Foot arthritis help

[Ravenbait]

I've been doing triathlon for four years. At the start of this year I apparently ruptured the plantar fascia in my right foot, and, to cut a long story short, have gone on to develop osteoarthritis. I haven't raced since the beginning of May and haven't even been able to run since then.

I'm 37, a technique-obsessive, and my GP has told me I'm to blame for training too much even though I didn't. She said that as a non-active type. I've been told I should never run ever again, which is gutting as I'd just bought a Stealth for racing.

The arthritis is in the 1st metatarsal and I've also got metatarsalgia in the 3rd and 4th. I've taken to wearing vibram five fingers as much as possible as they force the toes to stay apart and seem to be reversing the claw toe I was developing. I still have issues with a sense of swelling and dull pain at the base of the 3rd and 4th toes. I have some arch-support orthotics from the biomechanics lab and some custom-cast insoles I got from a private podiatrist.

Should I accept her assertion that running on this foot will worsen the arthritis and leave me practically unable to walk in 5 years (as opposed to the ten she suggested if I don't run), or was she being overly-pessimistic?

Should I go cry in a corner or say f*** that sh** and pretend I have a mutant healing factor that will sort it out eventually?

Are there any exercises I can do to strengthen the foot or ameliorate the symptoms so I can get back to training?

Any and all advice gratefully received. As long as it's good advice...

Sam

 

[Fiona N]

I can't comment on your specific case directly but I have osteoarthritis in both ankles (from many years of sprains and breaks - and not giving injuries time to mend properly and also big toe joints (possibly from climbing). It was already noticeable on X-rays nearly 20 years ago (in my 30's) and obviously things haven't improved since then. But basically I was told (by the orthopedic surgeon who carried out my ankle reconstruction surgery in 1992 - so in my mind, someone worth listening to) to keep doing at least a minimum of exercise which used the joints through their range of movement in order to keep them working. He was fairly conservative with respect to running (preferring walking) whereas the physio I was seeing for the post-op rehab (a very experienced runners' sports physio) was happy for me to run off-road (but not on-road). I'm only off running now as I've got too fat to subject my knees (also developing osteoarthritis for similar reasons) to the stresses.

I think a bit of common sense is useful but I take anything GPs take with a pinch of salt if it's on the subject of sports-related joint problems. I would definitely try to see an experienced sport physio. The sports physios around here treat a lot of fell runners of various ages so are pretty good on associated injuries and the long-term implications of chronic problems like arthritis.

I should also say that although my ankles are stiff on a morning, often swollen by evening if I've been on my feet much during the day and generally feel like the ball-bearings are rusty, I don't think they're that much worse than 20 years ago and I've done a lot of running, mountaineering and fell walking (including GR20 last summer carrying camping gear) in the intervening years.

 

[Ravenbait]

Thanks for that, Fiona. That's really good to hear. I was starting to feel pretty depressed about it, to be honest, because I'm a fairly active type and can't bear the thought of having to quit anything.

Sam

 

[ChrisKH]

I had a long response prepared but unfortunately none of it was positive and it all involved a river in Egypt.

Arthritis does benefit from light regular exercise, physiotherapy, shoe inserts and hot climates. But I think your first step should be acceptance and then plan accordingly - I think triathlons and competitive running in particular are probably now out (I was at this point ten years ago when I was 37 with my knee) - but you may find as I did that a limited amount of running on grass may be possible or a substitution of swimming and/or cycling for running exercise is in order. Unfortunately arthritis is degenerative which means it isn't going to get better, however, that doesn't mean life isn't worth living if you have it. You just find ways of doing things differently.

Best of luck in finding your way through and I'm sorry I can't be more positive or offer better advice.

 

[fossyant]

You've just got a stealth - start TT'ing then....

TBH as running is a impact sport, then you do have to accept easing off that sort of exercise. Cycling on the other hand will be most beneficial.

I've just been diagnosed with osteo in my shoulder (from a bike/car altercation) so it's been a bit of a shock (I'm 40) but I'm fortunate that I have no trouble else where (my main sport since being a kid has been cycling, so no silly injuries)....

