Foot pain– ART by Kevin Jones and shoe modifications by James Drain

I’ve met a few miracle workers during my time as a runner, and I just met another one: Pedorthist, James Drain, who works at Elite Feet in Edmond.

I tweaked my right foot back in ’09. We believe I subluxed my right cuboid and over time developed chronic cuboid syndrome. As a result, the bone/ligaments never healed properly back in place. Because of the quirky cuboid, it somehow irritated my peroneals and/or changed my gait, and I developed a very prominent 5th metatarsal tuberosity where the peroneal brevis inserts. I also don’t have much fat padding in my feet, so this prominent bone bears A LOT of pressure. I also had some popping where the peroneal longus wraps under the foot (between the cuboid and 5th metatarsal) and ocassional swelling where the two tendons wrap under the fibula.

My quirky foot has bothered me off and on the past few years, sometimes getting stiff and sore but not hindering my performance.  My foot seems to “flare up” when the seasons change, and sometimes with various shoe changes and running on uneven terrain. I was dealing with my hip problems when the foot issue first started, which was a far worse problem and sort of distracted me from my foot. I saw various doctors and health professionals:

  • One doctor (orthopedic surgeon) recommended a shoe change, but didn’t specify exactly what he thought I needed. I went to a shoe store, tried on a gazillion shoes, and settled on 2 different pairs. My foot generally felt better.
  • I saw a podiatrist– like the first doctor, he didn’t think I needed an MRI because he assumed I had a cuboid problem (a mechanical issue), which would show nothing on an MRI. He had me troubleshoot the problem with various pads and tapes. First I tried an arch support pad, which definitely didn’t help. Secondly, I tried a cuboid pad, which made my foot feel somewhat better, so we knew the problem had something to do with the cuboid/lateral part of my foot. While the pad felt Ok running easy, it didn’t feel Ok running fast, so I’d take it out.
  • I’ve had massage, ART, acupuncture, graston, PT, used The Stick/various massage balls, and tried all kinds of recommendations on stretching, strengthing, and balancing exercises for my foot.
  • I rested for 7 weeks when I had my hernia surgery. The foot felt quirky, even not running, and it flared back up immediately when I started running again.
  • I’ve tried lots of barefoot running, always my “go to/cure-all” for a lot of problems. While it seemed to help somewhat, because I wasn’t in the right/modified shoe for the rest of my running…. no amount of barefoot running could fully cure the problem.
  • I saw another doctor, who also recommended a shoe change, but was more specific– needed a beefier shoe, being firm in the heel and flexible in the forefoot. I ultimately settled on the Inov-8 233s, which felt perfect for the marathon and carried me to my two 2:37 marathons this year.

Anyways, my foot problem sporadically flared up last month, which seemed to coincide with the changing weather and a new pair of shoes. I went back to the doctor, again, and finally…. someone did an MRI on my foot. It turns out it showed nothing wrong with the cuboid (as the prior podiatrist mentioned), but it showed stress to the calcaneus and peroneal tendonitis (particularly to the peroneal brevis, where it wraps under the fibula).

Finally, we knew I had a peroneal issue, which assumingly was either caused by the “loose cuboid” and/or possibly causing the cuboid to be loose in the first place (because of how the peroneal longus wraps under the foot, plus the tight peroneal brevis pulling on the 5th metatarsal). I saw chiropractor/ART specialist, Kevin Jones, who noted that my ankle felt tight, but my cuboid felt loose. He began working on the alignment in my foot/ankle and getting the mobility and strength back in my peroneals (~ART and band exercises). Within a few days, my stride/pushoff started getting back to normal!!! It was miraculous! Finally, we figured out what the problem is and at least partially how to make it feel better.

Now the shoe woes– I’ve tried a gazillion different shoes, and it’s been tricky figuring out exactly what my foot needs. Enter pedorthist, James Drain, who owns Elite Feet in Edmond. I’ve had a few people tell me to go see him, and after finally meeting him this weekend and picking his brain some, I realized he really could help me figure out the problem. All it takes is one person, the right person, who understands a problem and knows exactly how to solve it.

