Monday, June 9, 2014

Morton's Neuroma, Hallux Valgus / Limitus and Vibram Five Fingers

Finally, I decided to face the music and go and see a podiatrist. I approached this with about as much trepidation as I would a visit to the dentist. As readers of this blog will know, I have been suffering from intermittent sharp pains and numbness in the tips of my toes, particularly when running at moderate speeds. It can't be a coincidence that this has cropped up in the same foot that has a bunion (or hallux valgus if you want to sound fancy) and that suffered a stress fracture in the 3rd metatarsal 5 years ago. As I haven't had any kind of running-related injury since then - and I have been running in "extreme" minimalist shoes (Vibram Five Fingers or Soft Star RunAmocs) exclusively for the last 3 years - I thought that I could safely delete the word "pronation" from my vocabulary, safe in the knowledge that I had managed to strengthen my bones, tendons, ligaments and muscles sufficiently to compensate any imbalance. But, in truth, fear of the word "pronation" and of being told to stop running in minimalist shoes was behind my dread of the podiatrist.

One thing that I cannot deny is that the bunion has not got any better. In fact, it looks like it has probably got worse. I had hoped that strengthening my feet by running in Vibrams might help my toes realign. It certainly didn't help the unfortunate little accident I had last year in which I tripped over a paving stone, painfully jarring my right big toe (I don't count this as a running related injury!). Amazingly, I was able to continue my training with little interruption and go on to get a personal best time in the Seville Marathon. The podiatrist explained that the accident may well have made things worse, but my right foot tended to over-pronate and this can cause the base of the big toe to separate from the rest: I'd always thought that it was more about the top of the big toe touching or overlapping with the others. This over-pronation could also be the cause of my pain and what looks to be a Morton's Neuroma. At one point the podiatrist pressed my foot in a particular way making me shout an expletive (in English) and break into a sweat. Now I really dread going to see the podiatrist! I think I must have shocked him because he kept on apologizing...

A Morton's Neuroma is an inflammation of the nerves that run between the 3rd and 4th toes or - less common but my case - between the 2nd and 3rd toes. Scar tissue starts to build up around the nerve, exacerbating the compression, and it can become so chronic that the nerve may even have to be removed in some extreme cases. By a strange coincidence, my Mum has also been diagnosed with a Morton's Neuroma and is due for an operation to remove some of the scar tissue. The inflammation in my case could be due to excessive pronation (that word again!) leading to the metatarsal bones rubbing against each other and irritating the nerve, or from increased load bearing in that part of my foot, perhaps due to changed bio-mechanics stemming from the bunion.

There are of course many worse things that can happen to you, but this is a bit of a double-whammy for me. On the one hand, this appears to go against my belief in minimalist shoes. The podiatrist was very intelligent and, rather than telling me what to do, he put all the facts on the table and left me to come to the conclusion that perhaps a 42 year old man with a (slightly) deformed foot should run in more supportive shoes and perhaps cut down a bit on the intensity. But I also have to ask myself if now is the time to accept that I can't expect to keep on beating my best times and that I should relax a little and run more for enjoyment than competition: as I said when I left the podiatrist "me estoy haciendo viejo" - I'm getting old.  He is sensibly reserving judgement until we have the results of the MRI, when he will be able to confirm the diagnosis as well as see how the bunion has evolved since the last scan from 5 years ago. One curious thing, though, was that it turns out that I have sesamoids under all my toes, not just the big toes - apparently this is very rare. I was surprised that even my wife spotted this immediately on the scans I showed her.

Anyway, what better way to cheer myself up than to buy some new running shoes? I initially tried running in the shoes I used for the Ironman - some Pumas which are relatively stiff and padded - but they felt too narrow and I'm not sure that they provide any useful support. So I ran down to the shop in Madrid to try on some Merrell Trail Gloves with my youngest son in tow (for whom I bought some cute toe socks to go with his Vibrams). I like the very wide toe box but I could hear the podiatrist saying that they were too flexible and I needed something with more support. I figured that if it comes to having to use orthotics again, I can at least put them in these shoes as they resemble a conventional running shoe. Let's hope it doesn't come to that. It may be the anti-inflammatory pills I have been taking or it may be that the shoes were better padded and allowed the impact to spread over a wider area, but I didn't experience any pain or numbness in my toes. I did, however, do something fairly stupid. As they were called Gloves and felt so comfortable, I decided to run without socks. What was I thinking? After a few kilometers I felt hot spots on the tops of my feet and, looking down, I could see the crimson patches spreading. By the time I got home it looked as though I had stigmata.

UPDATE (18/5/2015): It's now over a year since I first noticed that sharp pain between my toes as if I had a stone in my shoe. Since then, it's more or less disappeared from the right foot only to appear almost the next day in an identical fashion in the left; now it seems to have all but vanished in both feet. (By the way, that rules out the link with the bunion.) If I just happen to land on a sharp stone, then it still feels as though I have trodden on a sharp stone (duh) but, of course, it hurts a lot more than it would otherwise have done.

I've continued with my Merrell Trail Gloves which still give me problems with blisters, especially when they update the "version", meaning that I have to get used to them all over again. At least the Trail Glove 3 seems a bit more sturdy than its predecessor, of which I have already worn out two pairs. I also decided to go for a much bigger size than I strictly need, in order to give my toes ample wiggle room; this doesn't help with the blisters much either but after recently having seen a YouTube video explaining what those mysterious extra holes for lacing are for, I have seen a great improvement there too.

I've also taken my training (and my ambition) down a notch or two, which hasn't been easy to handle. But the biggest change has been a mental one after reading a post on LetsRun from fellow sufferers of Morton's Neuroma. It seems as though many people just "run through the pain" and have continued to do so for years without problems (so I can forget about those scare stories of people having their nerves removed). Although it's probably never a good idea to follow second hand advice from a Doctor's analysis of another patient, one person said that his Doctor had told him that the "pain hurts you, not it" if that makes sense. So it's just something I'll have to keep an eye on but for now I just try to avoid stony trails... and probably my beloved Vibram Five Fingers too for the time being.

1 comment:

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