Strange Foot Issues

[Ozzy McKinney]

Experiencing a strange problem with my feet that has kept me from running/hiking for a couple weeks now and is getting worse, not better. Looking for anyone who has had similar issues, or possible treatment options. I realize the first and most logical option would be to see a doctor, however I'm a student without insurance, and won't be able to afford that trip until I pass my boards and start working again. Any help would be greatly appreciated.

Background- I have been backpacking and hiking in trail runners for several years. I started trail running about a year ago to stay in shape during school. I work in an emergency room and routinely spend 12 hours on my feet. I usually just wear my trail runners at work as well, and I have never had foot issues hiking, running, or working until about 3 months ago.

At that time, I noticed a feeling on the lateral side of my left foot, where the fifth metatarsal meets the cuboid. Not pain, but a feeling like there was a "lump" under that area. At first it would come and go, then got to the point where it was constant whenever I wore the shoes. I couldn't find any structural problem with the shoe. It started to cause me pain, at which point I replaced the shoes (which were Sportiva Wildcats) with a very comfortable pair of Brooks Cascadia 7s. Problem solved!… or so I thought.

I wore the brooks running, hiking, working, for 3 months with no pain, no lump feeling. Then, randomly, at work, the feeling came back. I didn't roll or injure the foot (as far as I know). It got worse, fast. The feeling of having a golf ball in my shoe then started to additionally appear under the ball of my foot, behind the second toe. I tried the insoles from my climbing boots, felt worse. Oddly enough, in an attempt to make it through a shift at work, I removed the insoles all together… which helped! (?). Now I am wearing the cascadias with no insoles, and while the feeling is improved (from painful hobbling to just kind of annoying) I can feel it getting worse. The casual shoes that I have owned for years and are always comfortable are now painful to wear. The only thing I can wear without pain is a cheap pair or thin flip flops, or just bare feet….

It doesn't seem like what I can find about plantar fasciitis, because the pain is not constant, rather now every shoe I try on feels like it is full of river rocks. The pain only crops up when I'm on my feet in the shoes for 30 mins to an hour. I can walk in bare feet just fine, or the flip flops, but in a matter of months every shoe I had that was once comfortable feels horrible. I spent a week laid up, icing, etc, but my feet feel fine until I try to put them in shoes.

There are no bruises, tender spots, or blisters on my feet when I examine them.

I have some superfeet ordered, but honestly I'm doubting the "magic" of pricey insoles to cure this weird issue. I'm thinking I'm just going to get some super thin minimalist shoes for running, as I'm still OK in bare feet, but I'm not sure I can work a 12 hour shift in the ER in minimalist shoes.

Any ideas? I couldn't find anything in search (help me Anna!) that seemed to mirror the weird fit issues, and I would love to go to a podiatrist, but I can't afford it right now. Thanks for taking a look.

[Stephen M]

Hi Ozzy,

I am not from the US so some terms are strange to me, when you say "boards" do you mean a medical certifaication examination? if so do you not have a colleague or superior that could check it out for you, or maybe there is a free clinic nearby.

[Bean]

"The casual shoes that I have owned for years and are always comfortable are now painful to wear."

I don't think it is the same as yours, as I can't relate to the golf ball feeling, but it was in a similar part of the foot. Didn't really figure out what it was, but I ended up believing it was my casual shoes causing it (Patagonia Lantic)… I then took out my green Superfeet from those shoes and I thought it helped. Which would be strange, because I hiked for years with the same type of insert without problems. Although, at the same time I also started tying my casual shoes a little tighter, as before I would leave the laces really loose and just slip them on and off. The working theory was that because the shoes were really loose, I was gripping with my toes inside the shoe to keep them from coming off my feet, or just doing it from nervous energy. This was a notion I got from my brother, because he has small feet and would get shoes a few sizes too big to compensate for his small mans complex… and he was "gripping" too, and it was causing him a lot of foot problems.

All seems well so far, but its only been like six months. So, I'll be eagerly watching this thread to see if you come up with anything more concrete that might shed light on my own problem.