James had mentioned this weekend about “excavating” my inserts/shoes to relieve pressure where it hurts– basically looking at your insoles and cutting out the part where the pressure and pain is the greatest. You can see this on your insoles– where the “wear” is the greatest. LIGHT BULB GOING OFF IN HEAD– why hadn’t I thought of this before, and why had no one else told me to try this?!!! It’s soooo obvious if you just look at my feet…. I have a HUGE lump on my 5th metatarsal!

After talking to him, I went home and began butchering old insoles. I first cut out the part under the cuboid– no relief. Then, I looked at my old insoles and noticed how much pressure I put on that 5th metatarsal tuberosity. I cut out the insoles in this location. Ah ha…. foot feels much, much better!!!

I went to see James yesterday, told him what I did, and he looked at my feet, insoles, and shoes. He said it was very obvious what the problem is– the feet/insoles don’t lie! He began working away on excavating my shoes and insoles to take pressure off the 5th metatarsal. He noted that I’d likely feel better with a softer insole/shoe (to cushion and accomodate the 5th metatarsal). He also believes functional/hard orthotics aren’t the answer, as it would screw up my “ingrained mechanics” too much.

We spent a good 2 1/2 hours working on the shoes and insoles and running around the parking lot to figure out how to tweak them. While he modified the part where the 5th metatarsal tuberosity is located, it felt I needed additional excavation where the peroneal longus wraps under the foot between the cuboid and 5th metatarsal joint. It feels like I get popping here, so the excavation relieved the popping/pressure.

He also was able to modify the upper– stretching it near the ankle/fibula/cuboid.

Lastly, he has a tying technique that takes pressure off the lateral heel. He equated it to how you’d tape your feet, except with shoe laces. Mechanically, it felt like my foot moved better/toed off better with the upper using this technique. See pic below.

I am completely blown away by how James thinks! I wonder why I never thought of this, and why no else thought of it either! I’ve always believed a simple shoe change could solve something (whether you know how/why it helps). No shoe is perfect for a foot (being mass-engineered)… and sometimes no foot is perfect either (even barefoot)…. especially after putting thousands of miles on them over many years! I have a very specific problem that needs a very specialized answer.

I don’t know what will happen to my foot longterm and what I’ll need, but at least for now I’ve figured out what the problem is and how to provide relief for it. If you have a foot problem you can’t solve, I highly recommend seeing James. He can get the shoe to match the foot.


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Comments

  1. Great write up! Looks like you are on the right track. Some feet are tricky. You look like you have a bit of forefoot varus based on wear and photo of your foot. That can definitely cause you to crush the outside of your foot when you strike. Glad you’re doing a lot better!

    • runcamille says:

      Thanks for the comment Chris! Yes, I’m quirky all over! I have an anteverted right hip, so my right foot lands toe out a bit so my knee is aligned forward. Everyone assumes I’d have knee problems as a result, but I haven’t (yet!). I actually overpronate AND oversupinate with this foot– you can see it by how the upper tilts inwards over time (partially due to extra navicular bone too), and the wear pattern on the insole and sole. Dr. Coniglione thinks I “spin” off my lateral foot when I toe off, likely because of my anteverted hip. This puts a lot of pressure on the lateral foot. I’ve spent lots of time strengthening my lateral foot/hip, but it can’t change how I’m anatomically built. So we just have to do what we can to best accomodate my quirks and get relief.

      • You are in good company! Ali has significant excessive demoral anteversion bilateral. You probably have the external tibial torsion component if u r landing that way (or lack the internal femoral torsion). Either way, I see a few of these a week in very Good runners! I have a retroverted left hip/internal tin rotation and have never had any issues. With some of the bad cases I see. Running form changes or custom orthotics work best. We have to build very soft ones as the typical hard ones are no dice for runners. I showed one of mine to James from Elite Feet last year and he was very impressed. Ali can’t run without them! Do you have the “tail whip” or “helicopter” appearance in your running? I get pictures of it all the time in Anteverted women. It’s very common! Dont get too cocky, but one of the biggest measures of an elite athlete is their ability to compensate for bony anomalies. You have done great and have become a student of your biomechanics. You will give yourself a huge advantage in your running! Love reading your stuff and seeing a runner who is as interested in knowing how this stuff works as I am!

