Given the nature of our common hobby, I am surprised that I don't see this addressed more often...

I hiked the JMT two summers ago and developed a matching case of stone bruises on each of my two feet--technically metatarsalgia; pain of the foot pad just behind my second and third toes. This is similar to the more common plantar fasciitis, but in a very different location. (I've developed mild plantar fasciitis in the past, but have managed to shake it).

All the medical advice I've received leans toward reducing time on one's feet. HOW STUPID IS THAT? That would mean giving up hiking. What are these doctors thinking?

If you have experience with metatarsalgia or similar foot issues, maybe you can give me some input.

* Has anyone used specific footbeds that have helped this condition? Or have you altered off-the-shelf footbeds in a way that helped?

* Anyone know of online resources that address foot issues from a hiker's perspective?

Hope someone can help.

bryan~

while i haven't had the specific issues that you've experienced, as a former distance runner, i've had my share of foot problems. have you considered yoga? standing poses are fitting as they demand proper foot placement and bring extereme judgement to your posture (which is oftentimes easily overlooked, and is generally the sourcing of many feet problems). personally, i've had extreme success with this measure, as if i've retrained my body to effectively redistribute it's weight, resulting in far less strain on my feet. in fact, i've been injury-free for a near decade now, which i continue to attribute this to yoga! naturally, it requires practice and consistency, but consider the mechanical aspect-- much like a vehicle-- remedy from the source.
check it:
http://www.sunandmoonstudio.com/Articles/feet.html


good luck.
lt

+1 to the notion of yoga, or stretching of the calf/lateral muscles, +/- therapeutic massage. My boyfriend developed metatarsalgia while we were training for the Wonderland Trail. It was partially due to his foot wear (one specific brand of boots seemed to stimulate it), but what cured it was an excellent massage practitioner. He was afraid that he was going to have to stop, and within two sessions he was walking pain free. Avoid shoes that put pressure behind the metatarsals.

Hi Bryan

I don't know what the problem is in your case, but I DO know that pain in that region for walkers is very often caused by shoes that are too narrow. The tendons between the bones there get 'gently' squeezed, and get bruised. Recovery is possible albeit slow as the bruising takes a while to dissapate. Medical intervention is rarely (never) a good idea unless there are bones sticking out of the skin.

What most people do not know is that when you start walking for more than a few hours, the muscles etc in your feet swell up. That is perfectly normal. But it means your feet grow in size for a while. If your shoes were a snug fit when you were sitting at a desk, they will now be too small. It is well-known in the shoe trade that women 'always' buy shoes which are too small - and always have sore feet.

An awful lot of 'experts' (eg foot doctors) seem to think that adding a custom footbed to a shoe which is too small is going to help. It only reduces the volume more. And of course, their examinations are conducted days later when your feet have shrunk back down in size. The results are rarely beneficial. And do remember, man has been successfully walking for tens of thousands of years: shoes are a very recent invention, and many manufacturers do not really understand what they are doing (apart from making money).

I strongly recommend that you get your feet measured on a Brannock device in a good shoe store and find out what WIDTH they are. Then, when buying shoes make very sure that they are the correct width or one size wider (and maybe half a size bigger). Allow for the natural swelling which happens when you go walking. This may mean that many popular brands of shoes will be too narrow for your feet. SO BE IT!

Note that many shoe companies do not actually state their shoe width on the shoe or the box. They might say 'wide', but very often that is only a D width, which is NOT wide for a walker. Mine are 4E. Many others here also have wide feet with similar problems. Most companies do not make multiple widths because that is more cost, so they go for 'average'. Pity that wide does not fit into average too well.

If you are having trouble finding shoes which are clearly labelled with a suitable width for you, try New Balance at http://www.nbwebexpress.com/ That web site allows you to search for shoes with a specific size AND width. In addition we have a number of reviews of their products on the web site. They work.

Cheers

I would see a physical therapist. There usually is no cookie cutter answer to any musculoskeletal problem so you need individualized health care.

Bryan - I had similar problems - among others - with my feet. I also have flat feet. I spend most of my days on my feet working as a carpenter and construction project manager. I went to a podiatrist - one who I knew by reputation and one who is an ultra-distance runner. He made me custom orthotics and they have helped me a lot. You might be able to use off-the-shelf footbeds to alleviate your issues, but without some diagnosis, it's only trial and error.
If you do decide to try a podiatrist, I would suggest trying to find one who specializes in athletes - runners especially.
Roger's point about shoe width is well taken - though that's only one possible cause - it is worth making an effort to ensure that you have shoes that fit properly.
One thing that I have found is that walking more helps me, generally, while being on my feet without covering much ground (as I do at work) is bad. Feet are dynamic machines, and they do best in motion, or so it seems to me.
You might also try strengthening your feet by walking barefoot in the sand or on nice soft grass if you have somewhere you can do that. But start slow and work your way up very gradually, since you'll be getting your feet used to something new.

Bryan, how old are you. Eventually the ligaments in the foot start to sag, just like everywhere else in the body.

I recommend a custom orthotic.

I had a similar problem with pain, both in the forefoot between the metatarsal heads, and from pressure on the balls of the feet from atrophy of the natural padding on the soles. I was limited to 8-10 miles a day. The solution was a firm custom orthotic that fills my longitudinal arch. Much of my weight is now carried high in the arch, behind the forefoot, under the midfoot. This takes weight off the balls of my feet.

I love them. I don't go on a dayhike or neighborhood walk without them, let alone overnight with a pack. I consider them as natural an aid as walking sticks. I can move them from shoe to shoe.