[Nick Gatel]

Start going barefoot whenever possible. When required to wear shoes, wear the most minimal shoe possible and go up one size from normal.

Edit: And stay away from aftermarket insoles.

[Jeremy and Angela]

Hi Ozzy,

I agree with Stephen, a colleague or free clinic (usually universities have such) would be a good idea. In terms of your search, the article on Morton's neuroma looked interesting.

[John S.]

To test for Localized Interdigital Neuritis (Morton's Neuroma) see below. At first glance it does not sound like typical neuroma pain.

"A provocative examination, as shown below, involves manually compressing the forefoot and simultaneously palpating the affected web space between the fingers of the other hand. The compression may result in the Mulder sign, which is a painful and palpable click that reproduces the symptoms."

http://img.medscape.com/pi/emed/ckb/orthopedic_surgery/1230552-1237552-1484.jpg

[Mike W]

Ozzy –

I've experienced the problem you have described and did see the foot specialist but they treated me for plantar fasciitis and a heel spur (I also had these issues) but they didn't do anything about the golf ball underfoot issue.

In my case I eventually resolved it myself, firstly by grinding down the callous on the bottom of my foot (acquired after too many years of barefoot martial arts) but mostly by wearing a very sturdy trail shoe with a thick vibram sole. I also put a thick foam insert on top of my orthotic inserts and that helped a lot (requires a deep shoe, I use Merrell's). I actually can't walk long in a standard jogger, I need the thick hard sole on my shoe or my feet start to complain after a few miles. It took a while for it to settle down and I had to wear the hikers constantly (still do) which is not a great fashion statement (and not really appropriate where I work) but it keeps me on the trail so I don't care.

[Roger Caffin]

Feet are a problem. However …

Step 1: get your feet measured for size and WIDTH on a Brannock device.

Step 2: Buy some shoes with a dead flat insole at least a full size up on what you measured and at least as wide as the measurement. Wear them loose. Yeah, that will cut out lots of nice-looking shoes, but I suspect they just don't fit YOU.

Dead flat insole: absolutely NO 'arch support' and absolutely NO 'pronation control'.

Step 3: Allow at least 6 months for recovery.

Cheers
PS: if nothing else, try New Balance 889 shoes in a 4E fitting.

[Diane Pinkers]

My boyfriend used to have a problem with feeling like his socks were bunched under his foot, even when they weren't. It hurt to walk, and occasionally he would lose the feeling in his 2 smallest toes. The podiatrist called it metatarsal pain, and recommended orthotics. However, what really fixed the problem is a good massage–spasms in the calf muscles were pinching on the nerves, and causing trouble. Since calf spasms are often responsible for many foot problems, like plantar fascititis, find yourself a good massage therapist who is used to treating sports problems and therapeutic massage, and it may help a lot.

[Jennifer Mitol]

Could easily be a dislocated cuboid (yep, it happens!!).

Get a friend to help.
Found you a fairly good you tube video that shows you what to do about it:

http://m.youtube.com/#/watch?v=KI2VV-b9uWI&desktop_uri=%2Fwatch%3Fv%3DKI2VV-b9uWI

I've had great success with this when the cuboid is the problem; obviously without examining you I can only guess, but based on what you said this would be high on my list of differential diagnoses.

Good luck! Let me know how it goes…

[Ozzy McKinney]

Thanks, this gives me a place to start. I appreciate people willing to kick ideas around.

Free Clinics/Collegues- No free clinics around here that I know of (God bless america…) As to asking a doc at work, there is one guy is might be helpful, but I don't work with him very often. Also, I'm not sure people understand asking an ER doc about a podiatry issue is somewhat like asking a Ford car mechanic about your Honda motorcycle; much more knowledgeable than a layperson, but not specialized in that area.

As to Mortons Neuroma, that sounds like what is happening to the forefoot, but doesn't match the metatarsal issue (?) Someone suggested I may just be dealing with two different issues, which makes sense. I'm wondering if the neuroma could be caused by the other thing, as it came up more recently.

