Splay Foot issues

Discussion in 'Ask the Docs' started by jlubkoll, Nov 16, 2011.

  1. jlubkoll Barefooters

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    I've visited a doctor today because of a problem on my shoulder and when i was there I took the opportunity to ask about my always recurring pain in the foot (see another forum topic a while ago, which I assume to be Mortons Neuroma).

    They took an xray of the foot and came to the conclusion that I do have an "extreme" splay foot and therefore the reason for the problem is that I do actually step on my nerve which creates the pain. The usual treatment of orthotics I of course rejected - been there done that. The idea of cutting out the nerve was also not what I liked and was not really an offered solution.

    He however claimed that my amount of barefooting will make the splay foot likely worse (as I am already too old to develop that back). Any injection ideas that he had I refused as I do not see any help from that.

    Anybody of you having splay foot too ? I got an x-ray picture if there is somebody to actually have an opinion on the "extreme" and does it get worse ? Should I stop running barefoot and revert to a little padded footwear on the forefoot (where I do not have that pain after more than 10km, hattoris do the trick already).

    The shoulder does get an MRI...

    Jörn

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    Your best bet, if you have a

    Your best bet, if you have a serious neuroma, is to get it cut out, but this advice is according to my foot-hellish experience. Yes I have splayed toes, and I will find those pictures to show you. But know, your barefoot running isn't causing this. Studies show the #1 cause of MN is the types of shoes we wear, not our own bare feet. The problem is, once you get a neuroma beyond a certain point, there is no going back. You have to remove it. Running shod is impossible for me as the pain is too intense from the shoes (and I will never go back to the traditional boat anchors that caused this condition in the first place), and running barefoot isn't doing anything to stop it's progression, although it does allow me to run more comfortably. The only thing that would work for you is to stop running altogether, and I am not about to do that.

    I copied this from another thread, which by the way, you should ask the docs in the Ask the Docs forum what they think.

    ----------------------------------------------------------------------------------------------------------------------------------------------------

    Sorry for the repeated info to everyone who has heard this before, but here goes:

    Studies show the number one cause of MN is they types of shoes we wear.

    I would suggest you get an ultrasound to verify that you do indeed have a neuroma. I have four of them, two in each foot, and I cannot feel them by pressing on them, and one of them is ginormous, but other people may be able to feel theirs. I can, however, feel the one without even touching it. It just makes its presense known. Regardless, you need to see that monster to know what you are dealing with, to know that you are truly dealing with a neuroma.

    Once you get a real diagnosis of a neuroma there are ways you can try to treat it before succumbing to other damaging therapies and/or surgery.

    One that works for some people is called Serrapeptase, an all natural substance created by the silk worm used to dissolve its cocoon. They found that Serrapeptase dissolves scar tissue as well, and that's basically what a neuroma is. It's a nerve that has enlarged due to scar tissue. You take about 120,000 IU each day (3 pills of 20,000 IU twice each day) with lots of water. You can take it half an hour before you eat, but I wouldn't eat anything 2 hours before or after, which is really important to make sure that your body digests it properly. Then once a day use Magnesium Oil, which helps break up scar tissue and increases blood flow, to massage your foot. And take a B-Complex which helps nerve repair each day. Stay off your feet as much as possible for the next three to five weeks, no running. Learn more here: http://serrapeptase.info/pain-overview/morton%e2%80%99s-neuroma/mortons-neuroma/ (And you don't have to buy the book.)

    This hasn't worked for me yet, and I've been doing it for weeks, but I do have some seriously messed up nerves (I'll explain in a bit), but it has worked for others. The guy who told me about it was cured within three weeks. He noticed great improvement within one week. By week five, he hasn't looked back.

    Then there are other procedures you can try. Are you ready for this?

    *******************************************************************
    Here's my story as I've told it to others:
    I'll attach my whole sorted story below, but warning, I am not a success story...not one procedure has worked for me. This is not to say that the procedures out there won't work for you. Most people have great success with the typical treatments. I just have resilient nerves, and at this point, it appears I may have to go with the last resort...traditional surgery. But to be honest, if I had known then what I know now, I would have elected for traditional surgery and had it over and done with. (Traditional surgery is when they go in and cut the neuromas out. If you go that way, then make sure they take enough of the nerve, so that if it grows back (stump neuroma), it won't be where the metatarsals can compress it.)



