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5960 Views 1 Reply Latest reply: Feb 28, 2012 2:01 AM by JamesJohnsonLMT RSS
tntmm6 Rookie 2 posts since
Mar 4, 2009
Currently Being Moderated

Feb 27, 2012 6:48 AM

Knee pain and tingling and numbness in my foot

I am a new runner, having started C25K about 4 weeks ago, running 3-4 times per week.  Before I started I got fitted for new shoes, ones that stablize because I over pronate and have relatively flat feet.  I run on the road in our neighborhood, running mostly opposite of traffic, with lots of cul-de-sacs to go around.  My runs have been good, and fairly pain-free, except for the expected soreness from being a lazy bum for so long.  But during the last 2 runs I've done when I first start running, after a 5 minute warm up walk, both of my knees hurt and feel super stiff.  After I get going a little while, they feel better.  This last run, though, when I woke up, my right knee is so stiff, and is so tender it is almost hard to walk.  It is hurting on the left side, just below the knee cap, and the muscle (or tendon??) it tender to touch.  I have ice on it now.

 

Here is the other thing that concerns me - when I am done running and start to walk to cool down, my right foot gets tingly and numb.  Yesterday, my whole foot went completely numb.  I don't notice it when I run, but only when I'm done and walking home.  I'm afraid that I might hurt myself if my foot goes completely numb while running.  I've tried loosening my shoes, but that hasn't helped.  And is this tied to my knee pain?

 

I'm really making progress and enjoying running and I don't want to stop - but I don't want to injure myself either.

 

Thanks for listening

  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009
    Currently Being Moderated
    1. Feb 28, 2012 2:01 AM (in response to tntmm6)
    Re: Knee pain and tingling and numbness in my foot

    First thing I notice is running mostly on one side of the road, which can take a toll on the knees because of the gradient. I think, however, that the location of the pain you described does not match this cause, if your description is accurate. Your anatomical discussion is of more interest.

     

    There are many ways to tackle this one, but as podiatrists often say, it all starts in the foot. You mentioned the flat feet as if they were a liability, and I will agree with you that they are. However, the truth is that all feet are intrinsically flat. Without muscle tone, they are just a bag of bones. It's true that not everyone appears to have a flat foot, but a life of comparative leisure does little to keep them from getting that way. Don't blame yourself, there are experienced athletes out there with flat feet, and ones that over-pronate. In many cases those two problems go hand in hand, but I have a couple short stories to tell.

     

    There was a kid who lived 10 kilometers (6.2 miles) from his school. His only way to get there and back every day was to run. So, he grew up running 10k to school and 10k back every school day. Eventually he became very good at running the 10k, even setting some Olympic records. Until recently, he held the world record for the marathon. He was, and still is, a horrible over-pronator, Haille Gebrselassie of Ethiopia.

     

    There was another kid who lived about a mile from his school, and walked, ran, or a combination of both to and from school every day. Eventually he grew up and became like most of us, fairly sedentary. A mid-life crisis brought him the desire to run and compete in marathons, which he eventually did with no great success, but he managed to cop a couple overall trophies in the mile.  He also developed tingling in one foot that eventually became #$%^& painful and forced him to limp or walk in a few marathons. That kid would be me, and I still have the same foot, but I figured out a way to control it.

     

    The moral of these stories is that with some discipline, you become what you do. To get more specific, your body can potentially adapt to almost anything over time. However, it pays to examine what you are adapting to. Gebrselassie ran wild with little guidance over great distances, shaping himself into what he became rather successfully. While I aspired to similar success much later, my body was a product of old and new lifestyles, not nearly so successful. We play the hand we are dealt, but play it we must.

     

    When your foot lacks structure, it becomes very poor at absorbing shock. This causes your ankles, knees, hips, all the way up to the neck, to compensate somehow. While many years of growth can lead to successful adaptations, guys like me who roll off the couch into a marathon training program can be in for a rude awakening. Sure, some people are naturally gifted, yet that is only part of what they need. Haille did OK with the hand he was dealt, but it's also about knowing when to hold 'em, fold 'em, walk, and run, like the song says. It took the Ethiopian almost his entire career to set that marathon world record.

