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1428 Views 2 Replies Latest reply: Jan 6, 2011 8:03 PM by JamesJohnsonLMT RSS
Turtle Who Runs Pro 110 posts since
Sep 29, 2009
Currently Being Moderated

Jan 3, 2011 9:34 AM

I wish I had different feet! Foot pain again.

I've always had problems with my feet (heel spurs, ligament issues, etc) and I am a serious overpronator (and an Athena), so I knew that when I began running about 15 months ago, that there would be issues, but now I have a new foot pain which is making me crazy.  I am currently running in Brooks Addiction 9, a motion control shoe (and the fourth kind I've tried when I bought shoes last year), which were making the toes on my left foot numb and painful typically after running more than 2 miles. After running though, the paid would go away.  After pleading with my podiatrist, I finally was fitted for othodics, which, I though would make the pain go away, which it did for a little while.  Now, everytime I run I get this pain almost in the center of my left foot (right between the end of the arch and the ball of my foot), which hurts for 2-3 days after I've run.  I've tried to ice it after my run, but it only helps a little, and I'm still limping for an additional day or two after running.

 

I'm wondering if I need new running shoes, as I've had the Brooks for about nine months and around 400 miles, or if the orthodics are causing this new pain, or if it's something new and unrelated.  The shoes don't appear to have any wear on them, but could the midsole be breaking down and I don't know it?  I am starting to train for my next HM in February, so I have to get this settled before then, and it's discouraging because I feel like there is no "right shoe" for me.  Buying shoes is such a painful process, because I've been fitted incorrectly in the past, and have wasted a lot of money on shoes that don't fit my feet.  I also don't know if this pain persists should I go to a podiatrist or orthopedist for resolution?  I'm hoping new shoes will be the answer, since it's time for new ones anyway.

 

If anyone has any opinions of what this may be and if you have had any experiences like this, I would really appreciate any words of advice or information, because all I want to do is run without foot pain, which isn't too much to ask, I hope.  Thanks so much for your help.

 

-Kelly





-I may be slow, but at least I'm moving forward. 
  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009

    Sounds like a neuroma in the center of your foot (between the  metatarsal bones) that occurs after excess pronation forces the  metatarsal bones to crowd together as the first metatarsal (ending at  the ball of foot) is pushed upward towards them during impact. This is  sometimes called "Morton's neuroma."

     

    People often make  the mistake of assuming that the second toe is longest on a Morton's  foot. While this is often the case, I have a Morton's foot with toes of  normal length. If the first metatarsal head (bone forming the ball of  foot) is shorter (closer to the ankle) than the second metatarsal head  (behind the second toe), it causes foot instability when shifting to the  forefoot, usually resulting in overpronation to shift the pressure to  the largest toe. This arrangement crowds the metatarsals even when the  shoe is wide enough, even when the arch is supported by an orthotic,  even when there are plastic "motion control" stiffeners in the arch of  the shoe. The force is great enough to pinch the nerve running between  the metatarsals and cause it to swell over time, leading to tissue  build-up called nerve encapsulation, which combined with the resulting  inflammation is called a neuroma. The Morton's name is attached to  describe the above foot structure that usually causes it, named after  the podiatrist who first studied and described the condition in detail.

     

    Morton  treated the condition by simply placing a thin but tough pad underneath  the ball of the foot, which allowed the ball of the foot to contact the  ground sooner in the gait cycle, causing the brain to adjust the angle  of the footstrike away from overpronation. This rests the muscles of the  lower leg involved in pronation, and the hip rotator muscles involved  in turning the angle of the foot outward during pronation, with  resulting benefits for back pain, knee pain, ankle pain, tendonitis,  plantar fasciitis, and a host of problems above the waist related to  posture. While athletes run into the problem sooner, and as you have  found, more painfully, controlling this condition with the appropriate  padding has implications for anyone who is on their feet for any amount  of time.

     

    There are other possible reasons for  feet to be turned outward, but Dr. Morton identified his condition as the most  likely cause, and the easiest to treat. Sadly, many podiatrists are not  very familiar with how this condition affects athletes and recreational  runners, or how straightforward correction can be. This is probably  because the Morton's foot is very common and even considered normal,  rather than a disease of the foot, which it is not. It is a congenital  condition. Having said that, Morton went on to define a second condition  of metatarsal hypermobiity, and Dr. Rothbart (who visits this site) has  lectured and written on the subject of another problematic metatarsal  structure called Rothbart's foot. So, you are not alone wishing you had  different feet!

