I’m a 42 year old male, mostly a runner but recently started Tri training. In the past few months I developed a popping and burning in the 3rd toe of my right foot. After self research I figured it was a neuroma.
I run with Team in Training and we have a podiatrist closely associated with the team that I have been seeing. The first attempt at relief was the metatarsal pad. I got some very slight relief but was still unable to run. Next up he injected B12 into the foot, gave me a toe separator and casted me for orthotics which should be done in a few weeks.
Today I developed the same symptoms in the other foot, so I’m getting a bit anxious. I have a foot that requires a 4E running shoe and I’ve switched to a cycling shoe that is much wider than what I was wearing.
I struggle a bit with what options to pursue, there are days that I really can’t tell which toe is the problem.
Is this a condition I should just sit back and wait to see if it improves? I’m getting a good bit worried that this will never really go away.
I’ve read about the alcohol injections, the cryosurgery, and prollo therapy. What would be the next logical step in the process? Will the orthotics really make that much of a difference? I’m guessing that the met pad built into them will really only give me what I get with the stick on version now.
Thank you in advance for any insight you can give.
This is what you should discuss with your treating podiatrist. There are many treatment approaches since treating humans is not like wrenching on a bike 
It probably won’t go away on its own in a runner, but you very well may be able to live with it. Completely up to you. You did the right thing by trying to address the root cause first and that may help, but if true perineural fibrosis has ensued, other treatments are often needed. Also, if not responding, further diagnostic imaging may be helpful to confirm the intermetatarsal neuroma diagnosis (i.e. ultrasound, MRI) and rule out other pathologies. Also, we can assume you have no other issues that can mimmic symptoms (low back radiculopathy, peripheral neuropathy, etc.)?
I personally like the alcohol injections in active athletes (once mechanical issues like ice, met pads, orthotics, shoe changes, etc. have failed) since there is no “down time” or significant side effects (like the corticosteroid injections).
Good luck.
i had a similar problem with my second toe in my right foot. i tried the med. pad and didnt get a whole lotta luck. I didnt want to mess with injections or surgery untill i was absolutely nessasary. I found that the shoe i was running in was over build. much like the majority of shoes are now adays. alot of shoe companies put in their own version of med pads and it casuses problems. my solution was to train in a high milage racing flat. i run in the fastwitch 3 and love it. my pain went away. my guess is if you have a 4e foot i would be looking at your cycling shoe and see what you can do about getting one in that width. good luck and i really hope everything turns out well, neuroma is never fun.
I’ll agree with what has been said here so far. A wider super stiff cycling shoe will probably help alot, as will a more flexable running shoe. These things will likely help address the causes of the problem. To address the current symptoms I’d suggest a series of Graston Technique (A-stim) sessions and then, if symptoms still linger some prollo therapy.
I’ve had very good results with Graston Technique for this type of problem, however there will be some significant therapeutic discomfort during the treatment. No pain - no gain. ;-}
Thanks for all the input. I’m headed back to the podiatrist tomorrow to discuss next steps. I guess I’m hoping we start on the alcohol injections as that seems to be a good shot at fixing the problem without surgery. I know the B12 and met pads haven’t done much for me so far. Can anybody that has had or administers the injections tell me how much fun they aren’t? I hear that the cortisone injections are rather “enlightening”. I had a cortisone injection in my ankle last year, not fun but I survived. How do the alcohol injections equate?
If the alchol injections work will they take away the popping in the toes? That drives me absolutely crazy.
As for maybe having other issues mimick a neuroma, I’d never heard the word neuroma or neuropathy for that matter before all of this started so I guess I’m still in the early diagnostic stages.
I’ve had my right knee scoped, and my right ankle reconstructed years ago and subsequently “cleaned out” last year. So I know what pushing through injuries feels like. But for some reason I feel like the neuromas (if that’s what it truly is) are the injuries that could do me in.
My first tri is supposed to be Chattanooga in July. With all of this going on one of my concerns is the .25 mile run from the swim to the transition area. Doing that barefoot doesn’t sound like a lot of fun right now. Any suggestions on something I could do to help get through that? Maybe some sort of aqua sock or something to help with the pounding?
i have had great luck with the alcohol injections. very simple, minimally invasive, quick recovery. while the surgery for this condition is none of those things.
i have had great luck with the alcohol injections. very simple, minimally invasive, quick recovery. while the surgery for this condition is none of those things.
