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I am a recumbent cyclist, but my hubby has been a runner for over 30 years, so I know that neuromas can be a problem among runners too, so i am hoping to find some suggestions or ideas here.
I am not a hard core cyclist, Hubby and I rode about 1000 miles last year, hope to increase that this year. Our climate and loaction are not conducive to winter riding Our average ride is anywhere from 20 - 40 miles. We are signed up to do a 6 day, 300 mile, ride across our state, in June 2012 and will strt training for that as soon as our country roads are clear of ice and snow.
Last fall, I was diagnosed with 2 neuromas in my left foot and one in my right foot. I have been resting my feet, and using some natural treatments and taping to try and get things under control. I have consulted 2 sports medicine podiatrists, and I have been researching different methods of treatment. I am seeing a sports medicine podiatrist in Grand Rapids, MI., even though he is nearly 2 hours from where I live. I am trying to avoid surgery for the neuromas. My Dr., is suggesting alcohol injections next. I recently came across another option, cryosurgery, which has had some success, without the risk of stump neuromas that alcohol injections can have. I am not sure my podiatrist offers this treatment. Has anyone had experience, success, or failure with cryosurgery for neuromas? Do you know of any Dr. in the Grand Rapids area that is skilled in this?
Thanks for your input.
Surgery is not a good option for forefoot pain related to repeitive use. Take a look at this short article Diagnosis of Reptitive Use Injury. In my experience foot neuroma is often related to improper fitting shoes. The traditional belief is too narrow or small a shoe compresses the foot too much. My experience is too large or too wide a shoe allows the foot to sloop around in the shoe leading to shear force on the forefoot. Make sure you shoes are correct size and fit.
Damien Howell PT, DPT, OCS
I agree with Damien on the surgery, and the injections are a temporary fix. Your focus should be on removing the source of irritation, because even when removed, more neuromas can form. You already have at least three.
The internet chatter out there suggests if you are using cleats, to move them in back of the ball of the foot. Don't use toe clips at all, because they will bunch the toes in any soft shoe, and there is a riding sandal by Lake that will give your toes some room, if you are careful to protect them while riding.
Someone else suggested platform pedals, but shoes even when sized correctly may bunch depending on how you drive the pedals and how the shoe is fastened. Many bike shoes have fastening systems that may not prevent the toes from bunching. One problem is pressure on the forefoot while trying to grip a surface with the forefoot. The muscles in your foot can cause the metatarsals to squeeze together, pressuring the perineural fibrosis (aka "neuroma"), and this effect has to be eliminated by secure footing.
I found just today that I could irritate the nerves in my foot by working the pedals on a piece of gym equipment. It happened when I was trying to grip the pedal with my foot while placing pressure directly on the balls of the foot (metatarsal heads). Ordinarily, this pain does not bother me when running after I tape my toes properly to separate them.
To summarize, it appears that a secure cleating system + no pinching, jamming, or sliding in the toe box = no pressure on the neuroma. Even though you are not running, other riders suggest your feet will still swell, and this must be accounted for by sizing up your shoe and securing it properly, so the foot does not pinch by outgrowing the shoe or sliding in it, as Damien cautioned.
Thanks for the replies from yourself and damien. They were both helpful. I have an upcoming appointment with someone (a cyclist) who seems to have a lot of knowledge regarding sports orthotics. He was recommended by the Sports Medicine Center in Boulder CO. One of my cycling buddies had suggested that I contact the center to see if they might know of someone in my area that could help me with a good orthotic. Both sports medicine podiatrists I have seen, don't have much hope for orthotics, but i am hopeful they will help. My cycling shoe and the clip will have to be sent in with the molds tohave the orthotic made. I really think it will help. After all the meachanics of the foot and the action I am doing are what is causing the neuromas. What you said makes perfect sense to me. Riding without clips isn't an option. I am riding a tandem terra trike, which is only about 18 inches above the ground, so leg suck, or slipping off the pedals can cause serious injury. We tried riding a regular tandem, but found I am too smal to safely capatin one that fits my hubby, as a stoker. I am 5 ft 2, he is 6 ft, so we switched to a tandem trike, which works great for us. Hubby is unable to captain, because he is blind. However, after so many years of running, he is one powerful stoker. Here is a link to waht we ride.
Thanks again for the suggestions. I will let you know if the orthotics work.
Forgot to mention that I have tried Shimano pedlas that have a platform on one side and clips on the other, then I switched to anegg beater pedal. The egg beater seemed to help some, as the clip was a bit more recessed on the pedal.
Being an MN sufferer, and upon years of reflection......I just put my foot through too many overuse situations repetitiously. We are a nation of overachievers in everything and in trying to remain competitive, we give away our health.
The only reason I have shrunk my MN so far is:
1) extensive prolotherapy until Dr. Hauser says no more is necessary
2) wear toe stretchers every night (I am buying the sock version to sleep in soon too)
3) wear 5 toe sneakers for walking relatively short distances (no cushion or support for distance) but contemplate that barefoot cultures rarely see foot problems, contemplate that hard..........
4) got rid of the bicycle pedal toe cages
5) stopped trying toooooo hard in life, accepting more my fate and destiny
6) giving up on the too much ambition or greed or pride that got me here in pain
7) understand you cannot break the natural laws or pay you will............we are infinity ignorant
Over and out..........