Doctor, Doctor, Give me the News

Back in March I wrote about the challenges I was having with my feet going numb after a couple of miles. Getting bigger shoes and switching to Lock Laces helped a lot, but didn't completely solve my numbness. And I've found that it has gotten worse with the onset of the hot and humid summer weather. So I finally made an appointment to see a foot specialist and find out what was going on.

The Diagnosis
At the doctor's office I had X-rays of both feet to see if there had been any past trauma or injury; my X-rays were fine. The doctor manipulated my feet and found intermetatarsal neuromas in each of them, between my third & fourth toes and my second & third toes. He could feel them and hear them clicking. This basically means I have thickened nerve tissue, likely from the repetitive irritation of running. When I run and my feet swell the neuromas get compressed and I experience tingling and numbness that quickly spreads from my toes to my whole foot. Apparently I'm lucky that I'm not experiencing pain - I think my foot goes numb too fast to feel the pain!

photo from:
www.foothealthfacts.org/footankleinfo/mortons-neuroma.htm

The Treatment

• Padding: the doctor gave me metatarsal pads to try out in my running shoes. They provide support for the metatarsal arch, which reduces pressure on the nerve and lessens compression. This is a fairly inexpensive treatment - about $10 for a pair. Placement is a little tricky - they go on your shoe liner behind the area where the ball of your foot sits. It is common to put them on too far forward. I tried them out today while running and was able to adapt to the sensation of having them in my shoes, but the numbness wasn't alleviated. I moved them back a little farther in case the placement was off and will try them again.

a lesson in proper pad placement:
behind the ball of the foot

• Shoe modifications: wear shoes with a wider toe box, avoid high heels and narrow-toed shoes. I have gone up in shoe size and I keep my athletic shoes on at work whenever possible (yes, I am often that woman wearing a professional dress and sneakers; I've gotten over feeling self-conscious about it). I'm also going to experiment with alternative lacing techniques again.

• Activity modifications: activities that put pressure on the neuroma can be avoided. (Nooooo...don't make me stop running!)

• Orthotics: custom orthotics can also be used to provide support and reduce pressure on the nerve and lessen compression. The orthotics specialist happened to be in the office today and was able to fit me in, which he emphasized repeatedly was not a commitment on my part to order the orthotics. They were just making the mold should I want to order them. I went into the fitting thinking they were a strong possibility, and expecting they were something that would simply go into my running shoe. The more we talked, though, the more I began to doubt that I would be able to really adhere to the way they are supposed to be worn, not just for running, but all the time. And the best ones for me are more substantial and aren't going to fit into my work shoes. And they are several hundred dollars, so they aren't something you just try out casually (especially if you need a dress pair and a sport pair). I'm going to do a lot more investigating before I consider going down that path, which I've heard often doesn't work out for people. A middle ground that some folks have had success with is an off-the-shelf shoe insert such as Superfeet, which is around $50.

taking an impression of my foot

my foot in biofoam

"dress" shoe orthotic on the left;
"sport" orthotic on the right

• Injections: cortisone injections are sometimes used to lessen the symptoms and pain.

• Surgery: in some cases where patients don't respond to non-surgical treatment, surgery is considered to relieve pressure on the nerve or even remove it. (um...no thank you!)

While I am glad to finally have a diagnosis, I've clearly still got some work ahead of me to figure out the solution. I'm hoping it is on the easier side - padding and some shoe modifications. I have a follow-up appointment in 6 weeks. Wish me luck!