        • That would be “femoral” not “demoral”

        • runcamille says:

          Ohhh, I know what you’re talking about with the helicopter motion! I’m not sure I do this– when I had my hernias, Conor said it looked like I was churning butter with my legs! I saw an elite high school girl who does this– I couldn’t put my finger on it why she ran this way, and then it dawned on me with the hips, seeing how she stood (but she doesn’t toe out, I don’t think). Yes, I think that’s it with the tibia– you’ll need to look at me. Right femur anteverted, and tibia/foot rotates out (is that developmental or adaptive?). It’s only my right leg too, so I’m assymetrical…. which makes my running gait look awkward! My left arm swings out when it goes back, probably cause of the right hip. All of my injuries over the years tell a unique story that matches up with my gait. :) I’ve been mostly healthy the past 8 years, or at least troubleshoot things quickly, largely because I’ve gotten better and understanding these body quirks. Thank you for your input and I’ll look for you this weekend!

  2. Really excellent description of the problem and solution! It was great to be a part of (ok, mostly watching) the process. I’m thinking you are going to have a great race on Sunday and come back and visit us anytime, we love having runners stop by the store!

    • runcamille says:

      Thank you Heather for the side support! :) That was fun! Meeee too, feeling good and ready for Sunday! I’ll be sure to give a shout out to y’all on TV. :-)

  3. James Drain says:

    I have worked with quite a few Elite Athletes, but you have got to be the most humble, sweet and kind I have worked with. Thank you sooooo much for the kind words on my abilities on helping you it was absolutely a pleasure and I wish you the best in the upcoming race. Sorry it took so long to get it right I am glad you had the patience to wait around and let me tinker with your shoes. We should of given you that protein bar earlier , so you did not get so hungry.

    • runcamille says:

      Ahhh, thank you for the kind words James! You’re WONDERFUL! You have an amazing way of looking at things. I’m glad to have you around here to keep my feet healthy. No worries on how long it took– that was fun! Gotta get it right…. I put a lot of miles on these feet! :) We’ll keep on truckin’ into this weekend, in spiffy Inov’s! Thank you for all your help– I’ll keep sending people with quirky feet your way.

  4. I too have some really quirky feet! I actually broke my 5th metatarsal in 2010 and had to go through the all kinds of modifications (recovering oversupinator) . What’s great now is the understand I have gained about human biomechanics and how to adapt (or not adapt) my stride. And yes, hip and glute strengthening are incredibly helpful. Sounds like you’ve got quite the team on your hands:)

    • runcamille says:

      Interesting Adrienne! That’s a tough bone to break in terms of stability. It almost seems like if you hurt this part of your foot, it’s more prone to supinate even more. This is why I’ve been doing strength exercises with the bands. It’s feeling much, much better with everything! Definitely though, lateral stability is probably something all runners lack and can work on.

  5. Great post, as usual, Camille! I’ve been in my orthotics now for 4 years and after running (er swimming? or Sauna-ing?) at Boston last week, my feet now are finding the orthotics really uncomfortable. I have soreness on the outter aspect of the foot similar to where you point, but seems to subside when I walk in my Nike frees. So scared to give up the orthotics (crutch) but maybe this is a sign? They, very suddenly, feel like too much support… Is there a happy medium somewhere without going cold turkey? (I got them in 2008 when I broke through an sfx in my 3rd metatarsal and it healed a little funky… then got another sfx in 2001 in the 2nd metatarsal but it healed just fine. So naturally, I have a fear of having zero metatarsal support…)

    Thanks again for all the informative posts. I learn a ton from you! :)

    • runcamille says:

      Pam, I went through exactly what you went through with my metatarsal stress fractures and 4 years in orthotics! They worked temporarily, to help me get over the foot issues, but long term…. I needed to get out of them because they started causing problems elsewhere. You can read my post under health/injuries how I cut out the orthotics cold turkey (“How I became a minimalist….”). I went through about 3 months of sore/stiff ankles, and then the pain went away.

