Toe Pain - Morton's Neuroma?

Discussion in 'Health, Nutrition, Injuries & Medical Conditions' started by Rob Ogilvie, Mar 7, 2018.

  1. Rob Ogilvie

    Rob Ogilvie
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    Howdy-

    I'm suffering from some toe pain and metatarsal pain and am wondering if I'm dealing with Morton's Neuroma or something else - and looking for advice on how to continue training for my first marathon coming up in seven weeks.

    I'll start with symptoms and then go to back story.

    I'm feeling some pain and tingling in my second and third toes on my right foot, associated with running. When I first started wearing VFFs and using CorrectToes, I had similar pain when I wore them too long (and always took them off when I started feeling the pain). That was over six months ago, and three months into my minimalist transition.

    I've been building miles for my marathon (seven weeks from now) at the rate of 1-2 miles on my long run per week. I'm a heel striker and have also been working on Pose-style running for a couple weeks leading up to my injury, although my form hasn't changed much in that direction. On my first 20 mile training run (in VFFs), I experienced the same pain as when I was new to VFFs/CorrectToes during the last two miles of my run. I didn't think much of it at the time, but it persisted, especially after other training runs later in the week. Four days later, I decided to take a week long break as I had a 30k race coming up. My week long break from running didn't impact the pain, and my 30k hurt for the first mile, but then felt great. After, my toes/metatarsal area hurt again, moreso than before the run, but quickly approached my new normal. Going up and down stairs hurts the most, but not too much. Later in the day, when my feet are warmed up, I generally have less pain than right when I wake up in the morning.

    I have a hard time describing exactly where the pain is - it feels like my toes are being pulled apart, and the pain is mostly between the toes and into the metatarsal heads, but it's such a generalized ache it's hard to say for sure.

    Back story: I'm a minimalist runner. I suffered from plantar fasciitis for years, and more supportive shoes kept helping for a few weeks at a time. I read Born to Run and decided to try transitioning to minimalist footwear, and within a month my foot pain was gone and stayed gone. I've been building up miles for the last 9 months or so towards my first marathon. I'm a heel striker, and really want to improve that, but am worried that forefoot striking might be related to my pain. My daily wear shoes are Vivobarefoot Primus Trail FGs.

    Does any of this run counter to a Morton's Neuroma? I'm approaching this with my traditional medical provider, but am stuck in an HMO and their first suggestion was wearing support shoes whenever I walk.
     
  2. Barefoot TJ

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    I have a long history with MN, unfortunately. I founded Morton's Neuroma Talk, a forum dedicated to MN, but took it down after 5 years.

    I "had" two "neuromas" in each foot in the usual metatarsal spaces, and after too many procedures, treatments, and surgeries, I no longer have MN, but now I am left with something just as bad. Long, miserable story...

    First, when you are running do you notice that the pain increases as your distance increases?

    When you stop running, are you able to "massage" or rub the pain away?

    Let's start there, then I can respond more after you reply.

    :barefoot:
     
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  3. Rob Ogilvie

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    I read some of your posts yesterday while doing some research. Thanks for taking the time to respond!

    The pain does not increase as my distance increases. Quite to the contrary, the pain decreases during my first mile or two and then drops off to nothing until after my run when some pain begins to return.

    I haven't been able to massage or rub the pain away, but will try after my next run.

    Something I have noticed that seems odd is CorrectToes do not bring me relief - wearing them actually causes slightly more discomfort, especially for the first several steps after putting them on. That said, I'm trying to wear them more often so whatever is wrong heals in a correct position.
     
  4. Barefoot TJ

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    Hmmm. The pain and tingling sounds like MN, but other foot conditions could cause these same sensations.

    Your not experiencing increased pain with running but decreased pain is not my experience at all...not to say that you do or don't have MN (not that I could diagnose you anyway, as I am not a doctor). Everyone is different.

    I too could not stand to wear Correct Toes after a short while, and I can't tolerate Yoga Toes at all. Like you, I also experienced pain when wearing VFFs after half an hour.

    I always had trouble describing and locating a pinpoint to my pain as well.

    Were you able to get some answers or understanding from reading my history in the other threads?
     