The "gripping" theory is interesting, I do wear flip flops most of the time, and I suppose they require some toe grippage. I do like my shoes, both casual and hiking/running, large and loose.

Roger- a super flat footbed like you describe is the only thing that feels comfortable right now (like Coverse, or my flops), so that may be the ticket until I can see a doc. Also, care to expand on the NB 889?

As a thick vibram soles and inserts, I did try my mountaineer boot inserts in the shoes, but it was worse. The mountaineer boots produce the same symptoms, so I'm not sure if thicker is the way to go.

Nick- I am going barefoot most of the time now, not really by choice! The only issue is that standing for long periods at work gets pretty sore in a super thin-soled shoe. I realize this is a hiking forum, and I do plan on getting some minimalist shoes for hiking/running, which just leaves work as a concern. I just hope it doesn't "come back" with a new pair of footwear like it did with the last.

Jen- Thanks for the link! I'm going to have my wife help me out when she gets home… I better make a good dinner :-P The are does feel pretty strange when I manipulate it a bit.

[Dena Kelley]

I had developed a lump, that was red and inflamed, on the top side of my left foot a couple inches up from the second to last toe. Turned out one of foot bones was out. My doctor put it back in place for me. Took two adjustments but after that it held. It was quite painful. Maybe you have something similar.

[maria nobles]

I have had foot issues a while ago and its very frustrating, so hang in there! I stand on my feet a lot at work and Dansko clogs have really done the trick. And I don't have to wear my super feet insoles with them. They are really an awesome shoe for those of us in healthcare.
Hike on….

[Roger Caffin]

Hi Ozzie

> a super flat footbed like you describe is the only thing that feels comfortable right
> now (like Coverse, or my flops), so that may be the ticket until I can see a doc.
> Also, care to expand on the NB 889?

Review coming shortly. Very nice shoe, a step up maybe. Flat!

Cheers

[Curry]

Mind you I am not a medical professional, but I was going to suggest a nueroma as well. Your symptoms match a friend of mine who was originally wrongly diagnosed with planter facitis. Later, when a lengthy period of treatment for PF didn't resolve the issue, she got a second opinion, was diagnosed with a nueroma and had surgery that resolved it.

Also, I think you are wearing your shoes for too many months and for too long a period for each time because it sounds like your pain subsides when you switched shoes. Running shoes and trail runners don't last forever. You seem to wear/use them alot over a 3 month period, which may mean you need a new pair given that much use. I would recommend having a pair for hiking and running and a differnt pair for work. You may find for work that a trail runner is too stiff or aggressive and that a diffent shoe, ie a running shoe or court shoe would be better.

Also, your current shoes may not fit properly, especially since when removing the insole, you feel better. The size you are wearing maybe too small and in length and width. Remember to size up 1/2 to 1 size when you put in an insole. Also, the longer you are in your shoes or on your feet, your feet will swell, so you need to account for that as well. Finally, you may not be in the right type of shoe. Like street shoes, trail runners come in differnt types; motion control for pronation or suponation, stability, cushioning, lightweight, etc. You need to choose the right shoe for your anatomy, foot strike, etc.

+1 to finding a podiatrist that will at least examine you gratis or for a small fee. You could always barter something to cover or offset the cost.

Good luck.

[Five Star]

I AM a medical professional, and what you have sounds like peroneus tendonitis. Google it up and see if the details of your case fit.

[Ozzy McKinney]

Susan- +1 on wearing different shoes for work than for play. I'm beginning to realize this is common sense for most people, and a new revelation for me (haha).

Peroneus Tendonitis- Man, that sounds pretty familiar. Thanks for the input. If so, all signs are pointing toward "Stay Off Your Feet". We just got back from a week long road trip, taken in place of a hiking trip with the intent of resting. I'll admit I had to wander around Yosemite for a short while, and we did at short backpack in at Point Reyes, but other than that I've done nothing but drink beer and drive (NOT in that order!) and it feels pretty good. Wore flops the whole time.

Looking forward to the NB review.