      That’s not surprising your feet swelled after Boston! I’ve had that happen several times after marathons actually, and I think it’s due to hydration/electrolyte imbalance, plus edema and then flying after all that stress. I usually try to wear compression socks/tights to help combat this, but even wearing compression socks…. I still ocassionally get the swelling issue. I’m thinking the Nike Frees work because they have more “give” to them. Kinda like with the orthotics… maybe you temporarily or even longterm need a different shoe. Our feet change over time, as illustrated by my post! So experiment around like I did, and feel free to go see a pedorthist who can analyze your feet/shoes. :)

  6. Awesome post on unconventional running hiccup solutions and congrats on finding a solution! In a past life I was a skier, worked in a specialty ski shop for 6+ years and was something of a boot fitting expert. I had all sorts of fun tools to work with, weighted and unweighted custom footbeds, drummels, grinder, heat boot streatching with various pieces to bump/modify the shell. I’ve often longed for some of these tools when I fit running shoes! Kind of sounds like this guy is doing just that.

  7. Hi, Great article thank you. How are you at the moment?
    I have a very prominent 5th metatarsal tuberosity on my right foot complete with very thick skin/callus.

    This time last year I injured it when turning sharp right in a race. It was mighty painful to finger touch. I excavated an old pair of trainers as you did, rested and the pain subsided after a couple of weeks.

    Keep well,
    Peter

    • Hi Peter! Wow, this is really cool you did the same as I did, and got relief! Good to hear!

      I was finally able to kick my longtime foot problem, between the shoes that were excavated, and then also switching to wearing softer insoles and shoes. Through trial and error, I found my feet liked some Nike Pegasus insoles, which I took out and placed in whatever shoes I felt like wearing. So I was able to continue wearing my racing flats, but with a softer insole. This made a remarkable difference between July-August– my foot seemed to straighten itself out, and the pain finally subsided.

      Hope you’re back running and not having any further problems! I’ve learned through all of this that you can often troubleshoot foot problems by trying various shoes/insoles, and also barefoot running.

  8. So both of my feet have always had that prominent 5th metatarsal for as long as I can remember, I only realized that it wasn’t “normal” when my partner pointed it out to me…
    When I tried to find a picture of someone with the same “look” this is all I came up with… and yours is from injury…
    Just wondering if maybe I messed up my feet when I was little from wearing too small shoes now…

    • runcamille says:

      Hi Mo, everyone’s feet are different. If your feet aren’t giving you problems then don’t worry about it. Our feet can change over time too, so if you wore the wrong shoes at one time… you can change shoes (or even remove your shoes- go barefoot!), and your feet will change.

      I developed the prominent 5th metatarsal because of a foot injury and compensations. I’m no longer in pain, and while the 5th metatarsal is still somewhat prominent, it’s not as “enlarged” as it was a year ago.

  9. I am still wondering, sometimes how worst it can be if you do not select the right pair of shoe for you or if you do not go for the custom made shoe. I never seen such things before and I will say people with such foot disorder should be really careful while purchasing shoes and must consider custom made shoes if necessary.

  10. Richelle says:

    Thank god for this article. I’ve been searching and searching because my foot looks exactly like yours did in that picture you uploaded. I guessed it was a peroneal issue, but couldn’t find anything similar so I thought I was wrong. So helpful!!