    What is most important for you to know is that any treatment you have for MN requiring injections will cause you to develop scar tissue in the areas of the injections. This scar tissue will make other treatments down the road more difficult to be successful. Also know that if you try barefoot running for a while, you may be able to run farther than with something minimal; aqua socks/water shoes, socks, or Vibram FiveFingers may allow you to run and for many more months before you have to attempt your first treatment to combat the MN. I could only get 1 - 3 miles in traditional running shoes (trainers), 5 - 6 miles in VFFs, toward the end--just before I decided to have cryosurgery, I could run up to 17 miles fully barefoot. The FiveFingers help some people with MN and hurt some people with MN; some people get benefits from the toes being spread apart, some don't. Don't fret though - barefoot running is quite enjoyable for those who can stand to run barefoot with MN. Most of the people I have talked to who have MN and tried to run barefoot say it hurts a lot less than running with anything on their feet, and they are able to run much farther. Regardless, once it has reached a certain point (that is the neuroma has grown to a certain size) typically does not go away on its own. So doing nothing about it will not make it go away. The sooner you treat it, the better it will be for you. Fast forward to today, after the cryo 1-1/2 years ago, I can only wear the VFFs for about 20 minutes now before my nerves start to fire terribly, so the MN is progressing.



    It's also important that you know WHAT caused this condition. Shoes constrict the movement of the metatarsals, preventing them from splaying properly. This confinement causes the metatarsals to press on the nerves causing them to grow. Any pressure on the toe box area/ball of your foot, will aggravate that area. Wearing any shoes with the heel elevated will also lead to your placing too much weight on the forefoot, which can also lead to MN. If it continues on untreated, you will find that you can only wear flip-flops. I can only wear flip-flops and VFFS for short periods of time. Also know, that when winter comes, I actually find it easier to run on the cold ground. The frozen ground keeps the nerves from swelling too much, although they will still swell after a few miles, so I am able to run on.



    My first course of treatment was orthotics. As far as orthotics go, I believe wholeheartedly that for most people, they are a waste of money. I spent $300 out-of-pocket for custom-casted orthotics, and they only made my neuromas feel worse and gave me knee pain during my runs. (I would have to ice my knees after each run. Removed the orthotics, no more knee pain.) I would advise against them and say "save your money." Of course, a podiatrist will tell you the opposite. I can't honestly say they will or will not work for you. All I know is that there must be a reason why most health insurance companies don't cover them. Could it be because they've learned the success rates for treating foot conditions with orthotics is quite low, and considering the expense to make them, it’s not worth the gamble? I think so.)



    If you are contemplating surgery, just know that traditional surgery isn't your only or first option. You could always try cortisone injections. The con with this is that the relief only lasts for a few short months, if it works at all; I believe from talking to many other people on the running forums that only very few people experience relief, and all of them
    have to repeat the shots a few short months later. This didn't work for me at all. (On a side note: I also understand that cortisone can break down tendons, and if inserted in the heel for plantar fasciitis can cause fat pad atrophy (breaks down the tissues in the heel) and can cause the plantar fascia to rupture.) Please discuss this with your doctor.



    Now about the shots, any and all types of shots...they are NOT supposed to hit the nerve, just place the needle near the nerve. If you decide to have any type of shots, be sure they use the "Cold Spray" first, and if it is of a low concentration that they actually spray it for SEVERAL seconds before inserting the needle; if it is of a high concentration, you will know it pretty quickly as it can actually feel as though your skin is burning. If you get someone who is competent, the pain is tolerable. It is also very important that the doctor has an assistant/nurse with him when/while he does it. My first podiatrist decided to forgo his nurse and do the cortisone injection by himself. He only held the spray on for like 3 seconds with one hand and then stuck/jabbed the needle in with the other. The needle went ALL THE WAY through my foot! He actually hit the nerve as it punctured through. This caused some sort of reaction--there's a medical term for it, but I can't remember it--and I began to hyperventilate, and I had trouble breathing. My hands folded like lobster claws, and I couldn't open them up. My waist was bending, and it was as if I was being forced to double over. I was extremely hot and perspiring. This lasted nearly 7-10 minutes. Needless to say, I searched for another doctor and other options.



    Another option is Alcohol Sclerosing injections. The point of the Alcohol Sclerosing shots is to kill the nerve. My second podiatrist used B-12 in the injections, which made absolutely no sense to me. The shot is supposed to kill the nerve, but the B-12 is supposed to support cell growth. To me, that's a contradiction. (The con is that it takes anywhere from 3 to 7 sessions/visits to complete; depending on how many neuromas you have. I have 2 in each foot, so therefore, each session involved 4 needles. I went 4 times. That's 16 needles. Many people have experienced success with this. Some felt complete relief, and others felt only some relief. I felt absolutely NO relief.)