My doc's bascially said keep going..... Consultant's a bit 'ohh that's not going to help' - e.g. 100 mile sportives, track sessions etc.... but most importantly do what you can. Don't forget medical folk are mainly see non active folk...comes as a shock to them sometimes.

With the foot problem then yor are on the right track - BTW Specialised can custom fit their 'footbeds' for you. Even without this, the shoes have a ridge in the centre of the sole area to spread the metatarsals (a metatarsal button).

Cod Liver Oil and Glucosamine are supposed to help - I'm giving them a go to see if it does.

 

[Ravenbait]

I think triathlons and competitive running in particular are probably now out

I need a floods of tears smiley.

I was planning on moving up to middle distance this year, too.

Well. I can but give it a go in my special orthotics and if it hurts I'll know not to do it. Running in my VFFs offroad doesn't cause me any problems. Seems to help, in fact. Indeed, just wearing VFFs seems to help rather more than shoes do.

I guess it's a case of suck it and see.

Thanks for the advice, everyone.

Sam

 

[Tigerbiten]

Cod Liver Oil and Glucosamine are supposed to help - I'm giving them a go to see if it does.

I've been taking Glucosamine for bad knee joints for ~10 years now.
And Ibuprofen for ~30 ......

In my case the combination of the two drugs helps a lot.
Without I'm limited to ~4 mile on foot per day before my knees hurt, with I can cover over 20 miles but tend to limit myself to around 10-15 miles for day in/day out walking.
Cycling is the same, I get a big increase in distance before I get any pain.

But be warned, it can take weeks or month before you see/feel a difference.

Luck ...................

 

[Ian H]

Doctors and yer normal NHS physios are often not very good at dealing with active people's sports injuries. I've found a good sports physio who has worked wonders with various injuries over the years. It might cost £30 a session, but a good one (get reccommendations) might be worth it.

 

[ventoux50]

apparently ruptured the plantar fascia in my right foot,

have gone on to develop osteoarthritis.

The arthritis is in the 1st metatarsal and I've also got metatarsalgia in the 3rd and 4th.

I've taken to wearing vibram five fingers as much as possible as they force the toes to stay apart and seem to be reversing the claw toe I was developing. I still have issues with a sense of swelling and dull pain at the base of the 3rd and 4th toes. I have some arch-support orthotics from the biomechanics lab and some custom-cast insoles I got from a private podiatrist.

Should I accept her assertion that running on this foot will worsen the arthritis and leave me practically unable to walk in 5 years (as opposed to the ten she suggested if I don't run), or was she being overly-pessimistic?


Are there any exercises I can do to strengthen the foot or ameliorate the symptoms so I can get back to training?

Any and all advice gratefully received. As long as it's good advice...

Sam

Hi Sam, I'm a physiotherapist and treat a lot of running injuries, unfortunately, as with many desperate posts asking for advice and a magic bullet to speed recovery, to make an accurate informed guess as to your condition and likely prognosis / exercise/treatment regime requires a lot more information and a hands -on assessment.
Having said that, if you can answer the questions below I might be able to offer some preliminary advice;

a few questions first:

1. was the ruptured plantar fascia diagnosed as such - was it partial or complete and where anatomically did it occur ?
2. how do you know you have developed osteoarthritis - x rays for example or just the gps opinion ?
3. how long have you had metatarsalgia and again is that a professional diagnosis ?
4. the orthotics/insoles etc you use to alleviate problems - how long have you been using them and at what point in your injury process were you given these ? e.g. at the onset of metatarsalgia, following the pf tear or at the diagnosis of o/a
5. On what evidence has the gp made her assertion relating to your likely prognosis ?
6. have you ever suffered from plantar fasciitis or damage to calf muscles, had a heel spur, or broken any bones in your foot and/or ankle ?

In answer to your question re useful exercises - then yes there will be appropriate exercises depending on the current state of play, however, it would be wrong to suggest any exercises without more information as the wrong advice could exacerbate your problems.

