Haven’t run in three weeks, received 6 session of ART and my foot kill’s more then ever…
Unable to get motivated to squeeze my foot into my cycling shoe… It kills…
Can’t squeeze into my flippers at the pool. (Not that I need too.)
Visiting a podiatrist this afternoon, who may recommend first a cortizone shot…then who knows what… I have another Orthopedic (runner and has an excellent reputation in NJ) which I’m thinking of making an appointment with.
I ended up buying shoes 1/2 size larger running and cycling). Also tried a cycling shoe that is a bit flatter (was wearing Carnacs). After trying my old cycling shoes on yesterday, I can’t believe how tight and uncomfortable they are and am convinced that this is what started the problem.
If you try insoles, be careful that they dont make your shoes too tight. Also, you may want to look at some of the recent foot threads on this forum where there was a fair amount of discussion about cutting holes in your insoles to take pressure off of the painful area. I found this helpful in my case as well.
I also had cortizone shots and believe that they were helpful. My Doc recommended Sclerosing (sp) the nerve but my problem went away before I needed to go that route. Sclerosing is a series of injections that basically kill the nerve sparing you surgery and allowing quick recovery wiht little down time (i.e. missed workouts). I am sure other members of the forum can give much better info on this as I am not a Dr. (rroof - Podiatrist).
I wish you the best with your feet. I had my problems this past May and was really frustrated and thought I was going to have to forget about doing IMFL. Everything is sooo much better now - hang in there, this injury does go away.
What’s worked well for me is a trick Johnny Halberstadt at the Boulder Running Co. showed me: cut a small circle of orthopaedic felt and stick it to the bottom of the inner of the shoe, just behind the metatarsals. It usually takes a few tries with each new pair of shoes to get the pad situated just right, but once it’s there, it lifts and separates the metatarsals and relieves the pressure on the neuroma. This helps with the pain and helps prevent further damage.
Placement of the pads is critical - this is why any consumer product except a custom orthotic probably won’t work. Doing it yourself allows for cheap trial-and-error until the pads are exactly right.
I tried some expensive custom orthotics, but they didn’t work as well as the pads, so junked them. I looked into surgery, but the anecdotal evidence I have so far is that of 9 surgeries, 5 of them re-grew the neuroma in less than 2 years. That doesn’t sound like worthwhile odds to me. Several doctors whose opinion I respect do recommend the surgery as an option, however.
it’s critical to have plenty of room in the toe box of ALL your shoes, running, bike, and work/casual. Compression of the metatarsals is a factor in this injury. Make sure to get running shoes with excellent forefoot cushion, that’s the primary characteristic I look for these days; and replace them often. Try running on softer surfaces - grass, dirt roads, or synthetic tracks. Concrete is a terrible surface to run on…
Also, be careful of running with the pain. Last year, I didn’t put the pads in a new pair of racing shoes, and consequently tore a calf muscle because I was compensating for the neuroma pain by altering my pushoff. Stupid stupid stupid.
rroofie–Diagnosis Schmiagnosis, get out there and sell product! How do we know “rroofie’s Numbnot Toe Pillows” aren’t right for him until he lays down the $19.95 ?
Specialized cycling shoes have a ‘varus wedge’ built into the insole to spread the metatarsals. You might be able to just buy the insoles if the felt doesn’t work for you.
HA - actually, I think some of the specialized shoes have a met pad built in the insole (like doug in colorado) mentioned. Met pads are helpful.
The sclerosing injection(s) are actually a solution of dehydrated alcohol (cut down to about 4-8%) mixed with Marcaine with epinephrine. 2 studies reveals about a 70-75% success rate with 3-7 injections. They are very painful, but only while getting them. The plus is that there is NO down time at all (vs. the surgery). Few neuromas get this far though. I see probably 20 neuromas a week and resort to alcohol about once a month to 6 weeks (so about 1 out of 80 to 100). Surgery is even less common, but nothing to be afraid of. The return rate in the literature is NOT 5 out of 9 as one poster mentioned. Many surgeons “return” rate (actually a stump neuroma) is less than 5%.
The return rate in the literature is NOT 5 out of 9 as one poster mentioned. Many surgeons “return” rate (actually a stump neuroma) is less than 5%.
I said the 5 out of 9 was anecdotal - that reflects everyone I’ve talked to who had the surgery. I’d expect the literature to significantly under-report the re-occurrence rate. If the surgery didn’t work, it’s unlikely that the patient will return for more surgery…
Thanks all for the support… I’ve just returned from the podiatrist and after one cortizone shot, I’m confident that this will go away. Hoping for the best so that I may not lose my entire 2004 base before winter 2005 base period really picks up!!!
Huh, and researchers never thought of that … You are so wise in the ways of science (I loved the Holy Grail)
Come on now, most all papers cite or take into account non-compliance, no show, no returns, etc. issues. Of course this happens.
Hell, why would anyone want any surgery that had a 60% failure (return) rate?! And if you think it is money that the surgeon is after: I currently get about $450 for the neuroma surgery. The surgery itself only takes about 20 mins, but the whole process takes about an hour, plus liability issues, etc. I would make WAY more money staying in my office for the hour.
Bottom line is this pathology usually improves, and if not, surgery is a viable and well documented alternative (obviously done when most other measures fail to provide the relief that the patient is looking for - whatever that may be). The worst case scenario with this procedure is a recurrent neuroma (aka Stump neuroma). That means you are back to where you started. No worse. I have some patients who get a couple of injections, try some pads then BAM - they want/insist on surgery. Others suffer for years, try it all, accupuncture, healing touch and prefer to suffer or try the next magical approach that worked for their friend. That is fine by me - I want to help, not waste my time/drag someone into a surgical procedure.
Hell, why would anyone want any surgery that had a 60% failure (return) rate?..
my point exactly. I’m not casting nasturtiums at you professionally, just saying that my one data point of anecdote suggests that surgery is not a first option. The literature is not publically available (PubMed notwithstanding), nor does any surgeon publish his personal success rate (what free market ?). There’s not a lot of data available to make a rational choice.
That said, of course I had then to go on a data hunt. A more-than-cursory PubMed search finds: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11568193
65% pain-free after 5 years, but the same percentage have mild or major shoe-wear restrictions.
Several other studies that followed patients over several years have similar conclusions. So, in future, I will modify my advice to be… exactly the same. Surgery is still a last resort. Though I think we agree on this…
Boy Monk - really could make a 'killin on these things