    Then there's Digital Electrical Analgesic Shockwave Therapy--with numbing shots. This procedure is believed to rejuvenate cell growth/speed healing. (This may or may not work for you...who knows, since it's a fairly new procedure. Apparently, the technology has been around for a number of years, but the process for treating MN and other foot problems is really new. It didn't work for me. I understand that if you don't feel relief after the first session, there is NO NEED in going for a second session, third, etc. No one bothered to tell this to me, so I went for 5 sessions and gave up. Those 5 sessions involved 2 sessions of numbing injections. That's 8 more needles!) Another thing I didn't understand was why would a podiatrist perform Alcohol Sclerosing injections to kill the nerves in 4 previous visits but then the same doctor send me to 5 sessions for a procedure that promotes cell health? Was he trying to kill them or give them life?



    I had ultrasound-guided cryosurgery on all four nerves during the last week in April 2010. (Notice I said ultrasound-guided. I fully believe there is no other right way to do this. If the doctor can’t see what it is he is freezing, then how does he know what he is freezing-bone, tendons, ligaments, etc.?) With cryosurgery, you are completely awake; therefore, this surgery required three more shots per nerve (one inserted near the neuroma and the other two inserted between the fine webbing of the toes). Since I had four neuromas, that equated to 12 more needles. Then there were four teensy-weensy incisions made in the webbing to allow the cryoprobes to be inserted. You aren't supposed to feel the doctor turn up the dial to the cryoprobe, but I did on one nerve quite intensely and had to just deal with it. Recovery was quite painful and took forever to heal from. Others have reported getting back to work within a few days. They more than likely did not have four neuromas with both feet affected. After the surgery, I was pretty much immobile for 2-1/2 months and didn't begin to get around or even attempt to run until 3-1/2 months afterwards. In that time, I got around by walking on my heels just trying to avoid putting any pressure or weight on the balls of my feet where the cryoprobes were inserted, since it was so painful to do so otherwise. I developed a bad case of Plantar Fasciitis because I was walking around on my heels for so long. I was led to believe that the recovery from cryosurgery was to be quick, only 2-6 weeks, not months! That was the purpose for choosing cyrosurgery over traditional surgery: the down-time is less, and it is less invasive.



    It is possible that I have developed so much scar tissue from the many prior injections--37 needles in all!--and it was seen on ultrasound before and during the surgery, that the cryoprobes were unable to penetrate the scar tissue to reach the neuromas accurately. (See special note about scar tissue above.) Although others have had success with cryosurgery, it didn't work for me. I sometimes still have the rubber band snapping feeling when I first place my feet on the floor and for several steps afterwards, which is a good indication that my problem has not resolved. After all this time has passed, I still have no relief, I still have trouble walking or running on soft surfaces (carpet, grass, sand, trails), the neuromas still hurt terribly if I've been on my feet for a long period of time, and the amount I can run is getting to be less and less, even while running truly barefoot. Now, it looks like traditional surgery is the only option left for me, and I am considering doing so in January or February.

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  4. jlubkoll Barefooters

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    TJ, I remember the thread -

    TJ, I remember the thread - that is the one I was referring to for the MN. The question here was more whether the general diagnosis of splayed foot - not necessarily Mortons Toe or splayed toes is a general contra-indication to barefooting a lot as the doctor claimed that this will make it worse.

    I am seeking others that had a similar diagnosis. The MN is not diagnosed so far and at least that doctor was not assuming I do have that but that I generally hop around on that nerve in contrast to compressing it between the metarsals because these are far off each other anyhow - much further than they would be when I would not have splayed foot.

    Here is the x-ray, this is a projection from a 45deg held foot, so it is not generally from the top and things appear closer than they actually are due to the projection. Good thing though that there are no stress fractures visible.



    [IMG]

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  5. Barefoot TJ Administrator
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    I think you should post the

    I think you should post the questions to the Docs here as well to see what they think. Keep us informed as you learn what's going on.

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  6. joohneschuh Barefooters
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    Hi Jörn, I understand that

    Hi Jörn, I understand that this is worse news compare to a Morton´s Neuroma? Because MN can be removed and there´s no limit to barefoot running afterwards but extreme splay foot can´t be altered?

    I hope I´m wrong about this. In case I´m not, I´m very sorry for you. But I know we will run together again no matter what. [IMG]

    Have you already posted your x-ray in the "ask-the-docs-forum"?
  7. Barefoot TJ Administrator
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    What about Correct Toes? 