[Logan K]

To be brief, I had what you describe plus the addition of a fractured sesmoid or two. My problem was wide feet. I went from d+ to 4e over a couple of years but didn't actually get into wider shoes until my pain was real bad. The fractured sesmoid was actually from compression by my ice climbing boots. I was on the verge of several surgical options and sank $600 into custom orthotics.

Anyway, once I got into appropriately wide shoes, neuroma went away but fasciitis started. Then the neuroma pain came back.

To make a long story short, I went barefoot, and I no longer have foot problems… Of any kind.

I don't want to preach, but I really believe that there is something to be said for it. I wear soft star moccasins for work and vibrams for play.

Much lower cost and easier than orthotics, and certainly better than any surgical option.

Hope this helps,

Logan

[Dean L]

Do your feet swell? Tender and warm to the touch? Since it seems to come and go, it might be gout. It usually starts in the big toe, but not necessarily. Mine started in the ankle and migrated to the toes. A simple blood test for uric acid should tell.

Just a guess. Good Luck.

Dean

[Ozzy McKinney]

Thankfully, it doesn't look/feel like gout. Wouldn't wish that on my worst enemy… ok maybe I would, but I would have to be pretty upset :-P

Barefootin' It- I'm on the fence at this point. The information available seems widely varied, and technique for "transitioning" to barefoot seems to be a somewhat high risk (for furthering injury), very personalized process. I'm leaning that way simply because I am most comfortable and pain free in bare feet or thin flops, but I'm not sure how you barefoot it as a nurse. 12 hrs on a hard surface in minimalist footwear sounds… painful. I know this should be more geared toward hiking, but we gotta work too!

I think the idea of flat, zero-drop shoes, just with a thicker sole (which I think is what Roger is getting at) sounds like an obtainable level of compromise, if that is the right word.

[Jan S]

My father has gout and he needed to radically change his diet and loose weight. Other then that he's fine as far as I know and mostly symptom free – as long as he doesn't eat two large steaks in a row that is. If that would be it, it should manageable without long term meds – at least for him it is.

As for walking barefoot or running around in minimalist shoes: If you mostly use flip flops and shoes without heel drops you're almost there. I usually wear Merrell Trail Gloves for almost anything or no shoes at all and the hardest part in the beginning is to always land on your fore foot and hitting the floor a lot less hard. Takes about a week I'd say. If it's possible for you to change shoes during work, you can always take minimal shoes and other shoes and just switch if you start to feel uncomfortable. This assumes that you have already started to develop the muscles in your feet by wearing flip flops or other flat shoes or no shoes at all. My feet have also become considerably wider in the process, so that is something to watch out for.

EDIT: I just saw that your mom has rheumatoid arthritis. I know virtually nothing about the symptoms for that, but as far as I know there is a genetic predisposition suspected to cause this. Might that be it?

[Ozzy McKinney]

negative on the RA, at least so far, which is a relief!

[Jennifer Mitol]

All I can say is that as an orthopedic specialist, very little has come around that has been better for my practice than the barefoot running/hiking trend!

So many people think going barefoot is going to cure all their ills, and while there is a small place for it in a small group of people, for so many others it just brings on a whole new set of problems. The theory is nice, that thousands of years ago humans didn't wear shoes and we could run all day and bring down a cheetah; and tribes in Mexico can run 100 miles in sandals and never have an injury. Well that's great, except for the fact that nearly all of us started wearing little white leather shoes when we were 13 months old and have been wearing something ever since. You learned to walk in shoes, you wore them to school, to work…the whole time your feet were developing and your muscles and neurons were coming up with the pattern that would keep you upright when you walked and ran and jumped and stepped on uneven surfaces…

So THAT person is not at all the same as the tribesman who runs down a cheetah…who has never worn shoes in his life.

All I can say is keep running and hiking in bare feet, and the small group of you who are truly helped by it keep telling your friends…then give them my business card and have them take out more insurance.

[Anonymous]

discovered so far is approximately 7,000 years old. It was discovered in a cave in Armenia. They've been around for a long time now. I wonder why…….?

[Ozzy McKinney]

So you are saying I might be able to run down a cheetah?

Sold.

What do I do when I catch it?

[Author]

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