Stepping Into Better Health: The Insidious Neuroma

I ran my first Sun­burst in 1999 as a vis­it­ing fourth-year med­ical stu­dent. In the years to fol­low, I’ve enjoyed run­ning this even with friends, engaged many hap­py patients at the fin­ish line and even fin­ished one race car­ry­ing my shoe that became untied just out­side of the sta­di­um, (back when the fin­ish line was on the 50 yard-line). One par­tic­u­lar race stands out among the rest. It was the first year Sun­burst was going to include a half marathon. It had been a while since I’d run that dis­tance and this inau­gur­al launch was just the right moti­va­tor for me to get back to it. 

As always, I picked the train­ing pro­gram that suit­ed my work sched­ule and began strate­gic imple­men­ta­tion of the short­er dis­tances with great antic­i­pa­tion of a smooth long run on the week­ends. I real­ly tried to play it smart this time and not let my enthu­si­asm get the best of me. I built a sol­id mileage base and cross-trained with the ellip­ti­cal train­er and hills once a week and even a lit­tle speed work every oth­er week. For some rea­son how­ev­er, I man­aged to ignore a strange numb­ness in my third toe. As my mileage pro­gressed, the numb­ness sub­tly trans­formed to a dull ache between the sec­ond and third toes — which I also man­aged to ignore due to my com­mit­ment to stay on sched­ule. With the race just weeks away, I had time to not only hit my mileage goal but shoot for a per­son­al best time. A few weeks before the race, I set out on my next sched­uled long run — five miles out and five miles back — but with the turn­around with­in site, the dull ache between my toes burned into a stab­bing pain that shot up my ankle. Sud­den­ly, any notion of a per­son­al best record was gone and sur­vival mode kicked in… 

Neu­ro­mas occur as a benign thick­en­ing of a nerve from pressure/​trauma. Most neu­ro­mas in the feet exist between the toe bases, can occur in any web-space, and are the result of chron­ic trau­ma such as walk­ing, run­ning or impact aerobics.

Symp­toms: there is usu­al­ly a pat­tern of grad­ual pro­gres­sive symp­toms. It may begin as a sub­tle numb­ness in the toes or feel like a rolled up sock in your shoe. Some report a ​“full feel­ing” in the ball of their foot. Over time this numb­ness can progress to a dull ache in the fore­foot. At some point you may notice a dis­tinct spread­ing of the toes at the symp­to­matic web space. With fur­ther pro­gres­sion, the dull ache can become a sharp stab­bing sen­sa­tion — inter­mit­tent at first, then con­tin­u­ous. The symp­toms are aggra­vat­ed with walking/​running and are alle­vi­at­ed by rest. As the symp­toms progress, some may find a desrie to remove their shoes to rub the fore­foot and flex their toes, which usu­al­ly helps. In time, the pain pro­gress­es from a dull ache to a sharp stab­bing pain with weight bear­ing and can be aggra­vat­ed by wear­ing tight shoes. 

A nor­mal gait cycle relies on sev­er­al move­ments for nor­mal ambu­la­tion. As your heel strikes the ground with each step, your foot will pronate (roll inward) to con­form to the sur­face on which you’re walk­ing. As your body pass­es over your foot, it supinates (exter­nal­ly rotates), lock­ing your bones into a rigid lever and pro­pels you for­ward as your heel lifts from the ground. 

If you hyper­pronate (roll your feet in too far), the metatarsals tend to place abnor­mal pres­sure against the inter­dig­i­tal nerves, trap­ping them between each oth­er and the ground, result­ing in a benign thick­en­ing — much like a gui­tar play­er would devel­op cal­lous­es on his/​her fin­gers with repeat­ed pres­sure against the strings. I tight Achilles ten­don tends to aggra­vate the process further. 

Rest. Your body is respond­ing to a chron­ic trau­ma and needs to recov­er. If you have a lit­tle more than half of your mileage, you’ll prob­a­bly be able to com­plete your race. Tar­get com­ple­tion, not speed. Sup­ple­ment your efforts with swim­ming, ellip­ti­cal train­ing, or the recum­bent bicy­cle. When bicy­cling, be sure to place the ped­al away from the area of pain and more towards the arch. Slow­ing down speed or dis­tance can also serve your over­all goal. As much as I hate to say this, you may do well to call off plans for a cur­rent race for the sake of retain­ing your abil­i­ty to run through­out the rest of the year. 

NSAIDs: Non-steroidal Anti-inflam­ma­to­ries such as Ibupro­fen and Aleve can not only reduce the pain, but reduce the inflam­ma­tion con­tribut­ing to your symp­toms. As many drugs inter­act with NSAIDs, be sure to check any exist­ing med­ica­tion you’re tak­ing against poten­tial­ly harm­ful inter­ac­tions. You should con­sult your fam­i­ly doc­tor or phar­ma­cist if you’re unsure. 

The Runner’s Stretch is your great­est defense against any fore­foot pain. Be sure to hold it for a minute with the leg straight and a minute knee bent. In doing so, you will be stretch­ing both the gas­troc­ne­mius and soleus — both of which con­verge to become the Achilles ten­don. If you can repeat this three times dai­ly, a minute each leg, for a total of 12 min­utes each day, you should notice a dif­fer­ence by day three.  

Over the counter arch sup­ports with stretch­ing may be suf­fi­cient to offload the painful area. 

Treat­ment: What your podi­a­trist can do. 

The pain in your fore­foot can be from sev­er­al dif­fer­ent caus­es such as bone bruis­ing in the metatarsals, a stress frac­ture, joint pain (cap­suli­tis), or oth­er soft tis­sue injury. Your podi­atric physi­cian will be able to help you under­stand what is injured, but also why and help work togeth­er with you for a solution. 

A good his­to­ry and phys­i­cal com­bined with in-office x‑rays can nar­row the diag­no­sis and hone the treat­ment toward a pro­duc­tive out­come. Depend­ing on your diag­no­sis and its sever­i­ty, your doc­tor may prescribe:

In spite of dis­cov­er­ing a neu­ro­ma just sev­er­al weeks before the race, I was able to com­plete the inau­gur­al 2003 Sun­burst Half Marathon as hoped. Even though it took a bit more strat­e­gy and rest than antic­i­pat­ed, the expe­ri­ence had a hap­py end­ing. We’ve all had some degree of suc­cess in pow­er­ing through dis­com­fort while train­ing, how­ev­er this par­tic­u­lar injury would be best treat­ed early.