress fracture? The very limited information sounds very much like my stress fracture, which was confirmed by a bone scan. Yes, they'll probably do an x-ray but stress fractures may not show up on it.

 

[VNwalking]

@Martin Daly , lots of good advice here.
Especially to find a physio now, rather than waiting until February.
And to stay off it. Don't ruin the healing by testing it.
One thing to add which can be a huge help is to train in the pool. Google 'pool running' and you'll find lots of information. You will maintain your fitness, and it will keep you sane sane as well.
Edit - Here's a thread started by a forum member about her process in dealing with a navicular fracture; it has a lot of information, and gives you the sense of what's needed.
You have til May. All is not lost.
Buen Camino!

 

[gittiharre]

We all are such great "doctors"! We all would agree that the metatarsal needs rest while it heals and that some cushioning, whether on the foot or on the bottom, feels good.

Gittiharre, was the reason for wearing the stiff hiking boots during your healing process to keep the bone stable sort of like a splint or an orthopedic boot?

Yes it was to avoid a moonboot. I felt it would keep me more balanced. The lisfranc sprain was probably the worst part and needed rigid support.
I still don't know to this day how I made it to Le Puy. The last day I stopped every hour and when I got to Le Puy I crashed on my bed and only got up for a Kir Chataigne and dinner. I was furious when it happened and refused to let the injury stop me from my goal...bloody minded for better or worse...

 

[TaraWalks]

I am curious what is not consistent with a stress fracture? The very limited information sounds very much like my stress fracture, which was confirmed by a bone scan. Yes, they'll probably do an x-ray but stress fractures may not show up on it.

It could be a stress fracture, however everyone is different. And yes the info is limited. Some people have pain as soon as they weightbear and age and gender play a part too. But hey, that's why I suggested an XR to rule it out. As I said, start with the GP and continue from there - safest option if he wants to treat something properly. And true that it may not show up but really it's the first investigation I ask for - but I also work with a prison population, and they have old fractures that show up on XR they didn't even know they had!

 

[Rick of Rick and Peg]

Ask the doctor if you can train with a bike or a stationary bike. That should stress the foot a lot less than walking. Maybe it wouldn't be recommended at first but perhaps a bit later on, sometime before the doctor says it is okay to start walking.

 

[JFG]

Greetings all,

I have been in frequent training for the Camino del Norte which I had planned to start about the end of May. Now I fear I may not be able to achieve this dream as I have developed a severe Metatarsal issue in my right foot.
The pain kicks in at about the four kilometere mark, amd it is so serious that it forces me to stop walking. I am quite devastated by this development, as I can see my chances of walking the Camino disappearing.
I have read widely on the Web about this, and noplace have I found any references to a “cure”
I have good shoes, Merill Moab 11, Ventilator.
Are there better shoes around for someone with this condition?
So, in desparation, I ask: is it possible to walk the Camino del Norte - a difficult Camino, by all accounts - with such a severe case of Metatarsalagia?
Can anything be done to eliminate the pain?
As my physio is away until Februray. I have suspended my training regime - which was not severe or difficult .
With thanks ,
Martin

There is a lot that can be done. The first is to be certain of the cause or causes and the internet may not be the best place to determine that. A podiatrist and/or an orthopedic surgeon who treats foot and ankle may be useful to rule out bone issues or to try an injection if appropriate.
As for shoes Altras are my current favorite. Wide toe box so you foot isnt squeezed. Great cushion also.. Orthotics may be helpful. Custom many times are better than off the shelf.
Walking poles even when you think you dont need them. A physiotherapist to evaluate muscle tightness/weakness and lower extremity biomechanics as soon as possible.
And there can be more that can be done! I am a physiotherapist and managed 800 K this past summer with my crappy foot and metatarsal pain.

 

[dqduncan]

Greetings all,

I have been in frequent training for the Camino del Norte which I had planned to start about the end of May. Now I fear I may not be able to achieve this dream as I have developed a severe Metatarsal issue in my right foot.
The pain kicks in at about the four kilometere mark, amd it is so serious that it forces me to stop walking. I am quite devastated by this development, as I can see my chances of walking the Camino disappearing.


It sounds similar to an issue I encountered on my first Camino on CF. about 6 days in. Numbness and pain on right foot. Felt like walking on a marble lodged between 3rd and 4th digit. There's a nerve there which can become inflamed/irritated. There is a more serious manifestation but assume the best for now.