I recommend you see a good sports physio (try the local sports clubs / running clubs for recommendations) and get a proper assessment done, if you're not happy with the GP's advice (I wouldn't be !) then ask for a referral to an orthopaedic specialist at the local hospital . . . . don't take what the GP says as gospel, with all due respect to them they are generally medical 'jack of all trades' and masters of none !

Feel free to PM me if you want any more information.

 

[Pauli1968]

I´m a keen cyclist and sportsman, but I feel I´m on a downhill slope. I was diagnosed with ´Gout´ over 12 years ago at the age of 37 years, I then developed ´Shin Splints´through running ´Carpol Tunnel Syndrome in both hands´and more recently Osteoarthritis´, ´Metatarsalgia` in both feet. The last I thought were ´Gout`attacks. I went to see the ´Podiatrist´yesterday for the first time, I was only in there for 5 min and she confirmed it was Osteoarthritis. So I panicked and stocked up on ´Tumeric and Ginger capsules, Apple Cider Vinegar, Manuka Honey and Green Tea". I had an attack in my right foot Sunday 30th July 2017 and it´s just subsided today, Thursday 3rd August 2017. I´m taking ´Naproxen´ as an anti-inflammatory, Állipurinal` for the ´Gout`. I get very bad pin and needles whilst cycling in my hands due to ´Carpol Tunnel`. When all the symptoms subside, I feel as fit as a butchers dog, But when I´m out of action for 5 days or more I´m back to square one. I feel for everyone one here. I do not run anymore as the impact causes lower back pain. Road cycling and MTB are my sports now, but it feels like a kick in the teeth when I have an attack of Ósteoartritis in my feet`. My 30 min x £36 session with the Podiatrist which turned into a 5 min session as she heard my diagnosis, took a look at my feet and informed me that it was Ósteoartritis`. Any help or advice would be great.

 

[bozmandb9]

I switched from running to cycling partly due to problems with Gout and osteoarthrities in my 1st metatarsal joint. Acid erosion of the bones will not be reversed. No doctor advised me to stop running, but I was finding it too frustrating since I was missing too much training due to attacks or injury. Even with the cycling, I'm pretty sure that I'll have to get the joint fused at some stage, but that stage would probably have come sooner had I kept on running.

But you can certainly help yourself with diet and lifestyle. Before I got fit, I was in terrible shape and dependent purely on medications, which didn't stop attacks reliably anyway. Changing lifestyle made a massive difference, common sense changes, proper healthy diet, good hydration and sleep etc. There's tons of information on the internet, and some of it is even accurate!

Good luck anyway, and don't give up. If anything, maybe back off the running for a while, and focus more on cycling. You can always ramp up the running if the arthritis settles down!

 

[bozmandb9]

I´m a keen cyclist and sportsman, but I feel I´m on a downhill slope. I was diagnosed with ´Gout´ over 12 years ago at the age of 37 years, I then developed ´Shin Splints´through running ´Carpol Tunnel Syndrome in both hands´and more recently Osteoarthritis´, ´Metatarsalgia` in both feet. The last I thought were ´Gout`attacks. I went to see the ´Podiatrist´yesterday for the first time, I was only in there for 5 min and she confirmed it was Osteoarthritis. So I panicked and stocked up on ´Tumeric and Ginger capsules, Apple Cider Vinegar, Manuka Honey and Green Tea". I had an attack in my right foot Sunday 30th July 2017 and it´s just subsided today, Thursday 3rd August 2017. I´m taking ´Naproxen´ as an anti-inflammatory, Állipurinal` for the ´Gout`. I get very bad pin and needles whilst cycling in my hands due to ´Carpol Tunnel`. When all the symptoms subside, I feel as fit as a butchers dog, But when I´m out of action for 5 days or more I´m back to square one. I feel for everyone one here. I do not run anymore as the impact causes lower back pain. Road cycling and MTB are my sports now, but it feels like a kick in the teeth when I have an attack of Ósteoartritis in my feet`. My 30 min x £36 session with the Podiatrist which turned into a 5 min session as she heard my diagnosis, took a look at my feet and informed me that it was Ósteoartritis`. Any help or advice would be great.

