Feet are super complicated. Just look at all the bones. Imagine all the tendons and ligaments and other muscle type stuff all those tiny bones need to work correctly. There’s a lot of stuff down there. And I’ve fucked up one of mine.
Based on self diagnosis, along with some suggestions from more experienced folks, I’ve concluded that I have either extensor tendonitis, which means I have messed up the tendons holding all that stuff together and making it work, or else I have a stress facture of a metatarsal, which means one of those long bones that leads to the toe bones is fractured. Both are over use injuries.
The extensor tendons are a group of tendons that straighten the toes. They run along the top of the foot, and can get inflamed. According to this sports injury website a primary cause is lacing your shoes too tightly. Overuse is another cause, as is an increase in hill running. Uphill running means the extensor muscles must work harder to lift the foot, and downhill means harder work eccentrically to slow the foot.
In my case, there’s been an increase in hill running and I probably lace my shoes too tightly. The latter is suggested by the sort of crunching sound I’ve been hearing lately. That sound is due to an irritation of the mucous sheaths of the achilles tendon, which you can see in the picture below. The extensor tendons run underneath these sheaths.
Tendon Sheath, Gray's Anatomy
There are also a whole grip of little bones down there. Metatarsal bones are a group of 5 long bones that join all those bones at the heel/ankle/top-of-the-foot-above-the-rear-part-of-the-arch to the toes. They are basically underneath the tendons and tendon sheaths mentioned above. Metatarsalgia is the fancy name for general pain forefoot pain, which is where the metatarsus are. It’s commonly known as a stone bruise, although that term also refers to a rather different heel injury.
One cause of metatarsalgia are tight extensor tendons, which I just went over above. Another is age, which is an incurable condition I have but try not to suffer from. Stress fractures are common over-use injuries for runners, and the second most common is a stress fracture of the 2nd or 3rd metatarsal.
The symptoms are pretty much the same as any of the others listed above, except that touching the fractured bone causes pain, (which leads me to believe that this is not what I have). The causes of this for a neutral gait runner? Overtraining. Period. Rehab involves a handful of mobility exercises.
Because this post is a list of resources as much as anything else, here is a link to another article on extensor tendonitis. From there, you can browse around and find information on all sorts of nifty injuries you will hopefully never have.
I also need to be a bit more diligent and intelligent with stretching. See, us over 40 guys have tendons that are a bit like old leather. Mine don’t have so much spring and stretch to ’em as they did when I was 20, which was when 8-track tapes were still popular, VCRs didn’t yet exist, and Lindsay Lohan was just a little sperm floating aimlessly in her daddy’s balls. Achilles tendon issues are most common amongst us stiff old guys. They have the same general causes as everything else: over-training, and a sudden increase in hill running. (Wearing high-heels constantly is also an issue, but I don’t know too many cross dressing runners).
The deal with stretching is not to get all carried away doing a bunch of stretching prior to running, when your muscles are still cold. Run half a mile or a mile as a warm-up, and then stretch gently. Do the longer stretch after the run.