Thanks for sharing your experience. In your case did you have the popping of the toe like it’s dislocating, in addition to the pain, and if so did it go away? I’d give my kingdom, or at least my mortgage payment, for that to happen.
no, i just had the neuroma and pain (lots of pain).
but it sounds like there may be other things going on with you as well. i’d go talk to a good podiatrist with a sportsmed background and get a one-on-one evaluation.
Went back to the podiatrist today. Got a cortisone shot in the right foot, the worse of the two. Orthotics should be in next week. He’s hoping that the orthotics will solve the problem. Guess I’m a little skeptical because the met pad hasn’t really done anything to date. We did discuss alcohol injections but he wants to wait and avoid killing the nerve if possible.
I’m a fix it if it’s broke kind of guy. So if I could figure out the scheduling I’d say go ahead and cut it out and get it over with. But I’ve got a half marathon next weekend, the Chattanooga tri in July, and my next Team in Training team starts in May for the Marine Corps and Nike marathons.
you really should explore the alcohol scherlosing option. coristone is just a temporary anti-inflamation fix. the alcohol treatments actually permanently change the nerve. there are different kinds of surgeries, many of them change the architecture of the foot in ways that are pretty extreme, so i would consider them only as a last resort. you have nothing to lose by trying the alcohol injections. might be worth your time.
So the cortisone shot seems to have helped. Ran 5 relatively pain free miles on Saturday. Still able to walk after. Being able to do that made my day. But I guess I shouldn’t be too excited because it sounds like the cortisone will wear off soon enough and I’ll be back where I was.
Or is it actually possible that the cortisone together with the orthotics could clear it up? I guess if nothing else the fact that the shot helped might confirm diagnosis and location? Does it have any bearing on whether or not the alcohol injections will work if that’s where we wind up?
you really need to speak to good specialist to understand this:
the cortisone works via a temporary anti-inflammatory mechanism. note the word, temporary.
the alcohol partially destroys (schleroses) the neuroma. scientific and clinical studies indicate that is basically permanent and this treatment, if done correctly, is highly successful in most patients. and it is far far less invasive and extreme than the surgical options.
what makes so hesitant to try the alcohol treatments? i am a little baffled.
I’m not the least bit hesitant. My doc wants to be conservative and see if the orthotics and cortisone, combined with changes in the contributing factors, clears up the problem.
I’m hoping, with absolutely no medical knowledge, the fact that the cortisone helped means that the conservative approach or if need be the alcohol can correct it. Until now we haven’t been completely sure which toes the problem was between. I guess the cortisone working confirms diagnosis and location? A woman I work with says that they did up to 10 cortisone shots on her, none of which helped, before doing surgery on both feet.
It seems to be that there is a conservative progression of treatments. I’m guessing that, like Rrrof eluded to, that it’s possible that the conservative approach can fix the issue.
not a problem.
but based on that approach, i would imagine that, based on the toxicity and many side effects of the steroid, that the alcohol treatments would be far more ‘conservative’ than the cortisone.
I guess since the cortisone doesn’t kill the nerve, like the alcohol, that it is more conservative. Once you go ahead and kill the nerve you’re on a pretty narrow treatment path.
That being said, if that’s the way we go I’m fine with it.
It was amazing to be able to run without having to think about every step.
Next step, taken.
Started alcohol injections today, in both feet.
Surprisingly, not as much fun as I hoped it would be.
good luck with the ETOH injections - they get better
.
Had round 2 of the injections today. Don’t think the injections were much more fun than last time. I was able to run 3 miles a couple of times since the first set, with a tolerable level of pain.
I’m hoping that each session lessens the pain a little bit more.
Interesting that after todays injections my feet feel a little worse than last time. Almost feel as if they’re swollen.
Round 3 yesterday.
To Rroof, or anyone that has had the alcohol injections, how much better should I feel at this point? My doc says that the 3rd injection is sort of the telling point of whether or not it will work. Should I be feeling like it’s almost competely better? Or just try to quantify if it is better by how much?
Correct - usually after the 3rd ETOH block (and about 3-5 days), patients start to have less of the intensity of burning/tingling. Some completely gone (rare), but usually better.