An injured runner recently sought my services for left foot pain that was approximately one month in duration and located at the base of his fifth metatarsal. He was prescribed physical therapy 2-3x/week for 6 weeks by a local orthopedist, who diagnosed him with insertional tendonitis of his peroneus brevis. Foot pain in this region is not uncommon among runners and can be associated with a stress reaction or stress fracture of the fifth metatarsal. While taking a history, the patient mentioned that he could walk the entire length of Manhattan in his dress shoes, but within the first 1-2 miles of going out for a run, he was forced to stop secondary to a pain on the lateral aspect of his foot. His pain was of insidious onset and his running log was not indicative of a training error or recent equipment change.
As usual, I started by examining his shoes. Nothing jumped out in terms of premature wear or running shoe defects. I moved on to removing the insole to ensure that there was no debris which may have been creating a hotspot. As a cat owner, I know the tendency of litter to get stuck under the insole of my running shoes; special thanks to my cats who love to sleep on smelly objects. And what could be better than Dad’s running and cycling shoes that he often goes sockless in. While I failed to find any cat litter, which was not surprising since the patient was not a cat owner, I did turn up a penny in his left shoe. The patient was in disbelief over the fact that this penny may have been the source of his foot pain. After completing the rest of the evaluation, and checking for pennies in the other shoes he brought to the appointment, I flipped him the penny and reminded him to avoid using it the next time he makes a wish. This scenario makes it clear that evaluating patients with “running injuries” goes beyond the musculoskeletal system when equipment is involved. What would I do without my feline friends?
