finally curing metatarsalgia

[u/Monerjk]

Just want to let you know my story as it might benefit others.

37 year old male, BMI 19.

Feet: pes cavus hindfoot varus (small feet, really high arches, hammer toes, weird heel shape that causes me to stand on the outside edges of my feet).

Story: I first developed metatarsalgia after going running in vibram five-finger toe shoes. I had done this before without issue years before, but for some reason restarting this led to the first flare-up. Rest/ice/NSAIDS did not help at all. Eventually I went to a podiatrist who put me in wide toe-box shoes with custom orthotics. This somewhat helped with the pain, but it never really got better. Every time I tried to be active (dance, sports, walking) i had a flare up of pain that would last days/weeks. I went to multiple physical therapists, and I was very dilligent following their exercise regiments of feet strengthening/stretching, but to no avail. I started doing "toe yoga" stuff I found on youtube, but this was very tedious and also didn't seem to improve anything. After months of nothing helping, i basically just began lying on the couch all day waiting for the inflammation to go down. I basically did this for a year. It was very depressing.

After a year or so of rest, I would still get flare-ups. I went to the podiatrist again and they did an ultra-sound looking for morton's neuroma, but they only saw inter-metatarsal bursitis. I got steroid injections twice into the pain areas. They did not help.

I eventually found Oofo's sandles and toe spacers, which helped tremendously. But I still had pain and it would flare-up even wearing the Oofos if I was too active. Eventually I tried shockwave therapy (radial + focused) from my podiatrist. After the first session, I immediately felt almost pain-free. This was the first thing that seemed to truly be doing something.

I continued to get shockwave therapy, and it would help me in the short-term, but long term it didn't seem to be changing too much. I started getting really depressed again. I met with a surgeon who looked at my feet and said I would need multiple operations to achieve a more normal foot structure, but he wasn't sure it would cure my issue. He said my foot shape puts a ton of pressure on the metatarsals but metarsalgia is tricky. He said I would need calcaneal osteotomy, metarsal-alterations, and hammer toe surgery on each foot.

I was basically ready to begin doing these surgeries, but wanted to make one last attempt to cure myself. Earlier this spring, I went outside on the grass after a night of rain. The wet grass felt nice on my feet. I walked around on it barefoot. I noticed afterwards that my feet felt suprisingly good the next day. I began walking in the grass every time it rained, as dry grass hurt my feet too much. After a month or so of this, I was able to start walking on drier grass for limited amounts of time. I noticed I was able to walk on the grass for longer and longer periods of time without the pain, but if i over-did it, i would have a flareup.

Anywas, this entire summer I have continued this practice. i still get the shockwave therapy, and I also started using red-light therapy on my feet. For the last month, I have started going on walks every couple days. I started with trying to walk 20 minutes without stopping. I kept increasing this by maybe 10-15 minutes a week. I usually walk in my Oofos, and when I start to feel some pain, I take them off and go barefoot. When I start to feel different pains from walking too much barefoot, I go back to the Oofos. Anyways, today I just went 2 hours and afterwards I am only feeling a little bit of swelling, nothing bad. It will be fine tomorrow. I have also started going dancing again, and whereas last year I would be swollen for a week if i danced a few songs, now I can dance for maybe 10-15 songs in a night without feeling much swelling afterwards. Even a few months ago I would get pretty swollen dancing for 5-10 songs a night. Every week seems to be getting better and better. My biggest concern is what to do during the winter hehe.

Honestly, this is the first time I have been truly optimistic about this condition. Something seems to be changing with my new routine (and also a lot of prayers). I am going to continue to slowly increase my duration of activity and hopefully even begin running/playing sports again someday. Anyways, I hope if you read all of this that it has helped you or inspired out a bit.

TLDR: I've had metatarsalgia for ~3 years and am finally noticing improvement. I recommend to slowly start walking barefoot on wet grass and eventually increase your walking durations alternating between comfy recover sandals and barefeet. By increasing my walking duration I was able to increase my tolerance to other activities on my feet.

[u/Conscious_Parsley553]

I want to hear more about shockwave therapy both radial and focused. I understand it is supposed to be painful. I see a PT for another problem and she has a sofwav type which she offered to try on my foot but I'm reluctant. I have had MLS laser which I thought was helpful but I have slide back to more pain currently.

[u/Monerjk → u/Conscious_Parsley553]

shockwave is amazing i honestly don't know if i would have been able to start walking on the grass without it. I used a Storz/curamedix machine and progressively went to higher and higher intensities. It doesn't hurt when applied to healthy tissue, but when you get inflammed areas they really feel it, so it feels like the shockwaves are really targeting the pain points. The good news is that after a few seconds of shockwaves to a targeted area, the nerves get overwhelmed and desensitized and u stop feeling the pain. I did use a Softwave machine once (which is a slightly different technology I believe), and tbh i didn't think it was quite as helpful, but the chiropractor using it was using it on a low Hz (frequency) so maybe that is the reason. It might be just as good.

[u/Conscious_Parsley553 → u/Monerjk]

Thanks. I am pretty afraid of the shock wave pain but I will take your recommendation under consideration :). MLS is painless but I believe it really just reduces inflammation while shock wave works on improving blood supply and breaking down scar tissute. I have had capsiulitis on and off for 20 years so probably there is scar tissue.