A little more than a year ago I did a multi-day backpacking trip. When I came back I had serious stabbing pain and numbness in my second toe on my right foot. I visited numerous doctors and podiatrists, had an MRI, x-rays, etc. I never received a conclusive diagnosis, most came on the side of maybe a torn plantar plate, neuroma (I don’t think so - no Morton’s click), metatarsalagia, dropped metatarsal, ect. The MRI and X-Ray didn’t show anything. I finally found a great local podiatrist who modified some Superfeet with a met pad and a reverse morton’s extension and got me running again. Over the past year I have been able to run as much as I want with very little discomfort. However, I haven’t been able to walk barefoot on any solid surface without pain. I was also able to wean myself down to just the met pad in the orthotic. Well, last week I ran the Leadville 100. I finished and did not have any pain during the race. However after the race my first and second toes went numb again, but I will say that the pain has been very, very minimal. I’ve done some aggressive icing and everything seem to be healing well. I’ve done a couple of runs since with about the same discomfort that I had before.
A couple of things.
I have a hammertoe and small bunion on my right foot. I have had the hammertoe since I can remember. From what I have found on this forum, my diagnosis is the hammertoe has caused the met head to drop and it puts retrograde pressure on the nerve – causing the pain.
I’ve lived with this for a year, it not unbearable at all, it just makes running a bit uncomfortable at times. What are my options moving forward, keep with the met pad? Will hammertoe correction solve the issue? What are the long term side effects of that surgery? I know a couple of folks on this forum have had the surgery. My podiatrist has said that we can discuss surgery when I am ready. Well, I’m getting close to being ready. I’m just not sure it is the right/best option in the long term.
You seem to have the classic sub 2nd met pain (“metatarsalgia”) with your foot mechanics (i.e. slight bunion drift causing the 2nd toe to “hammer” and retrograde pressure down on the met head - you seem to have a good grasp/understanding of this). Good that a plantar plate tear/injury has been ruled out - often missed, even by good practitioners.
You have been addressing your mechanics correctly so far (1st met cutout/“reverse” Morton’s extension, met pad, etc.), but this won’t work forever (even in my “normal” pts, let alone someone running the Leadville 100!).
Yes, hammertoe surgery should be curative - for a while. Depends on what surg and you should carefully discuss this with him. A simple tendon flexor tenotomy won’t have much down time, but is definitely limited in its effectiveness. Hammertoe surgery will help longer (with or without fusion the PIPJ), but this may still progress if you don’t deal with your hallux valgus deformity as well as this always progresses in time. But, that “time” could be 20 years from now, and you really don’t want to address that unless you have too.
Thanks Rodney. We briefly discussed a tendon flexor tenotomy, but he didn’t think it was the right way to go. He is going to refer me to a local foot and ankle orthopedic surgeon to discuss other options. In the mean time, if I can tolerate the numbness/discomort and there is minimal pain am I doing any immediate damage?
Probably not doing any “immediate damage” as you put. But, might want to google “lesser MPJ pre-dislocation syndrome” though (credit the late Dr. Gerard Yu) to see how much applies to you.
I don’t have any pain in the second met head. I’ve had hammertoes for as long as I can remember, and I don’t have any of the other symptoms of pre-dislocation syndrome. There was some swelling after Leadville, but then again both feet were pretty swollen. The pain is more neuritic when I squeeze in between the second and third toes. It really presents itself when I try to walk barefoot. I’m at a loss for a diagnosis, but so far treating the symptoms have been really successful.