Question about my Left Foot and Arch with Pics

dianne9106

Guest
Hi!

First I am new here. I am also on the Barefoot board on RW and I saw a thread about Ask the Docs for this board, so I decided to join. The below post is a a crosspost from RW. For a little backgroud that may not be in the post: I am almost 40 (3 weeks shy), I have had PF and had the surgery on my left in 2007. It was better and I have had stiffness off and on through the years. I have recently lost over 30lbs and I have become physcially active again. I am training for a half marathon in Merrell Pace Gloves - started before I knew about BFR. I do enjoy MR at the present since it's easier on my knees and hips, etc... I am also racing in my first Sprint Tri this weekend (400m, 14 miles, 5K). I do plan to start with BFR after my HM since I know it will take a little time to start over again in some respects. So here we go:

For quite sometime I have been noticing that my left ankle has been bothering me - doesn't really matter what I do, what kind of shoes I wear, go barefooted, how long I run, etc... I know I rolled it (not tooo badly) in a pair of lower wedge shoes one day about 2 months ago. I babied it a little and then it felt fine. Then between runs, I noticed it would hurt a little, but after I rotated it and stretched a little it was fine. I went to my chiro and he said I had an inverted sprain and there was likely an old injury there from before as well. He adjusted it a couple of times and said I was good to go. He did say I might have a little tendonitis in it - but not surprising since I have it in my right elbow with it trying to start in my left (lucky me). During my runs, I notice if my form starts to slip a little, I can hear my left land a little harder than the other and I straighten it up and all is well. I know my left is my dominate foot - it's larger, I always step off with it (it is the way you march in the Army), I start all of my runs with it, walking, skipping, etc... I am actually going to a different chiro this evening - he is more sports minded, does marathons, Ironman's, etc...

Sometimes when I put my feet together, I notice something is off about my left foot - it looks different, almost like I don't have the same arch anymore. Now, I have always had high arches - always. Beautiful, supple, wonderful arches. But now the left doesn't look as high as my right. This morning when I was stretching and I had my feet together my sitter (she is also sports training intern at a local high school) noticed that my left was rather longer than the other. I knew that it was, but not the way it is now! See pics - my left looks like it's got some sweet toe splay going on - LOL! I did the paper bag thing since it was raining outside, otherwise I wouldn't have bothered.

Right now I am only running in my Merrell Pace Gloves - sometimes I take my shoes off and run a few hundred meters (nothing to brag about or report) at the end of my run. I normally only wear my Merrell Pure Gloves or ultra flat flip flops or just plain barefoot. Nothing else hurts - my Achilles feel great, I am not having TOFP, bottom of foot pain, sometimes it hurts on the edge of left foot - but I have had that off and on for a few years. I did have a plantar fasciaectomy (sp) done on my left foot 4 years ago were the podiatrist cut my fascia and and stitched up my foot.



**My new chiro is going to treat me this evening (9/7) based on what he sees on my xrays. I have stressed factured my hip in the past (1994) and he thinks that might be part of my problem. He adjusted my feet yesterday, but I am still having some pain on the outside left edge (peroneal brevis??) Oh and my left foot does tend to flap more when I run and I am not paying attention to my form. The chiro said I might have a little drop foot going on too.... Oh and I do know that this has happened within the past 3 weeks. I was just comparing my arches to my husband's lack of arches before he left for a few weeks for work. Will my arch ever come back? I am kind of sad and I hope this dosen't hobble me :( I just want to make it through my HM and then figure everything out.

http://i717.photobucket.com/albums/ww172/thewebbs03/feet1.jpg

http://i717.photobucket.com/albums/ww172/thewebbs03/feet2.jpg

http://i717.photobucket.com/albums/ww172/thewebbs03/feet3.jpg
 
Hi Dianne,Because of your

Hi Dianne,

Because of your surgical history I'm hoping The Doc will weigh in on this one but I didn't want to leave you hanging without a response.

The most concerning aspect of your history is the relatively short duration of progression. Three weeks is a pretty short time to see such changes. As a complete picture your history starts pointing to possible common peroneal nerve impingement.
  • Pain at the lateral foot
  • Foot drop (weakness of anterior compartment of leg - deep branch of peroneal nerve)
  • Loss of arch (peroneus longus helps maintain the transverse arch - superfical peroneal nerve)
  • Your Chiropractor noticed some weakness - I'm assuming it was subtle or he would have been more concerned
The common peroneal nerve technically ends right behind the fibula where it splits into the superficial and deep branches so if there is a compression it is likely near the fibular head.

