Front foot pad pain

[Harrier]

Finally gave in and went to the medics today... 2 months after the first symptoms. Doh!

Xray to follow but 90pc certain I have something called a Morton's Neurome in the 2nd/3rd metatarsal area -- a kind of benign tumour apparently in the nerves runningbetween the toes. Sounds nice. Cortisone injections seem to be first course of action, then surgery to remove if not. Heaven alone knows when i'll be running again - stationary bike in the gym is getting a little dull ...

Anyone else had this particular pleasure - can anyone recommend anything that means you can run with this, that's not mentioned above>?

Thanks in anticipation.

[Chris H]

How bad is the pain? I've been suffering with similar for a couple of years and the only time it really bothers me is if my left forefoot lands directly onto a stone especially when running on hard tracks. I was worried earlier this year just before the Lakeland 100 when I discovered that I'd lost sensation in the second toe on my left foot and could no longer curl it. A visit to a podiatrist confirmed that it wasnt a metatarsal problem so I ran the LD100 anyway and had no real problem with it. Having a numb toe doesn't really affect my running or climbing so I'm just ignoring it at the moment. Not perfect but I can't see it getting any worse than it is.
Hope that helps.

[Harrier]

Thanks Chris. I think I have gone a b it beyond what you have experienced so far, so be careful. I have had a little numbness in 2nd and 3rd toes for a while and like you have had to avoid toe landing on anything awkward for a bit. Had put it down to a bit of occasional bruising and shoes being a little tight perhaps to ensure firm foot placement. Radiologist friend of mine confirmed this morning straight away after Xray taken no bone damage [ no arthritis either - bonus!] so 99pc sure this is Neuroma now. Only real treatment apparently is surgery to relieve the pain by cutting away to release the pressure on the nerve.

This is definitely one to avoid -- if you think you have the same thing apply pressure to both sides of the foot to curl it inwards / squeeze it. If it is neuroma one big give away is that you'll want to punch yourself in the face to stop you ever doing that to yourself again, the pain will be so intense! Local wait list for even seeing the local foot guy is 5 weeks, even privately - marvellous.

As I said previously, at least this gets me out of the SW Wales traverse solo attempt this winter!

Any physios out there know any tricks to at least let me get a few runs in this side of the surgery please?

[Chris H]

Blimey, you've got me worried again now. Thought this was one I could forget about!

[zephr]

Mortons Neuroma. common in runners who run uphill (and also sprint) - often aggravated by wearing highheels...
Bascially, its a nerve between the 3rd and 4th toes that can become inflammed when your foot is in a sustained dorsiflexed position (ie. pointed down) once the nerve is inflammed it is open to entrapment by the metatarsals, and can eventually become scarred- if this happens it will become enlarged and will form a neuroma.

If you catch it early, you can manage it by changing footwear, (bigger toebox, lower heel), ice and apparently ultrasound is also effective.
Harrier, I'm afraid it may be a little too late to get a couple of runs in before surgery, unless you want to take up a new sport of fell hopping- or unless you take some really really strong pain killers. Not something I would think is a great idea.
fellhopping though. Thats a good one. I might start up an association....

You could theoretically pad it up, but really, at this stage, maybe patience is the best plan- and yes, from what I understand, it would appear that surgery is the best option for you now.

[Harrier]

Thanks Zephyr. Not the answer I perhaps wanted but sounds like very good advice.

it is interesting you mentioned about the foot pointing down causative issue - I have been doing a lot more hill work than normal and in particular fast descent practice to harden up after a successful but fairly grim LAMM this year on the downhills [ its a Southerner issue]. I'm in the mix for surgery now and as long as I stay off it it seems to be tolerable for everyday life now the acute phase of the injury has gone. It must have been building up for a while though it came on very suddenly. Thinking back I did have some tingling while swimming of all things for a year or so and have had a feeling of the right show being a bit tight at times, but didn't think anything of either. Funnily enough though I always run off road in low 6mm incline feel shoes ie Walshes and Inov8 212s so the high heel thing is a bit of an odd item on the lsit of things that might have triggered this.

Guess I have to do my time on the touchlines with matron and the fat wheezy boys with the oranges, to quote Blackadder..... Suppose it gives me some opportunities to work on my Abs eh?

Chris- hopefully you can prevent this! Orthotics are supposed to help if it hasn't gone too far. 4% alcohol solution injections and Cortisone jabs into the nerve area are also cited by Wikepedia et al as possible cures if it hasn't developed too far.