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  5. Rob Ogilvie

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    I now feel like I know a lot more, at least - but I'm not sure I know more about what's going on with me.

    I have an appointment with a sports doc tomorrow morning. I'm hoping he doesn't freak out when my running shoes are a pair of VFFs and will actually look at the problem rather than prescribing support shoes.
     
  6. Barefoot TJ

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    Let me know what he diagnoses you with and what treatment options he recommends. Before you decide, even on say an injection, do your research. Some treatments are dangerous.

    It's important to know that MN can't be detected on x-Ray, and MRI is hit or miss. There is an MRN option (which is an MRI but was developed for the nerves that will tell you exactly if your nerves are involved and how), but it's not offered everywhere locally--you would have to hunt for it. Ultrasound is a good option, but not as good as MRN.

    Magnetic Resonance Neurography (MRN): https://en.wikipedia.org/wiki/Magnetic_resonance_neurography

    We do have a Barefoot-Friendly Doctors & Specialists Map you can look at to avoid the stares we sometimes get from our doctors.
     
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  7. Rob Ogilvie

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    Thanks! I actually live about an hour from NW Foot & Ankle, but their appointments are always months out and, unfortunately, aren't covered well by insurance. I may have to go out of pocket depending on what my HMO says, though...

    I'll let you know. I won't be getting any injections tomorrow.
     
  8. trevize1138

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    Be sure that you're not too focused on where your foot "strikes" the ground. In fact, you should never think of your foot as striking the ground harshly at all. Your internal vocabulary really makes a huge difference and I found that out myself ramping up my own unshod miles in preparation for a marathon.

    A heel-strike gets a lot of the blame but it's really just a potential symptom of a far bigger issue: over-striding. When I first transitioned I basically just changed from heel-strike to forefoot-strike. But, as i was still just over-striding I only traded up what part of my legs inevitably got injured. I also got metatarsal tendonitis thanks to reaching my foot out way too far to get my toes to touch first.

    Flip that focus around: try running by only focusing 100% on lifting your feet off the ground. Don't push off, don't worry about lifting high or how/where your feet come down. The general movement should feel like this: stand in place, let your right leg go dead below-the-knee and then lift that leg until the toes are dangling an inch or two off the ground.

    You'll notice you need no lower leg strength for this movement. Start switching legs doing this and build up speed until you're doing this at 180 steps/minute. That's how it should feel: all about lifting feet off the ground ASAP.

    Gravity exists: your feet will come down without your micro-management. You will move forward: a lot of good, instinctual movement starts to take over when you stop worrying about foot "strike" or over-striding or cadence or any of those good, obvserved traits of running. Just worry about lifting that foot easily off the ground the very second it touches the ground.

    I've found whatever part of my body I'm focused on that's the part of my body I'm asking the most of. Focus on my feet and I stress out my feet. Focus on my upper legs lifting quick and I'm properly asking my large, strong upper leg muscles to do the heavy lifting they're best at.
     
  9. Rob Ogilvie

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    I had an eventful morning! Here's what the doc finally said: "Possibilities include metatarsal irritation, stress fracture, sesmoditis and early neuroma" and "Please wear the boot when up and walking until we discuss MRI results and no running of any kind. Stretching, especially hamstring stretching during this time will be beneficial" - which all sounds reasonable. I have an extra sesamoid on my second metatarsal.

    He watched me run and while I may heel strike a bit, he said I'm not overstriding (or if I am, it's not bad). HOWEVER, my right foot is splaying out when I'm running, which can cause all kinds of problems. He think my ankle is to blame - and that may be, as I rolled it quite badly several years back. He recommends I work on strengthening up and fixing my ankle post-marathon.

    Until them, I'm sidelined and wearing a boot until I can get an MRI scheduled... hopefully early next week.
     
  10. Barefoot TJ

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    The boot for now sounds like a good recommendation. An x-ray after 6 weeks should be able to pick up a stress fracture too, but MRI will catch other stuff.

    Did you know about this extra sesamoid, or did the doc tell you that you had it?

    Did he watch you run in shoes or barefoot?

    How will you "fix" your ankle (post-marathon)?
     
