OpenHealth Q&A

Tightness in the Forefoot

**Overview** About four months ago, I began a routine of running daily in minimalist footwear for approximately a month on concrete surfaces. (In hindsight, perhaps not the wisest choice.) Since that time, I have experienced **continuing tightness in my forefoot and a notable sensitivity to pressure** across my metatarsals, particularly beneath the 2nd and 3rd metatarsal heads on both feet. There hasn’t been any sharp pain or identifiable injury, nor do I feel discomfort when applying pressure on the metatarsals. Instead, the sensation manifests as **tightness, fullness, and an overall sense of exhaustion**, rather than acute pain. **Notable Patterns** Upon waking, the tightness in my feet registers at approximately 8/10, yet it tends to **ease quickly with gentle movement**. Walking barefoot on hard surfaces like tiles or concrete significantly heightens the sensitivity of my metatarsals. Engaging in vigorous foot activities, such as calf raises or barefoot standing, often leads to **delayed exacerbations** of symptoms later in the day or at night. Remaining stationary aggravates the discomfort more than walking does. The symptoms I experience are **sensitive to loads and exhibit a delayed response**, meaning the pain doesn’t manifest immediately. **Additional Insights** Occasionally, I feel a general warmth or “heat” sensation in my feet. Symptoms tend to diminish when I sit or lie down, but the tightness returns once I resume a standing position. There are no visible signs of redness, swelling, or acute inflammation, indicating that what I'm dealing with feels more like **sensitivity to pressure** rather than actual structural damage. **Factors that Exacerbate the Issue** Walking barefoot on hard surfaces or carrying weight that increases pressure on my feet, as well as prolonged standing, seem to worsen the situation. Recently, I underwent an MRI. **MRI of the Right Foot** **Indication:** Chronic pain in the forefoot and MTP (metatarsophalangeal) joints. **Technique:** Non-contrast imaging sequences were performed. **Findings:** A small ganglion cyst is observed at the 3rd MTP joint along the plantar surface, positioned between the flexor tendon and the lateral accessory collateral ligament, measuring about 3mm. The attachment of the plantar plate to the phalanx appears torn, most noticeably on sagittal images (refer to key image on PACS). Minor signal alterations indicative of degeneration are noted in the adjacent accessory collateral ligament part of the plantar plate complex, but there is no significant disruption. The articular cartilage remains intact, while both the flexor and extensor tendons appear normal. The medial accessory collateral ligament at the attachment point of the phalanx in the 2nd MTP joint also shows signs of degeneration and slight fraying without clear disruption. The cartilage here is preserved. The overall forefoot shows no remarkable findings, with no evidence of marrow edema or stress changes. No Morton’s neuroma was seen. **Conclusion:** Small ganglion cyst located on the plantar surface of the 3rd MTP joint along with degenerative features in the accessory collateral ligaments and a minor perforation in the plantar plate. Currently, I am free of any acute pain. Has anyone else experienced something similar?

Answers (1)

2/8/2026, 9:30:39 AM

OpenHealth AI

It sounds like you're experiencing significant tightness and sensitivity in your forefoot, especially after your transition to running in minimalist footwear on hard surfaces. This tightness, particularly around the metatarsals without sharp pain, along with your MRI findings, indicates some structural changes due to stress on the tissues in your foot. Here’s a tailored approach to help manage your symptoms and promote healing.

Key Points:

1. Tightness and sensitivity in the forefoot are likely related to overuse and adaptation to the minimalist footwear.
2. MRI findings indicate a ganglion cyst and some degeneration in the associated ligaments, which may contribute to discomfort but not acute pain.
3. Symptom patterns suggest loading and pressure significantly affect your tightness.

Explanation:

The tightness and fullness you feel could be due to repetitive stress and strain from your running routine combined with minimal cushioning from the footwear. The ganglion cyst may not be directly causing pain but indicates a need for extra care in that area. Degenerative changes suggest that the ligaments are responding to the increased load and may require rest and modification of activity.

Next Steps:

1. Modify Activity:

   • Limit high-impact activities like running or vigorous foot exercises (calf raises).
   • Consider low-impact alternatives, such as cycling or swimming, while allowing your feet to recover.

2. Footwear Adjustments:

   • Switch to supportive footwear with cushioning, especially when walking or standing on hard surfaces. Using shoes with a slight heel can alleviate pressure on the forefoot.
   • Avoid barefoot walking on hard surfaces to prevent exacerbating sensitivity.

3. Gentle Stretching and Strengthening:

   • Incorporate gentle foot stretches that target the arches and metatarsals to improve flexibility and reduce tightness. For example, try rolling a tennis ball under your foot to relieve tension.
   • Gradually work on strengthening your foot muscles with simple exercises like toe curls or picking up marbles with your toes, focusing on controlled movements.

4. Rest and Recovery:

   • Prioritize rest for your feet, especially if you feel tightness increasing during certain activities. Frequent breaks during prolonged standing or walking can help manage symptoms.
   • Elevating your feet when sitting or lying can reduce tightness and sensitivity.

5. Monitor Symptoms:

   • Keep a journal of your activities and symptoms to identify patterns or triggers, helping you adjust your routine more effectively.

6. Consider Cold Therapy:

   • Applying cold packs to your forefoot for 15-20 minutes, especially after activities, can help reduce any minor inflammation you might not see but can feel.

If symptoms persist or worsen, it may be beneficial to consult a healthcare professional, such as a physical therapist, who can provide personalized exercises and treatment options for the ganglion cyst and degenerative changes. Please keep an eye on your symptoms, and don't hesitate to seek help if you notice new signs like increased pain, swelling, or changes in mobility.