[hanoverharrier]

Harrier, please keep me posted how you are getting on as I have exactly the same thing, Mortons neuroma/metastalgia. Started in September 2009, doc said take ibrufen & rest, 3 months later referred myself to podiatrist, keep running/rest 6 weeks/keep running/rest...orthotics didn't help, cortisone jab in right foot didn't help, finally two cortisone jabs in each foot, directly into pain area, this tingles a fair bit!! rested for another 3 months until specialist finally sent me for scan which I now await results. Its been the worse 12 months ever, fitness levels dropping and nothing worse than driving past the fells near home to go to the gym!
If anybody else on here starts with this, REST!! It has been a long twelve months, I carried on running and taking strong anti inflammitries (Naproxen) big mistake. The way you advised to test by holding the sides of your foot then wiggling your toes is correct as when the podiatrist first did this on me I nearly kicked him through the ceiling, you will know. Also felt like I had a stone in my shoe all the time.
Sorry its not very positive, i'll let you know if I have any advice after scan results.
Suspect mine started when upped milage, but mostly due to fell trainers on hard surfaces as I didn't like too much padding. Just purchased some solomon trail trainers that appear to offer more cushioning, we'll see.

[Harrier]

Hi Hanoverharrier

Sorry just got to log in after a sabatical and saw your post. I will keep you posted. Agree, total rest the best plan - after 3 months off all running [ it would be too painful anyway] I can now walk the 2 miles into town. I had an MRI on Friday and await results - Xrays pretty inconclusive. Specialist thinks I have a neuroma and a broken metatarsal in the upper foot also, so we will see. In terms of keeping fit I am using the stationary bike in the gym without difficulty or aggravation to the injury, level 25 standing on the pedals for an hour seems to get the heart rate up to about the bottom end of hat we normally achieve, so hopefully a viable way of maintaining a baseline to build back up from. Everything I have read and heard about this injury is that unless it is caught very very early and you a FUB [fat, useless, b@@@@@d] cortisone and the 4% alcohol therapies don't work - as soon as you get back out there the neuroma is highly likely to grow again. Surgery doesn't seem to be as catastrophic as the Americans would have you believe [6 weeks recovery, almost total bed rest!] though the NHS website suggestion you'll be ballroom dancing a fortnight after surgery is rather on the hopeful side too....


If you have any inkling you have one of these babies, get to your GP and start the referral to specialist process ASAP folks - this isn't one to run through. A good couple of simple tests are to press down on the top centre of the foot , and to squeeze the sides of the foot inwards hard - if the pain is 'exquisite' to quote my GP, you're probably heading to the touchlines with us fat wheezy boys and matron and oranges for while. I walked / hobbled around on a broken femur for 2 days a few years back before going to a medic -- to put the level of pain in context.

I'll keep everyone posted and try to post some man-scar photos of what they do to my foot!

[Andy A]

There is an orthotic device called a mortons dome which goes under the met heads lifting them up and pushing them apart. It opens up the space between the mets which gives the inflamed nerve a chance to recover. It works very well with a classic Mortons between mets 3/4 but I'm not sure about mets 2/3 due to there being less movement between these bones. They are not a long term device, just worn till the inflammatioon has gone and they normally produce instant relief. Boots sell a very soft dome which may or may not work usually something a bit more sold is needed.

[Headless]

Harrier, hope the rehab goes well. I've just come across this thread and this sounds just like something I've been having problems with since April. Nothing as advanced as you've got but for anyone else whose concerned, I saw a podiatrist and we think we know the initial cause. I hope the following is useful.

I initially felt the a pain under my 3rd and 4th toes (one foot only) towards the end of an ultra. It got progressively worse but was at it's worst when I changed pace from a run to a walk and vice-versa. After a couple of steps at the new pace it eased but never fully stopped. I stopped running for a few weeks and then started again. Two months after the initial problems I did another ultra. No problems for 40 miles but then the pain started to build (same symptoms for change of pace initially). After 5 miles of this the pain was building and shooting on every foot fall. I had to retire.

I then saw a podiatrist. He thinks that the original cause was the shape of my foot. Across the base of the toes there's meant to be a slight arching such that the middle toes don't strike the ground at quite the same time as the rest of the toes. I'm striking more evenly due to a bit of collapse in that arch so there is more impact load on those toes and hence the repetitive strain/nerve impact that sounds like the early symptoms of the neuroma.

My treatment has involved lots of working of the small muscles around the front of the foot. Combined with enforced rest due to an entirely unrelated injury, this seems to have worked; although I haven't done more than marathon distance since June so don't know how it may react when I start ultras again.