     

    My advice is to sit back, prop your  foot up, and bend the toes downward with your hand so you can examine  how the metatarsal heads line up. My money says the one over the ball of  the foot falls short just like mine. I had at least four bad marathons,  along with some painful training runs, before I learned how to pad my  shoe and beat the condition, which no longer bothers me. I just  qualified for Boston a couple weeks ago, which would have been  impossible a few years back. Before I applied the fix, after a certain  number of miles the pain was like crucifixion - I remember it well - but it's just a memory now. BTW, I'm using the exact same shoes (a light racing flat by Adidas), which I use only for marathon competition. I train long distances in two much heavier shoes with firm padding, the Nike Air Max 360 and New Balance Zip (which I believe has been discontinued).  Both pairs have over 750 miles on them (the Nikes nearly 1000 - don't try this at home), so I am  not kind to my feet, but I have modified all of the shoes I run in for  the short metatarsal, including the Adidas. I have other tips I will share if this advice is working for you, but I think you should examine your feet first.

  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009

    Just an update to my previous post. If a neuroma is what you have, it  is not always easy to identify without an MRI, because currently it  can't be seen any other way except during surgery. To complicate things,  there are other conditions that mimic the pain and location of a  neuroma, listed in the following article: http://www.footdoc.ca/www.FootDoc.ca/Website%20Neuromas.htm

     

    The  reason I steer you toward treatment for neuroma is because excess  pronation, combined with repetitive motion, are known causes of the  condition known as "Morton's Neuroma," and runners who over-pronate  repeat this motion a lot. Though we call the condition Morton's Neuroma,  it is inaccurate in two ways: (1) It is not really a neuroma (which  would be a tumor), but a perineural fibrosis, or thickening of scar  tissue around the nerve as I described in my earlier post. (2) Surgeon  Thomas G. Morton, for whom it is actually named, attempted to define the  pathology. His son, Thomas S.K. Morton, also took a crack at it. The  first guy to actually describe it (correctly) as a nerve problem was  chiropodist Lewis Durlacher, also in the 19th century. The most recent  Morton, Dr. Dudley J., is the one to whom I was referring in my previous  post. He practiced in the first half of the 20th century, and was the  first to write and speak extensively about the relationship between the  congenital foot structure I referenced earlier, and its relationship to  pronation (flat foot) and a host of other painful conditions.

     

    Today,  there are a few brave souls trying to keep this knowledge in public  view. They are few, possibly because there is more money in preserving  the problem and treating the results, than there is in correcting it. It  has been estimated by some physicians that as many as 80% of chronic  pain sufferers have the Morton Foot type, and I would love to see the  numbers on runners and other athletes, whose foot plant is of greatest  importance. While the neuroma has dogged many runnershttp://community.active.com/thread/35089,  it is more prevalent in women, particularly of middle age, and is often  linked to fashionable footwear such as high heeled shoes. Dress shoes  are often too narrow for a neuroma sufferer, and running shoes become  too narrow as the foot expands during prolonged running. For this  reason, I buy wider shoes or ones that are two sizes larger than my  foot, to accomodate this expansion and take pressure off the  inter-metatarsal nerves. I also tape my 2nd and 4th toes to increase  intermetatarsal space where neuromas typically develop. However, this is  not enough if the structure of your foot causes you to pronate, because  pronation rolls the ankle inward and forces the outer metatarsals to  collapse inward with it, pressing them together with a little rubbing  action that irritates the nerves in between. This irritation leads to  encapsulation of the nerve by protective scar tissue, which indeed  protects the nerve from being sawed in two, but increases the potential  pressure on the nerve within a given shoe.

    http://www.footdoc.ca/www.FootDoc.ca/neurom1.gif

    Thanks to the above referenced website for this image, as well as for the handy list of similar conditions.

     

    The  reason why most orthotics, even custom fitted, prescribed ones, do not  work, is that they attempt to limit the roll of the foot rather than  making it unnecessary. Orthotics made especially for Morton's are rare  and somewhat pricey. For many, Dr. Morton's prescription for the  quarter-sized two-dollar pad under the ball of the foot (1st metatarsal head) is sufficient to alter pronation and progression of the neuroma.  Most orthotics, on the other hand, try to spread or prop the  metatarsals by forcing padding up into the neuroma itself, making the  problem worse.

     

    If the first (short) metatarsal is allowed to drop,  pronation will continue to fight any orthotic, arch support, motion  control shoe, or anything that gets in the way, and the poor neuroma  will be caught in the middle. Without a pad under the ball of the foot,  the 1st metatarsal will drop during push-off, and the leg will turn to  pronate the foot toward the 1st (strongest) metatarsal to take the  pressure off the longer, thinner minor metatarsals. With the pad in  place, this no longer needs to happen. If you or your doctor make  changes in your footwear, make sure to allow time for your body to adapt  to it, before throwing in the towel on your running. Also, make sure  the fix is applied to all of your footwear, not just your running shoes,  and avoid walking barefoot on hard surfaces.

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