Podiatrists can make them. I went to an "orthotist," a physical therapist who does nothing but make orthotics. Most areas with Division I sports teams, or a Sports Medicine program have someone who makes orthotics for their elite athletes, and anyone else who wants them.

They usually make a plaster cast of your feet, and then from the cast, mold a custom orthotic out of plastics and rubber, that fits your foot exactly, with support where you need it. Sometimes they need to add various internal features for extra support and protection. But in general the custom molding distributes the weight evenly over the entire foot.

In my state, an orthotist needs a prescription from a physician. But the orthotist looks at your shoes, watches you walk, examines your feet, listens to your story, makes their own diagnosis, and designs the orthotic.

Bring the shoes you plan to hike in. The orthotic will complement the natural support and strength of the shoe. I found using an orthotic made hiking in light running shoes possible for the first time.

Unfortunately custom orthotics are expensive. About $400 and up per pair. But thats not too bad for a piece of high end gear used every day. And my first pair has now lasted over 5 years. I tried many of the over-the-counter arch supports and pads, but none of them worked.

Also they are heavy. My pair weigh in at 7oz.

They also make my feet hotter. There is less airspace under the foot, and less movement of air around the foot. I feel the need to take off my shoes and socks more often.

They are flexible, but in the long run they may decrease flexibility and movement of the foot. I think this is how they work. But the intrinsic muscles and joints of the feet probably don't get as much of a work out. I find that massage and foot exercises at the end of the day help.

Good luck.

Get your feet examined by a podiatrist. It cant hurt, and can only help.

20 years ago I had fallen arches,leading to plantar fasciatis. I had no arch in my instep. Orthopedic doctor said it was hereditary, prescribed 8x strength ibuprofen. I knew it was aggravated by weightlifting and running. It hurt to take a step when I got out of bed in morning. If I wore certain shoes I might be hit with a burning pain under my foot that would suddenly keep my from walking at all.

Enter a run-in with a salesman who sold orthotics to RESHAPE the foot to correct problems. Not support, not molded to your foot custom to support, but actually to reshape your foot back the way it is supposed to be. At first it was extremely painful, felt like I had golfballs under my insteps, couldnt wear more than 30 min a day. Over time worked up to all the time. After 6 months my feet had shaped to the orthotic, and even without them I now had arch back in my feet. I have worn them every day for 20 yrs, to keep my feet in the correct shape. Feet are actually quite moldable, and when they get out of shape, it puts all the joint in bad positions, ankles, knees, hips and leads to all kinds of problems.

At the time this guy had outfit all kinds of professional athletes. By taking footprints and comparing to the ideal footprint, you could see what was wrong with a foot, and orthotics were chosen (out of dozens) to reshape the foot back to the ideal. My wife has some toes that are hammering, as many women do due to crappy shoes, and got some too to fix that, but never wore them due to the initial pain.

At first I was very skeptical, but the returning customers that swore by how this had fixed knee pain, back pain, etc convinced me to pay the $250 (lot of money in 1991) to try them. After a few months, I swore by them too, never had any more plantar fasciatis, stood straighter, etc.

Edited by livingontheroad on 01/21/2012 18:08:50 MST.

Before we were married my wife developed plantar fasciitis. She was wearing shoes from payless shoe source. I had her get a quality shoe that she felt fit correctly. The big issue for her is that she was wide feet for a woman. When shoes don't fit in width she just tends to get a bigger size. This wasn't working. She needed shoes that fit, especially the width.

This is really just to reinforce Roger's post about widths being important.

Oh yeah, New Balance shoes have worked best for my wife.

Edited by Hitech on 01/21/2012 23:05:28 MST.

Re: metatarsalgia- That is what brought me to this thread while searching what you have described. Last Saturday while doing a local trip of about 18 miles I fell prey to this condition and set out on finding a way to address it. I was in so much pain I was routinely the last person at each break along the trail among our group. All the input I've seen here is invaluable and while sifting through the various articles I found that in terms of DPM's I would focus primarily on a Sports Medicine Podiatrist with the following criteria in the selection of one:
A: Are they board Certified? Check either www.abps.org and www.abpoppm.org
B:What memberships do they hold? -www.aapsm.org, www.apma.org
C:- Call their office- are they accustomed to seeing athletes. What specialty do they treat?
D: Check Online- Their website, reviews (yelp).
E: Do they provide Custom Orthotics and do what do they do to determine if their needed? Do they measure gait, use treadmills, or have you walk down the hall?

In addition, I found that the shoe condition you are using could be a factor. Perhaps the condition you are now experiencing is the result of the outsole wearing out during your hike or the design of the outsole. Is the outsole's wearbar (the pading under the metatarsal heads) still intact? If not and you've been doing several miles it could be time for new shoes. Are the outsoles firm enough to provide enough support for the application still? Is the forefoot rigid or is it too flexible thereby causing the problem. Again these are all issues to check in terms of seeing if it's your shoes or a combination of needing orthotics and footwear. In any case it's time for me to replace my shoes AND see a DPM with the qualifications I've posted here.
Regards-
A

Edited by surf1div1 on 03/31/2012 12:47:03 MDT.

Not exactly what ultralighters want to hear, but I can't remember having any foot pain when I wore old style heavy hiking boots, other than blisters. I have had foot injuries since moving to lightweight and less rigid footware though. Of coarse I've been getting older too, but sometimes I wonder if I go too far in pursuit of ultralight and in doing so, I give up things that might not have been all that bad after all.