What is a "Stone Bruise" and how is it treated?What is commonly referred to as a feeling of a "stone bruise" may be
metatarsalgia, which is like a "toothache" of the metatarsal head at the bottom
of the foot. Sometimes there is swelling at the area of tenderness but usually there
is no discoloration. Pressing on that metatarsal head at the ball of the foot is
tender. Pulling up on the toes, dorsiflexing them, can also cause symptoms as this
stretches the capsule and soft tissue at the bottom of the joint, causing discomfort.
There can be several factors that may contribute to the development of
metatarsalgia. The runner may have a structural problem, such as a long/short
metatarsal, plantarflexed, and thought of as a "dropped" metatarsal, a pronatory
or supinatory fault. These structural problems had existed prior to the onset of the
symptoms. What often starts the symptoms of the metatarsalgia can be wearing a pair
of shoes that are too old or worn where the midsole has bottomed out, a stiff shoe,
overstriding, hard surfaces, or overtraining.
For this reason it is important to review these factors in understanding what may have
triggered the onset of symptoms. Using a cushioning innersole, and sometimes a
metatarsal pad, can be useful also in taking the pressure off the area. It is
important to avoid going barefoot or walking around in slippers/socks. Icing the area for
10-15 minutes can help with the acute inflammation as can oral antiinflammatories. X-rays
may be needed to rule out a fracture or other osseous problem. The runner may
need a different type of running shoe and some accommodative padding in the
spikes. Most often, metatarsalgia is self-limiting and responds well to the
above measures, once
the probable contributing factors have been discovered.
As with all injuries, if the simple measures do not alleviate the symptoms, a
consultation with a sports physician is in order.
Phyllis A. Ragley, DPM, JD
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