So, IF that sounds similar, my salvation was walking the rest of CF (3 more weeks) in Keen sandals I bought in Santo Domingo. The 'anatomic footbed' seems to behave differently from all my other shoes. On return, i got an orthotic with a metatarsal pad (raised area which forces a more natural curvature of the foot). I find splayed toes or just walking <au naturel> in bare feet is very comforting.

Good luck. There are feet people who can help. They focus on our natural foot function and how shoes/boots (even 'good' ones) actually cause us all problems. For example, @alignment.anarchist on Instagram is a friend who has fixed her own (way worse) foot disasters by applying her engineering brain to sensible problem solving and disciplined exercises. Hope it helps!!!!

BuenCamino!

 

[Northern Laurie]

Hi Martin

One other person brought this up, and I can call confirm that there is a substantial amount of paved surfaces on the Norte. Sometimes there are are alternate routes that may not be paved, but a susbstantial proportion, especially in Cantabria are hard.

Cushioning in your shoes is important. There is the “right” balance between support and cushion which varies by foot and by person, so sadly I can’t tell you what is right for you - but you probably won’t need a hiking boot (there weren’t many rocky sections-just steep ones) and walking shoes probably wouldn’t cut it either. I used trail runners, and wished I had a touch more cushion-I probably would have done well with a different insole in the same shoes.

1kg of weight can also make a tremendous difference to your feet, especially on hard surfaces.

I can’t help with healing, but don’t wait for your physiotherapist to get back. Healing takes time.

 

[peregrina2000]

I'm wondering if the Norte is the best camino for you. I've gotten the impression (maybe incorrectly) that there was a lot of road walking on the Norte. Walking on pavement can be very hard on the feet. Any opinions from veterans of multiple caminos?

Yes, there is a ton of pavement on the Norte. On my first Norte I really did some major damage to my heel. After getting a lot of help from forum friends, I was able to put together a list of coastal alternatives that were different from the camino in two ways -- mainly dirt trails, and right next to the sea.

If you are interested in these alternatives, I put up a link here, https://www.caminodesantiago.me/community/threads/coastal-alternatives-to-the-nortes-asphalt.49578/ but @Dave's soon-to-be-published new edition of Northern Caminos will list them all, he tells me.

See his comment in this thread: https://www.caminodesantiago.me/community/threads/mar-stages.52094/#post-574352

Buen camino, and for those who feel the bad effects of pavement, icing is a very good idea, as is obsessively hunting for an off-road dirt option next to the pavement. It slows you down a bit, and may involve walking in weeds, but I will do almost anything to avoid the pavement!

 

[Colette Z]

Yes, there is a ton of pavement on the Norte. On my first Norte I really did some major damage to my heel. After getting a lot of help from forum friends, I was able to put together a list of coastal alternatives that were different from the camino in two ways -- mainly dirt trails, and right next to the sea.

If you are interested in these alternatives, I put up a link here, https://www.caminodesantiago.me/community/threads/coastal-alternatives-to-the-nortes-asphalt.49578/ but @Dave's soon-to-be-published new edition of Northern Caminos will list them all, he tells me.

See his comment in this thread: https://www.caminodesantiago.me/community/threads/mar-stages.52094/#post-574352

Buen camino, and for those who feel the bad effects of pavement, icing is a very good idea, as is obsessively hunting for an off-road dirt option next to the pavement. It slows you down a bit, and may involve walking in weeds, but I will do almost anything to avoid the pavement!

Peregrina2000, I’m studying your El Norte alternative routes to reduce road walking. It’s very good. I have the new Wise Pilgrim El Norte Guide and it seems to have the coastal variations you suggest. May I ask what kind of footwear you used? I’m considering Trail runners (plus sandals) which are super light, cushioned and with significant treads. Any guidance? Another OP posted that she wore trail runners on El Norte but it seems not clear if she liked them or not. KR

 

[Acoupar]

I too have metatarsal issues on both feet. Burning and extreme pain, feels like my bones are broken at the base of my small and middle toes. I sought out a podiatrist and had custom orthotics made to fit my good quality hiking boots. 1/2 size larger than I normally wear to accommodate the orthotics and smart wool socks (with liners). I used Traumeel cream every night on the sore area, which seemed to help. I forced myself to take a rest every 5 km, removed my boots, stretched my toes, adjusted my socks. Used my trekking poles to take some weight off, and I always switched to supportive sandals when my hike was done for the day. Seemed to work and I walked the 1000km of the Via de la Plata from Seville to Santiago.
Buen Camino!