Jogger’s foot is seen in athletes that participate in running endurance sports such as marathons, ultramarathons and Iron Man competitions as well as any athlete that is repetitively training with long-distance running. A runner with flat feet is more predisposed to this injury than someone with a more pronounced longitudinal arch of their foot. Medial plantar nerve entrapment has also been seen in an unusual presentation in ballet dancers.
The medial plantar nerve is a small nerve that supplies sensation to part of the bottom of the foot. It branches off of the much larger posterior tibial nerve above and behind the ankle on the medial (or inside) aspect of the ankle. The medial plantar nerve travels beyond the ankle and curves under the medial border of the foot. It enters a tunnel behind a bony prominence, known as the navicular. This tunnel is also bordered by a small muscle known as the abductor hallucis muscle which originates from the heel and inserts on the great toe. Repetitive trauma and inflammation caused by long-distance running lead to swelling and compression of the medial plantar nerve in this tunnel. This effect is exacerbated by a flat arch and foot (known as pes planovalgus). With a poor arch, more pressure and stretch are placed on this nerve since the foot contacts the ground with higher force.
Pathophysiology
- General
- Uncommon disease, not well described in the literature
- Symptoms occur due to compression of the medial plantar nerve
- Classically described as burning pain along the medial heel and longitudinal arch
Etiology
- Compression of the medial plantar nerve
- Can occur in either the fibro-osseous tunnel (fascial sling) or the knot of henry
- Typically occurs between the abductor halluces muscle and the knot of Henry
- Chronic Ankle Instability
- A history of multiple sprains and chronic instability is common
- Medial Plantar Nerve
- The terminal branch of the Posterior Tibial Nerve
- Motor: innervates the Abductor Hallucis, Flexor Hallucis Brevis, Flexor Digitorum Brevis, and first lumbrical muscles
- Sensory: medial and plantar aspects of the foot, plantar aspect of the 1st–3rd toes, and medial aspect of the 4th toe
- Sports
- Endurance Running
- Anatomic
- Pes Planus with calcaneovalgus
- Abductor Hallucis hypertrophy
- Hallux Rigidus
- Extrinsic
- Compression due to poorly fitted or new footwear
- Compression from insertional orthoses
Differential Diagnosis
- Fractures & Osseous Disease
- Traumatic/ Acute
- Talus Fracture
- Calcaneus Fracture
- Traumatic Navicular Fracture
- Cuboid Fracture
- Cuneiform Fracture
- Metatarsal Fracture
- Fifth Metatarsal Fracture
- Toe Fracture
- Hallux Sesamoid Fracture
- Stress Fractures
- Navicular Stress Fracture
- Metatarsal Stress Fracture
- Other Osseous
- Tarsal Coalition
- Accessory Navicular Syndrome
- Traumatic/ Acute
- Dislocations & Subluxations
- Toe Dislocation
- Lisfranc Injury
- Chopart Complex Injury
- Cuboid Syndrome
- Muscle and Tendon Injuries
- Posterior Tibial Tendon Dysfunction
- Peroneal Tendonitis
- Tibialis Anterior Tendinopathy
- Flexor Hallucis Longus Tendinopathy
- Ligament Injuries
- Plantar Fasciopathy (Plantar Fasciitis)
- Turf Toe
- Plantar Plate Tear
- Spring Ligament Injury
- Neuropathies
- Mortons Neuroma
- Tarsal Tunnel Syndrome
- Joggers Foot (Medial Plantar Nerve)
- Baxters Neuropathy (Lateral Plantar Nerve)
- Arthropathies
- Hallux Rigidus (1st MTPJ OA)
- Gout
- Toenail
- Subungual Hematoma
- Subungual Exostosis
- Nail Bed Laceration
- Onychocryptosis (Ingrown Toenail)
- Onychodystrophy
- Paronychia
- Onychomycosis
- Pediatrics
- Fifth Metatarsal Apophysitis (Iselin’s Disease)
- Calcaneal Apophysitis (Sever’s Disease)
- Freibergs Disease (Avascular Necrosis of the Metatarsal Head)
Diagnosis
- History
- Pain and numbness at the medial heel and arch radiating towards the first and second toe
- Pain may be described as shock-like or burning
- Symptoms may coincide with the implementation of new footwear or an orthosis.
- Physical: Physical Exam Foot
- Palpate for pain along the medial arch
- Pain with Abductor Hallucis palpation, specifically at the navicular tuberosity
- Reproduced pain and tingling with nerve percussion and forced passive heel eversion
- Standing on the balls of the feet may worsen symptoms
- Because symptoms are often exercise-induced, may be normal unless performed immediately after running
- Special Tests
Radiographs
- Standard Radiographs Foot
- Often normal
- Useful to evaluate foot alignment, degenerative changes
MRI
- Unclear role in the diagnosis
- Diagnosis on MRI has been briefly described in the literature
- Findings specific to Jogger’s Foot have not been reported
- May help exclude
- Space-occupying lesions in the tarsal tunnel
- Radiographically occult midfoot arthritis
- Tendon pathology at the MKH
Ultrasound
- May be useful
- Exact role in diagnosis is unclear
Treatment
Nonoperative
- Indications
- Most cases
- NSAIDS
- Orthotics
- Rigid foot orthotics should be modified, replaced, or removed to avoid compression
- Footwear modification
- Activity modification
- Running mechanics may need modification
- Physical Therapy
- Hyper pronation may be addressed by medial arch strengthening, kinetic chain rehabilitation
Operative
- Indications
- Refractory to conservative treatment
- Technique
- Surgical release
