An inflamed toe joint.

I have been experiencing pain in my right foot. It occurs in the sole between the second and third toe, right at the base of the two toes. It feels like a pulling force, as if it wants to make the two toes curl. There is no blister, swelling, or bruise there, and the pain is isolated in that one spot. It is noticeable most of the day, but much worse when I run. It doesn't prevent me from running, but is uncomfortable. I have tried several pairs of running shoes, and it makes no difference. I have been running 20 to 30 miles a week for several years. The pain has been with me for only about a month. Any ideas?

Michael Menesale

Newburyport, MA

"Pulling force" pain between two toes in the ball of the foot is typically associated with a chronically inflamed joint, aka capsulitis. The structure that holds the joint synovial fluid is called the joint capsule. This can become inflamed and hurt with increased pressure, as when pushing off while walking. This explains why running makes the pain more severe. As your shoe padding breaks down over time, more pressure winds up on the foot with each stride. Be sure to replace your shoes every 300 to 500 miles to ensure adequate support. Alternating two pairs of shoes can make them last longer. In addition, you may ice the area and/or try anti-inflammatories. If these strategies don't help, see a doctor who can take x-rays and fit you for an orthotic. Note that a neuroma (inflamed nerve) can occur in the same area, but it is usually described as a shooting pain and is associated with toe numbness. In any case, treatment of a neuroma is essentially the same.

Brad Wadington, DPM