If you were in my office, I would refer for electrodiagnostic testing. An Electromyography (EMG) and Nerve Conduction Velocity (NCV) can show if the nerve is actively denervating and where exactly a blockage may be. As an experiment, Google search the Extensor Digitorum Brevis muscle for a picture location and then try to find those muscles on your feet. If the left one is starting to waste away it is a good indicator of nerve entrapment. Those are small muscles and waste away quickly.

As a Public Service Announcement only, and please don't take this as a diagnosis, Dianne is of prime age to begin to show signs of Multiple Sclerosis. MS is a strange disease and can begin to present in any number of crazy ways. I hesitated to even add this paragraph in, but it would be on my list of things to rule out. In this case it would probably be ruled out quickly.

Good luck and I hope you find an answer soon.
 
Thank you so much Dr. Klein!

Thank you so much Dr. Klein! The pain has kind of moved to my toes. I raced in a Sprint Tri this weekend (400m, 14mile, 5K) and then I ran 9 very slow miles Sunday. The front of my toes and forefoot was killing me when I was done! I am taking a rest for a few days from running and I had my Chiro adjust it today and will tomorrow as well. He actually raced in the Tri(placed first for his AG though). Would my toes "burn" if it was the peroneal tendonitis?

My biggest worry is that I will slap my left foot more when I run to compensate for the difference in feel of my feet. Should I look for my right arch to come down a little? I am just shocked it took over 4 years for it to happen! Granted I haven't been as physically active has I have been in the past 7 months, but I guess it just come up rather quickly. I will visit my primary care MD and ask for a referal for the EMG and NCV. How would I go about asking for such a thing? Honestly, there are not a lot of great podiatrist in my area, so I wonder if my PC could read and under the results??

Thank you again for your input and I do promise to look into the last paragraph as well.
 
The foot drop indicates a

The foot drop indicates a compression of the peroneal nerve rather than tendonitis in the peroneal tendon. I would just ask your MD for the referral. The results of the test will be pretty much yes or no in regards to nerve compression. If there is compression of the nerve, it would explain a lot of your symptoms and the compression needs to be resolved quickly.
 
Dr. Andrew Klein wrote:The

Dr. Andrew Klein said:
The foot drop indicates a compression of the peroneal nerve rather than tendonitis in the peroneal tendon. I would just ask your MD for the referral. The results of the test will be pretty much yes or no in regards to nerve compression. If there is compression of the nerve, it would explain a lot of your symptoms and the compression needs to be resolved quickly.



Just as I said there are no good pod's in our area - I remembered, we are an hour from Vanderbilt and they accept TriCare. Duh! I will get a referral as soon as I can. It's unlikely I can get in before my HM on the 24th though. Do you think my Chiro can adjust my foot a little as to take the pressure from the nerve? Everytime he adjust my foot it always feels better. When I walk on it short distances, it hurts, but after I get to running on it, it's fine. Granted my 9 mile run Sunday (after my Sprint Tri on Saturday) was my slowest to date - 14min mile, but I think that's because I was tired and I was pushing myself more normal. Yes - one can still be "running" even at a 14 min mile pace - I just conserve my energy!
 
dianne9106 wrote:Do you

dianne9106 said:
Do you think my Chiro can adjust my foot a little as to take the pressure from the nerve? Everytime he adjust my foot it always feels better. When I walk on it short distances, it hurts, but after I get to running on it, it's fine.

He is likely decompressing the nerve with the work he is doing, but I'm not sure a HM on the 24th is a good idea. If you can't get in for electrodiagnostics before that to make sure the nerve is functioning I would recommend against it. You may be doing more harm by running. That is a difficult call to make via internet, so I would defer that decision to you and your Chiropractor. Feeling better is good, but function is most important and pain can sometimes be taken care of long before proper function is restored.
 
Well, I ran my HM and it went

Well, I ran my HM and it went great! I am still having pain in my left foot. I think I broke or really jammed my pink toe on my left foot about two weeks ago and it was still tender, but didn't bother me. My foot did hurt a little throughout the HM - it would rotate around from the side, to the toes, to the arch and the ankle. But as long as I kept my form, it didn't hurt that much. I know I need to get into a poditriast soon, it's getting the referreal that takes so long. After my chiro adjust my foot it feel so much better - like it never even hurt! But I know I can't get him to adjust it everyday or every other day for the rest of the time that I run, so I am going to have to figure something out. I really need to find a local pod that is runner and athlete friendly. Most just want to give you shots or offer surgery and I think I am dealing with issues from both cort shots and the stupid surgery
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