21: Forefoot Pain in Runners: Understanding Metatarsalgia & Training Load

In this episode of Interdisciplinary Case Miles, Dr. Sara Raiser MD, Dr. Kate Mihevc Edwards PT, and sports dietitian Kelsey Pontius discuss a common running injury that is often oversimplified: metatarsal pain, or forefoot pain.Using the case of a recreational runner in her mid-20s who recently increased her mileage after joining a social running group, they explore the many factors that can contribute to forefoot pain — from rapid training increases and footwear choices to biomechanics, nutrition, and overall load management.The conversation highlights how lifestyle changes such as walking more in a new city, wearing heels for work, increasing weekly mileage, and under-fueling can all add up to overload the body.They discuss how clinicians evaluate metatarsalgia, when imaging may be necessary, and why assessing gait mechanics, strength, and movement patterns is essential for long-term recovery.The episode also explores the role of nutrition in injury prevention, including the importance of fueling appropriately when transitioning from casual exercise to training like an athlete.Listeners will also hear discussion around common contributors to forefoot pain such as calf tightness, forefoot loading, Morton’s neuroma, footwear transitions, and even referred pain coming from the lower back. Throughout the episode, the importance of treating the whole athlete- not just the painful area- is emphasized, along with understanding whether the body can truly tolerate the physical and mental load being placed upon it.Whether you’re a runner dealing with foot pain, a clinician treating runners, or someone trying to better understand training load and recovery, this episode provides practical insights into injury prevention, rehabilitation, and performance optimization.00:00 – Welcome to Interdisciplinary Case MilesIntroduction to the podcast and the interdisciplinary approach to runner health and performance.01:20 – The Case: Recreational Runner with Forefoot PainA runner in her mid-20s develops metatarsal pain after increasing mileage and joining a social run group.03:00 – Understanding MetatarsalgiaDr. Sara Raiser MD explains why forefoot pain is often multifactorial and requires a broad differential diagnosis.05:30 – Stress Fractures & Medical Red FlagsDiscussion around bone stress injuries, imaging, neurological screening, and determining when further investigation is needed.09:15 – Biomechanics, Gait & Foot LoadingDr. Kate Mihevc Edwards PT reviews running mechanics, calf tightness, forefoot loading patterns, and mobility considerations.14:00 – Morton’s Neuroma, Orthotics & Footwear ChoicesDiscussion around nerve irritation, shoe structure, metatarsal pads, toe spreaders, and footwear transitions.17:30 – Nutrition, Under-Fueling & the “Girl Dinner” ProblemKelsey Pontius explains how convenience eating, low carbohydrate intake, and under-fueling can contribute to injury risk.24:00 – Shifting Into the Athlete MindsetWhy recreational runners often underestimate their training demands and recovery needs.28:00 – When Foot Pain Might Actually Be Coming From the BackThe importance of screening for referred pain, neural tension, and lumbar spine involvement.34:00 – Training Load Includes More Than RunningHow walking, commuting, standing at work, and social activity all contribute to overall load.39:00 – Managing Recovery & Modifying ActivityStrategies for reducing stress on the foot while maintaining activity and supporting healing.43:00 – Key Takeaways for Runners & ProvidersFinal thoughts on strength, biomechanics, fueling, and finding clinicians who understand runners.46:00 – Closing Thoughts & Listener QuestionsHow listeners can submit their own running cases and support the podcast.Become a supporter of this podcast: https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support.If you enjoyed this episode, don’t forget to follow and subscribe so you never miss a case.Have a question or a case you'd like us to explore on the show? We’d love to hear from you. Reach out anytime at [email protected].