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  11. Rob Ogilvie

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    Howdy!

    I agree, the boot does seem like a good idea. Maybe a few days of complete isolation with the boot will let everything heal up.

    I did not know about the extra sesamoid before he pointed it out on the x-ray and then wiggled it around a little bit so I could feel it. It's below my metatarsal, so there's a chance it might be part of what's causing me discomfort.

    He watched me run barefoot, maybe 50 feet down the hall and back. It was enough to bring the pain on - he couldn't trigger it on his own by tweaking my feet. I think it's driven more by impact stress than anything else.

    I plan on fixing my ankle post-marathon with strengthening exercises. I may engage the services of a physical therapist. I'm also planning on cutting back my mileage and giving the Pose Method a solid try to see if it can help clean up more running form issues - and Pose Method includes a lot of strengthening exercises.

    If you have any suggestions for exercises I can add to my routine, I'm open to suggestions! I've added picking up a marble with my toes to the mix recently. I also have some VSO-strengthening exercises (runner's knee on my right knee) and a regular weight lifting routine.
     
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  12. migangelo

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    Rob,

    I'm around 30-60 mins away from NW Foot and Ankle in Forest Grove. I'm a DC and take most insurance. I run barefoot, though not running now. I can't diagnose you over the internet nor recommend any treatments. I will say if you're pain or injury is more than two weeks old then a fracture would show up on x-ray. You say you suffered PF years ago. That makes me want to look at your back as the cause of your pain. Most people have heard of sciatica. It's caused by back problems and leads to leg pain or weakness. Your sciatic nerve starts in your back and runs through the glutes, hamstrings, and lower leg to toes. If you have instability or a weak core it can cause foot problems.

    I follow and teach a program called fixyourownback.com Go check it out and take the 3 minute test. If i'm too far then the man himself who created that website is in SE on Hawthorne and 39th. If you can't get in to see him he has two associates I would trust. Dr.s John Parker and Corey Peterson. John is more minimalist minded. Dr. Snell is a runner. Me i'm foot focused and a barefoot runner.

    http://www.hawthornewellness.com/

    http://balladtownechiropractic.com/

    https://www.fixyourownback.com/three-minute-sciatica-test/

    Good luck and hope to met you soon. I'll plan a run and get together for barefoot day.

    Dr bf Mike
     

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  13. Rob Ogilvie

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    Awesome! I just sent your office an email to see if my insurance will work. I'm down for trying anything at this point...
     
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  14. Rob Ogilvie

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    The MRI came back showing no stress fracture (yay!) but with absolutely no indication of what might be causing my pain (boo!) ... doc cleared me to take my boot off to lift weights as long as it doesn't hurt, but no running yet and I'm not really sure what next steps are.
     
  15. Adriakus

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  16. Rob Ogilvie

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    Thanks - I don't recall on the x-ray if my second metatarsal was longer than my first, but my second toe doesn't stick out further than my first (see attached).

    I took the attached photo early on in my foot pain - if you note, my big toe gap is smaller on my right foot than my left. I didn't notice this before my injury, so I don't know if this is new or not.
     

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  17. Barefoot TJ

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    The best way to tell is to bend the knuckles on your toes, then compare. Can you retake the picture doing this?
     
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  18. Rob Ogilvie

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    I owe everybody an update!

    After wearing THE BOOT for most of a week and then slowly adding activity back, my odd toe pain has seemed to go away. WOOHOO! My sports doc cleared me to start ramping miles back up. I've seen Dr. BF Mike, and am seeing him again on Saturday. I definitely don't have Morton's Toe.

    After running a bit the last few days, I'm now having pain near the top of my foot near my toes, but hopefully that goes away soon. I suspect not running much for several weeks has me running differently, and my foot isn't ready for this new and updated running form.

    Post-marathon (end of April), I'm going to scale my mileage all the way back and start following the Pose Method to build a solid running form. I really think all the tweaks to try and improve my running form without dialing back mileage is what's causing my injuries. So for now, I'm just going to make it to the marathon and then reset!
     
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  19. Barefoot TJ

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    Good luck, Rob. Sounds like a plan. Glad Dr. Mike could help.
     
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