Fractured Foot

[yogi]

Hi,

I play Australian Football and also do Triathlons. Over the last few weeks when I kick the football I feel like there is a fracture in my foot. After a while the pain goes away and I am fine. I'm pretty sure it isn't bruising as it does stop hurting after a while. Are there any stretches that I could do to help?

Thanks

[Dr. D]

If there is the pain disappears after time, is the worst when kicking the ball, there is no bruising or swelling in the area of pain and there is no pain with regular walking, it is unlikely you have a broken bone (fracture) in your foot. But, there are conditions which can feel like a broken foot.

It could simply be the impact of the ball on the cleat, placing pressure on the foot. There could be an underlying nerve being aggravated when the ball hits the foot. There could be a bony prominence on top of the foot which is being aggravated when kicking the ball. The motion of kicking could be over-stressing the tendons on the top of the foot.

Is the pain on the top of the foot - the central section (midfoot) or further towards the toes where the ball hits or more towards the ankle? Is the pain sharp, dull, tingling, electrical, achy? How long after you kick the ball does the pain last? 1 minute, 5 minutes, 1 hour? Is there any stiffness?

[yogi]

HI Dr D,

Thanks for getting back to me!
The pain is in my right foot more toward the top of the foot on the inside (see picture). The pain shoots through my foot, some times it goes away in a few minutes. If I persist on using it the pain stays around a bit longer. Some kind of nerve pinch makes sense. Someone told me on the weekend that tying my laces differently might help. I've only had this problem for the last couple of weeks and I've played football for about 15 years. I have taken up triathlon training in the last 2 months also.

Thanks,

Mark

[Dr. D]

Great picture! That definitely helps to localize your area of pain. It could be a nerve impingement, but they typically occur more on the top of the foot. I would expect you to have some discomfort (usually in the form of burning, sharp or electrical pain) while training for the triathlons - either running or biking.
nerve-impingement-area.jpg

Considering you've been training and competing in triathlons the last 2 months (and playing footy the last 15 years), it is more likely a result of the triathlon training, and you are experiencing the pain more with kicking.

For nerve impingements, place padding around (not on) the area of pain and lace your shoes differently. Tips for lacing shoes.

But, more importantly is that you are running in the right pair of shoes. Shoes which are too flexible will cause foot problems. More on choosing shoes.


The area of your pain is at an area where the foot transitions from the rearfoot to the midfoot. Shoes that are not supportive will place excess stress in this area. The anterior tibial tendon travels where your pain is occuring and attaches on the top of the midfoot area. This tendon lifts the foot up (dorsiflexes the foot), and could be overworked if you are hill running. This tendon would also be one of the main stabilizing forces while you are kicking the ball.

Pain from the tendon could give you the initial sharp pain when you are kicking the ball. The pain would most likely be from the ball forcing the forefoot down and the tendon unable to stabilize the forefoot on the rearfoot. Stiffness and dull pain would follow, and then it would work itself out. Treatment for this would involve backing off on any hill training or running on uneven surfaces and a making sure you are in a stable pair of shoes.

It's difficult to know exactly what the cause is, without an examination. If the pain continues, you should visit your doctor. Hopefully this helps.

[yogi]

Thanks for all that info! that is extremely helpful. I'm probably going to buy a new pair of shoes this week. I've also changed my running style a bit with the triathlon which has meant I am not landing on the heal of my foot as much (as that tends to waste more energy).

Say hi to Joe B for me! Tell him Yogi says hi!

[Dr. D]

Great! - keep us posted.

[yogi]

Hi Dr D,

My foot is still bothering me. It only hurts when I actually kick the football. I have been running alot and I also have been biking and swimming without issues.
When I kick the football and the ball makes contact near the tip of my foot (closer to my toes) it hurts far more as it feels like I am straining something further up along the top of my foot.

Do you know what the problem might be?

[Dr. D]

Is the area you are experiencing pain different from the area you had circled in the image posted above? More towards to the toes, on the top of the foot?

If you don't have pain with running or walking, and you only experience it with kicking, then the chances of it being a nerve impingement or tendon problem (tendonitis, tendonosis) or stress fracture is unlikely.

I have to admit, it's hard to say without an examination of your foot. Can you localize the area? Do you have pain when you press on the area, when the shoe is on? when the shoe is off? Any redness, bruising, swelling?

It could be an impact injury from the ball contact on the foot, which probably wouldn't improve until the off season, but wouldn't necessarily be damaging to continue to play on (but I would expect some swelling, possible bruising). A poor fitting cleat with the laces bunched up or the tongue overlaping too much, where the ball has contact could cause a bruising type injury. Overtime this could result in pain with pressure even without swelling or bruising.

The last problem I can think of would be hyperflexion at the joints in the midfoot as a result of the impact of the ball and due to a lack of stability in the foot (either ligamentous or tendon). An X-ray and exam would be needed to diagnose this.

[yogi]

Thanks for the response Dr D.

It's a pity you are in Tahoe otherwise I would have tried to visit you. The pain is towards the top of my foot. It only starts hurting when I start kicking the ball. I haven't had any problems with running or riding. After the kicking the pain will reside in about 5 minutes but will come back after kicking. Hyper extension sounds about right.

Not sure what I should do or who I should see.

[Dr. D]

If you have had pain for this long and it has not responded to the things I suggested, I would definitely recommend seeing a podiatrist. Your health insurance may dictate who you see. Or, you may have to see your primary doctor first. If you do, they may be able to recommend a podiatrist for you. If you are established with a primary care doctor, you can always call their office and ask for a recommendation. I know it sounds like a hassle, but I think it would be worthwhile for a doctor to examine your foot. Sorry I couldn't be of more help.