    What about Correct Toes? Will they help? https://nwfootankle.com/correct-toes

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  8. jlubkoll Barefooters

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    No, 'correct toes' would do

    No, 'correct toes' would do the opposite. The Metarsals are too far from each other flattening the whole foot. In theory (and cosmetic reality) there exists surgery correcting splay foot which works by cutting pieces out of bones and altering the whole structure.

    Personally I do not believe that anything that will alter so much of the structure will scale afterwards to any real workload (runload that is :))

    (Nearly) All problems can be fixed, this certainly will get it's fix too somehow.

    My next longer run in two weeks demands shoes anyhow (and a helmet) :)

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  9. Barefoot TJ Administrator
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    Perhaps there is such a thing

    Perhaps there is such a thing that will do the opposite then; keep the toes correctly aligned but together.

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  10. jlubkoll Barefooters

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    i've moved the topic into the

    i've moved the topic into the ask the docs Forum, hope I did it right.

    In my efforts to learn more about foot structure and my specific case and looking at the x-ray of a non splayed left foot in pretty much the same projection one could come to the conclusion that my foot is in fact "extremly" splayed. (Looking at http://www.dr-guenter.de/1.2.7.6_roentgen_fuss.php) of which I am specifically referencing one picture here:

    Normal: [IMG]



    Mine: [IMG]



    The ultimate question being left: Given the situation, will I make it worse by running barefoot or will my feet even get better from doing so given my age of 40 ?

    What is the best and worst case scenario in such case?

    Thanks

    Jörn

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  11. Barefoot TJ Administrator
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    Actually, that first x-ray of

    Actually, that first x-ray of an unknown stranger's foot doesn't look ideal to me. The toes and bones are all scrunched together. Your bones are supposed to fan out, somewhat like what you have going for you already. That person has probably been wearing confining shoes their whole life. The docs should be able to tell you for sure.

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  12. Dr. Andrew Klein Barefooters

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    Jörn,Dont be fooled

    Jörn,

    Don’t be fooled by the “normal” x-ray. It is a “lateral” view. The position of the two sesamoid bones under the first metatarsal, the overlap of the 1st and 2nd metatarsal bases, the positioning of the toes, as well as the soft tissue shadow is what gives the positioning away. Comparatively, your toes are much more splayed, but since you are looking at two different projections, the comparison is not appropriate.

    As for your question of will it get worse or better, I’m not sure. How long have you been running barefoot as of now?





    *Edit: I mis-spoke. Your xray is an Anterior-posterior view, the "normal" x-ray is an oblique view, not a lateral view. Your x-ray shows your foot almost directly from the top. Sorry for my brain melt-down.

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  13. jlubkoll Barefooters

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    Andrew,I am running

    Andrew,

    I am running (partially) barefoot for approximatly a year by now. If not barefoot it is minshoed, zero drop (or max 4mm) nearly no padding. In that last 12 month I did run approx. 3200 km, completly barefoot was approx 600km. The pain did not change over time (bad after 10km), the effects on the foot skin did go nearly to zero even on a half marathon barefoot on asphalt.

    According to the doc my picture should be a 45deg Angle to the right but I might have taken the wrong picture from his screen. I'll fetch the original two pictures these days (there was one from directly above and one with the angle). When I mentioned to him that the 3rd and 4th toe (from the left) are so close to each other (metarsal heads) he said that this is the projection that moves them closer together, which brought me to the conclusion that this is the 45deg picture.

    Thanks

    Jörn

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  14. footloose2 Barefooters

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    The x ray with the 'splay'

    The x ray with the 'splay' toes looks fabulously normal to me (on the low resolution image available). The other 'normal' one is usual for Western shoe wearing society but if you visit countries with people who have never worn shoes, you will see that they all have 'splay' toes because they have developed normally without constraint of shoes. They also do not suffer from neuromas or any other painful conditions. I therefore do not think that the splay shape causes problems. It is the more normal shape of a healthy foot.
  15. Dr. Andrew Klein Barefooters

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    jlubkoll wrote:According to



    With that information, I can say for certain that the xray you showed is the top-down (A-P in radiology terms). As far as splay foot, the conventional wisdom is that running BF will cause your toes to be more splayed out, while the arch actually starts to look a little higher. To my knowledge there are no studies on this, though the conventional wisdom is probably accurate to a point. Whether or not your splay will get worse, or if barefoot running is bad for you, any advice from me would be a guess. I can say with certainty that your splay will not increase to the point your foot just collapses.

    I will say again that the two xrays you used above cannot be compared because of the projectional issues between the A-P and oblique views. If you saw the A-P view of the subject in your "normal" xray example, it may indeed look exactly like yours.

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