RUNNER’S PAIN ON THE BALL OF THE FOOT

RUNNER’S PAIN ON THE BALL OF THE FOOT

— Dr. Jay C. Goldstein —

Nancy continued running until she was five months into her pregnancy. She was also three weeks into a pain she had never before experienced.

However, no big deal because it disappeared when she stopped running about that time due to her pregnancy.

During the last two weeks of her pregnancy she developed a shooting pain into her third and fourth toes whenever she put on her shoes, especially while walking.

 

NO BIG DEAL …

However, no big deal because during the last two weeks of her pregnancy she had lots of other things to think about, and it disappeared as soon as she gave birth.

She resumed walking outside a few weeks later and developed some odd sensations on the ball of her foot. Sometimes that area felt numb, and sometimes she experienced pins and needles.

Once, she also experienced an electric shock. On another occasion the adjacent edges of her third and fourth toes began to burn. However, no big deal, because it did not last very long.

Then she returned to jogging. Within a week, an unpleasant pattern developed. Within a minute of running, the ball of her foot near her third and fourth toes felt numb. Two minutes later, it felt like pins and needles.

Five minutes later, she felt an electric shock. A minute after that, the pain spread into her third and fourth toes, and her toes began to burn. 

She had to stop running.   Now it was getting to be  a bit of a big deal.

Running used to be fun; now, not so much. Time for a trip to my office.

 

THE DIAGNOSIS …

Dr. Thomas G. Morton

Why is it called “Morton’s neuroma” (named after Dr. Thomas G. Morton) when it was first described by Dr. Lewis Durlacher in 1845?

Apparently, not as many people read Durlacher’s book, published in 1845, as read Dr. Morton’s article on the same affliction in 1876.

Ironically, Morton inaccurately described the problem as related to the bone and/or joint, and Durlacher accurately described it as a nerve etiology thirty-one years earlier.

Nevertheless, over a century later we still credit Dr. Morton.

I don’t think that Nancy cared about the slight to Dr. Durlacher. 🙁

 

COMMON SYMPTOMS …

Most often, patients describe the problem as beginning with numbness, tingling, and/or pins and needles on the ball (bottom of the forefoot) of the foot, often radiating into the adjacent borders of the third and/or fourth toes.

As the problem progresses, the pain becomes an electric shock or burning sensation.

 

THE CAUSE …

A nerve between two bones may get irritated by tight shoes, by shoes that are too tight (Did I mention tight shoes?), pivoting/twisting, being up on your toes, and walking on uneven terrain.

As the nerve is injured, it often enlarges.

When it enlarges, it occupies more space, and therefore is even more likely to be impinged upon by the adjacent bones, causing the nerve mass to grow still larger.

Thus begins a vicious downward spiral.

 

 

WHY NANCY? …

This could have, and most often does, happen to runners (and others) who are not pregnant.

However, Nancy’s pregnancy introduced an additional risk factor.

As her pregnancy progressed, Nancy’s foot enlarged due to swelling.

After giving birth, her foot became permanently larger due to a small shift of her foot bones due to hormonal changes that facilitate birth and allow ligaments to stretch at a time when Nancy was understandably the heaviest she had ever been.

 

 

THE TREATMENTS …

1. Proper style and fitting shoes.
2. Did I mention proper shoes?
3. Pads to help offload the adjacent bones.
4. Custom biomechanical foot orthotics.
5. Inject sclerosing alcohol.
6. Inject cortisone.
7. Surgery (Minimally Invasive Nerve Decompression).
8. Surgery: Use a method to destroy the nerve through a minimal incision.
9. Surgery: Open procedure to resect the damaged portion of the nerve.
10. Walk flat-footed and eliminate many activities.

 

MY COMMENTS ON THE ABOVE …

Of course begin with one through four. Duh!

#5: Usually requires 3-7 injections at 1.5-2 week intervals. Minimal side effects and if it works, helps one to avoid surgery.

#6: I err on the side of minimal cortisone due to potential soft tissue damage caused by some forms of cortisone.

#7: My favorite if surgery is needed.

#8: Reasonable if surgery is needed, although I would prefer beginning with #7.

#9: Reasonable if #7 or #8 fail.

#10: Reasonable if you are over 100.

 

Dr. Goldstein is a podiatrist who is Board certified by the American College of Foot and Ankle Surgeons, the American Board of Podiatric Medicine, and a Fellow of the American Society of Podiatric Surgeons. He is a member of the American Podiatric Medical Association and the American Society of Podiatric Sports Medicine. He has run about 33 marathons; if his brain had not bounced up and down so much he could probably remember exactly how many, a problem not usually helped by any of the above ten treatments.

 

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