I am experiencing a pain in the first metatarsal on each of my feet. While I am out on the walks it doesn't usually seem to bother me....although this last week (11 mi) it was sore at the end. It is painful to the touch, and really is sensitive for 1-2 days. I am flat footed, but have never had ANY problems with my feet before. An osteopath discovered a leg length discrepancy and I wear a 1/2" lift in one shoe, but it doesn't cause me any discomfort. I feel that I have very supportive shoes, that are in very good shape. Could orthotics be necessary since I am putting in more miles? I have walked 3.5-4 miles 4 x's a week for 6 months...it just seems to be the longer distances that aggravate the pain. Any suggestions? I really don't want to rely on ibuprofen if there is another way.

Thanks!

Laurie,
A few answers will help us sort this out. Is one foot worse than the other or are they equal in pain? Is it he base of the 1st metatarsal (center of arch) or the head (where the toe attaches)? What is your height, weight, age? Any family history of arthritis (Rheumatoid, Gout, etc.)? Do you stretch your feet along with your legs? Was the lift thickness prescribed from measurements on an X-ray or CT? How far can you walk until it is painful?
Fire off some answers and I'll get back quick.
Cheers.
Dr. Jake

Dr Jake,
The pain is equal in both of my feet. I am not sure when the pain starts, but it must be after 5 miles, because I don't notice as much during the week. The pain is in the center of the arch. The lift was prescribed after X-rays not CT. Stretch? I roll it on a golf ball, but that doesn't seem to give any relief. I am 5'6'' and weigh 155 lbs.
Thanks for replying!

Laurie,
With the pain being in the arch and you being flat footed I am wondering if you are transferring weight properly onto the big toe during your gait cycle. If you are not, a little muscle on the bottom of the foot that flexes the big toe can get overworked and become spasmed causing arch pain that is often mistaken for plantar fascitis. Is there a specific muscle or tender point that you can find while working your foot with the golf ball? Does it feel like the pain is more in the metatarsal-tarsal joint space? What is your age? Any history of stress fractures, osteopenia, calcium deficiency? I assume no family history of arthritis?
Keep with the ice and golf ball massage. Try stretching out your calves, feet and toes. Stop by the tent on Sun in Vancouver if you can.
Cheers,
Dr. Jake