  11. Hello Camille, I’ve probably asked you this before via other social media and you have given me great advice from a range of topics. Thank you so very much=) But the sesamoids and I’ve been diagnosed with sesamoiditis. How much do you know about this little nagging pea sized bones that we absolutely need to use to push off from. I was diagnosed with a positive sesamoid stress fracture in my right foot (medial sesamoid) in 2010 and then two months later in my left foot (medial also)..how does this happen. Then I was fine in 2011 with training, 2012 got hit HARD with plantar fasciitis in both feet, mostly the right foot. The right foot is still I’d say still a “hot” area still just no real flare ups. I treat it myself with stretching it out and keeping it flexible. Last year was a very rough year, with my whole left partial hamstring tear in February and continuing to run on it until June was a very dumb mistake. Then in August I also got diagnosed with tendonpathy in my glute/hip region along with the tear. Got two PRP injections, went through intense PT for about three months, did chiropractor as well. Got my gait analyzed and I’ve been jogging/slogging/running for a solid two months now with my new form and it feels better.
    Also in February 2013 both balls of my feet started bothering me with dull aches and some pain here and there. Then working my butt off to save money for school last summer by waitressing my PF started nagging me, nothing to really worry about. Left that job because of these injuries mean more to me to take care of and to chase my dreams down someday.
    I’ve finally been seeing what seems to be the right podiatrist (he runs, but his knowledge of mechanics and other running related things is very low, he just runs recreationally obviously) for the last 4ish months. I have custom orthotics, and the new Brooks Glycerin. I have also spent money out of my pocket for laser treatment to heal the tissue back naturally in both balls of the feet. I’ll probably do another round of laser treatment. Not to be a pessimist here but the type of training I have ALWAYS dreamed of doing I don’t know if my body handle wants to handle 60-65 mpw (what I’ve been doing all throughout college) and eventually I would love to be 80 or more mpw someday. And to be a part of an elite running club post college, I don’t know what will put these nagging little bones to rest. Also surgery is a NO, NEVER HAPPENING, my podiatrist will not touch them. Not even an option. Advice? Or maybe if you see this you can get back to me via facebook so I can always go back to the feedback you give to me? Thank you for your time and looking forward to hearing back from you!

    Jill=)

  12. Phillip Cohen says:

    I appear to have the same painful lumps on the sides of both my feet. I retired from ultra running years ago but keep running shorter slower distances and dancing. I trim callous that may build up around the lumps and carefully tie shoes to minimize pain. Here is the strange thing. I have relatively high arches. However, I wore straight lasted Brooks Beast for years because of the overall foot comfort (but not the weight of shoe). During the past year I returned to Nike (Eclipse) but seem to experience more sensitivity. I don’t know if I should return to the heavier clunkier Brooks which makes my slow running ever more slow but less painful.
    Complicating matters, I had retro-calcanial surgery on both of my feet. This means I have metal anchors holding both of my achilles in place. The right foot seems to function exceptional well. The left foot, not so much. There was a post surgical infection and it continues to feel as if there was some fusion or adhesion as a result of the infection. There is a slight limitation to the range of motion in the left heel area. Is it a suggestion that I play around with the inserts of my shoes to see if I can reduce pressure in the area of the lumps? Any idea why a straight lasted shoe would feel better on a foot with a high arch and lumps?
    Thanks for any insight.

    • runcamille says:

      Hi Phillip, thanks for commenting! I can’t remember now if I did a follow-up to this blog post. I ultimately cured my foot pain by playing around with the insoles from various shoes. It was the Nike Pegasus insoles that worked, because they were soft! All it took was a few days wearing them, in my Inov-8 233s (a racing flat), and it was miraculous cause my foot pain that had lasted 3 yrs was gone! I think with age, my feet are starting to prefer softer shoes/insoles (losing their fat padding!).

      Definitely, you should play around with different shoe and insole combinations. You could even try playing around with whatever shoes/insoles you have in your closet. I’m currently sponsored by Skechers– I think their shoes agree with my feet because they are softer and have a wider forefoot than most other brands. You might really like them– I know a lot of older runners have raved about the Skechers GoRun Ultras, which are extra soft (similar to the “maximalist” Hokas, but a better fit and cheaper!). You should go with what feels right though– go to a running shoe store and try on all kinds of shoes. More shoe isn’t always best– I still prefer ~racing flats/lightweight trainers, being more flexible.

      Good luck figuring out what works best for your feet! :) Camille

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  1. [...] issues are really the same because no two bodies are the same. Check out Camille’s blog on the most recent addition to her education on foot [...]

  2. [...] in Oklahoma City, who does both acupuncture and ART together. I previously wrote about getting ART treatments with Kevin last spring (my other foot). To describe a typical treatment, Kevin inserts the thin [...]

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    Foot pain- ART by Kevin Jones and shoe modifications by James Drain

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