     

    The arch of your foot is no more an architectural constant than a hand is a fist. It's not just for mechanical advantage. It's more of a spring that gets all of its resilience from muscles and fascia. The foot itself is held together with lots of ligaments and interosseous muscles. While some of these tissues are tighter and more substantial on some than on others, one important element for holding all arches in place is not even in the foot. It's in the leg, way up and inside the middle of the leg...

    https://upload.wikimedia.org/wikipedia/commons/thumb/4/49/Tibialis_posterior.png/29px-Tibialis_posterior.png

    It's called the Tibialis Posterior muscle, and there is a very good chance that yours is way out of shape, because one of the main purposes of this muscle is to pull up on the arch of your foot, via a long skinny tendon that wraps around your ankle like so...

    https://upload.wikimedia.org/wikipedia/commons/thumb/9/92/Gray442.png/222px-Gray442.png

    The Tib P is not the only player involved in arch height, yet it is a key component that must be developed, to allow the other tissues to successfully contribute to maintaining a healthy, shock-absorbing arch. However, we are getting ahead of what may be the real problem. Suppose a raised arch could actually make your foot less stable as a platform to run on. This is indeed the case with many people, due to a structural anomaly involving the length of the metatarsal bones...

    http://3.bp.blogspot.com/_S1Zg1_V744M/S6P-e2ZKA4I/AAAAAAAAAbw/5UUi5CE4HwY/s400/mortonsfigure1.gif

    In the case of this type of foot, which many people (including myself) have, the shorter 1st metatarsal (B) causes the smaller bones (A, etc) to bear more weight as the heel leaves the ground, forcing some adaptations to strengthen their ability to bear this extra load, one of which may be calluses (C). Another adaptation is over-pronation, which flattens the arch as the foot rolls to shift more weight  onto the heavier 1st metatarsal (ball of the foot), and away from the smaller bones. Does this happen in everyone? No, but there are other adaptations you should know about, which have to do with lifestyle, as well as anatomy.

     

    Tingling in the feet may not seem serious at first, but it can be the precursor to excruciating pain. While there is not a direct link between foot structure and nerve problems that result in tingling or pain, there are indirect ones. People with strong, stable feet tend to enjoy time spent on them more than people with structurally compromised feet. This often leads to a more active lifestyle, and further strengthening of the muscles and tissues of the feet and legs. Those of us without this gift have to work harder at sports like running, especially when we have spent a good portion of our lives avoiding them.

     

    Part of this hard work is adapting to a less than ideal anatomical structure, made much more difficult when we haven't had our entire lives to train for Olympic glory, but instead make a sudden switch from sedentary to athletic lifestyles. Feet encased in shoes do not develop the same tonus in the interosseous muscles of the foot. This tissue between the bones gets exercised best by bare feet on soft ground. Without much mass here, there is little to protect the sensitive nerves running between those bones to power the many small muscles and deliver sensation back to the brain. The crowding and grinding of the bones around weak muscles, especially during repetitive motion like running, exposes the nerves to pinching and irritation, leading to symptoms such as numbness or pain, but there is more.

     

    Ideal circulation in previously unexercised legs doesn't happen overnight. It can take a while, not only for the tissues to develop, but for all the plumbing and circulation to be optimized. There is more than one cause for foot numbness, and poor circulation is another possibility. So is Sciatic nerve entrapment. However, my money's on the structure and conditioning of your feet.

     

    Now, there is a lot of money being made on foot remedies like orthotics. Some words of caution are in order. Orthotics are not all the same, any more than all doctors are the same. Some can help and some can make things worse, much worse. The arch, for example is partly supported by the Plantar Fascia. Yours is pretty well stretched out. People often respond to this by propping up the arch with a support, but this does no more to strengthen your arch, than a crutch will do to strengthen your leg. You may need an arch support or a highly structured shoe to hit the road, just as some might need a crutch to get around, but it is not the device that makes you strong. It is weaning yourself off of it that will lead to success. If your Plantar Fascia were to tighten, an arch support would simply stretch it out with every footstrike. If you want an arch, it's not about propping up the bones. It's about strengthening the muscles and tissues to do that for you. Bare feet on soft sand or soil, or some equivalent, can begin the process of rebuilding the arch.

     

    Once again, your foot may be more stable without the arch, if its structure is as I suspect. The way out of that kind of dilemma is usually with a proprioceptive orthotic, that prosthetically extends the ball of the foot to meet the ground sooner, eliminating the need for overpronation, thus provoking the Tib P to resume its role of actively maintaining the arch, which allows the PF to tighten. Won't happen overnight, but if my suspicions are correct, it would be a possible outcome for someone with the patience to persevere. If you managed to suffer through this entire blog, you've got potential. Others have "regrown" the arch, and you can, too. When you do, you will require less of the muscular compensation that puts destructive pressure on other parts of your anatomy, such as your knee.

     

    Many thanks to Wikipedia, Gray's Anatomy, Doc of Ages, and Clair Davies for graphics & info.

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