I've had the same issues Pauli,

Sometimes what appears to be a gout attack isn't, especially if it's after running or cycling. It can be a muscle in spasm either in the calf, or higher up, which is pulling through your tendons. All of our muscles are inter-connected in chains. I had what I thought was a gout attack, I went to my GP, he said take the NSAIDS, elevate it, rest it, give it a couple of weeks to clear up.

I went to a sports injury clinic, they traced a pull going though the arch of my foot to the tip of my toe, and up from the calf to the base of my skull. They got me foam rolling my hamstrings, and deep massaging (myo fascial release), into my calf, with a physio ball, and stretching out my toe on a wedge up against a step. To my amazement, after 90 minutes of tortuous treatement, the pain had subsided, and I was able to do sprint training that evening!

The Carpal Tunnel syndrome, in my view, will be caused either by poor bike fit or insufficient core strength, causing you to put too much weight through your arms on the bike, rather than supporting yourself with your core muscles. When riding, try taking most of the weight off your arms, or even all of it, and just using your hands lightly on the bars to steer. If you find it all but impossible to take any weight off your arms, for any length of time work on your core strength.

Try going to a good sports injury clinic, get a postural assesment. What is your work? Do you sit a lot? Any chance you have developed anterior tilt to your pelvis through sitting too much? Are you quad dominant in your running (lazy glutes).

Lots of things you can do to address all of the above. Osteo-arthritis and gout are horrible, but sometimes, attacks are bought on by musulo-skeletal factors, and so can be reduced or mitigated in the same way.

 

[Pauli1968]

Thank you for your reply, very, very interesting. Apparently my uric acid levels are normal now after taking 200mg Allipurinal daily. So my doctor told me that the pain was not gout. I was then tested for Rheumatoid Arthritis and the blood test came back negative. I then visited a podiatrist thinking I was maybe flat footed and suffering from Metatsaraglia or Osteoarthritis. She advised me that it was Osteoarthritis. I then went for an X-ray to check for Osteoarthritis and the results came back satisfactory. So what is causing these flare ups? If it isn't gout or osteroarthrits, then what is it? I´ve been pain free for 5 days now and feel as fit as a butchers dog. I have a referral to the foot and ankle specialist on Friday, so hopefully, they can correctly diagnose me. It would be better if I had a flare up whilst visiting them, but knowing my luck I´ll be skipping in there to see them. Thank you once again.

 

[kingrollo]

I have found yoga in particular putting you toes under when kneeling great for PF - not so sure about the OA - but just try and keep everything supple would be my advice. (apart from getting on your bike of course)

 

[bozmandb9]

Thank you for your reply, very, very interesting. Apparently my uric acid levels are normal now after taking 200mg Allipurinal daily. So my doctor told me that the pain was not gout. I was then tested for Rheumatoid Arthritis and the blood test came back negative. I then visited a podiatrist thinking I was maybe flat footed and suffering from Metatsaraglia or Osteoarthritis. She advised me that it was Osteoarthritis. I then went for an X-ray to check for Osteoarthritis and the results came back satisfactory. So what is causing these flare ups? If it isn't gout or osteroarthrits, then what is it? I´ve been pain free for 5 days now and feel as fit as a butchers dog. I have a referral to the foot and ankle specialist on Friday, so hopefully, they can correctly diagnose me. It would be better if I had a flare up whilst visiting them, but knowing my luck I´ll be skipping in there to see them. Thank you once again.

Next time it happens, the easy way to tell is this. If the toe itself is very inflamed, and literally agony to the touch, it's gout. What I've experienced is swelling of the first metatarsal, which whilst painful, is not painful in the tie above the joint. Or at least any pain seems to be inside and from the tip of the toe. There is also a pulling sensation in the sole of the foot.

Hope you get it sorted anyway, and let me know if I can help!