Cuneiform Pain (Midfoot Pain during Running)

Symptoms

• Sharp or aching pain on the top of the foot (midfoot area), especially near the cuneiform bones.

• Pain worsens during activities involving pushing off, particularly while running or walking, and may persist after activity.

• Tenderness to the touch over the midfoot area, possibly accompanied by swelling.

• Difficulty or discomfort when trying to push off the ground or during the support phase of running.

Causes

Cuneiform pain during running is typically caused by overuse or repetitive stress on the midfoot region. The cuneiform bones, located in the middle of the foot, work with surrounding structures to stabilize the arch and transfer force during running. Overuse or biomechanical imbalances can lead to inflammation or stress fractures in this area.

• Cuneiform Stress Fracture: Small cracks in the bone caused by repetitive stress, often due to overtraining or improper running mechanics.

• Midfoot Sprain (Lisfranc Injury): Damage to the ligaments or joints in the midfoot area, often due to excessive force during push-off or twisting motions.

• Overpronation or Supination: Abnormal foot mechanics can increase stress on the midfoot, leading to pain in the cuneiform area.

• Improper Footwear: Shoes lacking proper support for your foot type can exacerbate stress in the midfoot.

Where It Occurs for Track & Field Athletes

• Distance runners are highly susceptible to cuneiform pain due to the repetitive impact during long training runs and races.

• Sprinters may experience pain due to the high forces generated when pushing off the starting blocks or when accelerating.

• Jumpers (long jump, triple jump, high jump) may also experience pain during the takeoff and landing phases, which place stress on the midfoot.

Rehabilitation Phases

Phase 1 (0-2 weeks)

• Goal: Reduce pain and inflammation, prevent further injury.

• Rest and Ice: Rest from running or activities that place stress on the midfoot. Apply ice to the affected area for 15-20 minutes, 2-3 times per day to reduce inflammation.

• Footwear modification: Switch to shoes with adequate arch support and cushioning. Consider using orthotics if needed to distribute pressure more evenly across the foot.

• Anti-inflammatory medication: Non-steroidal anti-inflammatory drugs (NSAIDs) may be used to reduce pain and inflammation (consult with a healthcare provider).

• Immobilization (if necessary): In severe cases, a walking boot or brace may be recommended to offload the midfoot and allow healing, especially if a stress fracture is suspected.

Phase 2 (2-6 weeks)

• Goal: Restore strength and flexibility while protecting the midfoot.

• Arch and foot strengthening exercises: Strengthen the muscles that support the midfoot arch. Start with exercises like towel scrunches (using your toes to grip and move a towel) and marble pickups (picking up small objects with your toes).

• Calf stretching: Stretch the calf muscles to reduce stress on the midfoot during push-off. Tight calves can limit proper foot function, leading to increased midfoot strain.

• Foot intrinsic muscle strengthening: Exercises like doming (lifting the arch of your foot without curling the toes) can strengthen the intrinsic muscles of the foot, improving stability and reducing stress on the cuneiforms.

• Low-impact cross-training: Engage in low-impact activities like swimming or cycling to maintain fitness while minimizing stress on the midfoot.

Phase 3 (6-12 weeks)

• Goal: Gradual return to running with focus on proper mechanics.

• Gradual running program: Start with short intervals of running on flat, even surfaces, alternating with walking. Gradually increase the running time as pain subsides.

• Footwear check: Ensure that running shoes have proper arch support and cushioning. Consider custom orthotics if abnormal foot mechanics (e.g., overpronation or high arches) are contributing to midfoot pain.

• Sport-specific drills: Slowly reintroduce sport-specific activities like sprinting and jumping, ensuring proper mechanics during push-off and landing.

• Plyometric exercises: Gradually incorporate plyometrics (such as jump rope and single-leg hops) to improve foot strength and resilience.

Prevention Tips

1. Strengthening the Foot and Arch: Regularly perform foot strengthening exercises like toe curls, calf raises, and foot doming to build resilience in the midfoot.

2. Proper Footwear: Wear shoes that provide adequate support and cushioning for your foot type (e.g., arch support for flat feet or shock absorption for high arches).

3. Gradual Training Progression: Avoid rapidly increasing mileage or intensity in your training. Follow a gradual progression plan to avoid overloading the midfoot.

4. Running Mechanics: Work on improving running form, focusing on avoiding overpronation or excessive pressure on the midfoot during push-off.

Exercise Videos