MORTON'S NEUROMA
Q: I am interested in trying your technique. I have been bothered by neuromas in my feet . Does your technique work if you have neuromas? It appears that your technique would put more pressure on the forefoot?
Thanks for your help.
John
A: A neuroma is a swelling of a part of a nerve caused when the nerve gets pinched. In the foot it is called a Morton's neuroma, an interdigital neuroma, or a plantar neuroma. It usually affects the nerve between the third and fourth toes or, less often, the second and third toes. The swelling, or neuroma, occurs where the two branches of the nerve intersect, which makes them thicker and more likely to be pinched between the bones of the foot (1).
Morton's neuroma, a common neuritis, is classically characterized by localized pain between the third and fourth metatarsal heads that often radiates into the third and fourth toes. The medial and lateral plantar nerves converge between the third and fourth toes where the junction becomes enlarged. Tight shoes compress the metatarsal heads against the nerve, producing a painful neuroma. The plantar nerves and other interspaces of the foot may also be involved (2).
These are two different descriptions of the same injury - Morton's neuroma. As we see, the cause is the nerve being pinched between metatarsals bones.
In addition to it, Michael Kent (3), for example, considers that, this "condition is accentuated in athletes who spin on the ball of the foot (e.g., golfers, bowlers, and tennis players)". Spinning on the ball of the foot certainly could be one of the reasons of this injury incidence, but in running, from my point of view, there exists another one. It's possible that it's related with landing on the rigid supinated foot in front of the body, when the body weight applies to the side of the foot. If the foot muscles are not well developed to accept the body weight loading, then the foot will be very likely squeezed and as a consequence the bones will pinch the nerve.
It's not a very common injury, and not a pleasant one, either. When it is located in such a place as a forefoot, then it is inevitably very difficult to avoid its involvement in any movement of the body. In running it's the reason of reducing training or dropping it completely, with a small chance of coming back without some serious treatment, including surgery.
The treatment usually consists of reducing running, using inserts in shoes, changing the shoe size (to wider ones), medical treatment and surgery as the last resource.
All of this is related to outside intervention, while the most effective way of treatment and prevention is based on changes, which are supposed to happen inside the movement of the body.
Do not get scared by getting this pain and do not get frustrated by the necessity to reduce the mileage of running. Get focused on your problem and do everything to avoid reoccurrence of any possible cause of this problem. In the Pose Method the pressure is shifted from the lateral side of the foot to the medial, where there are bigger bones and bigger muscles to support the body weight, plus it doesn't stay too long at this place, either, because the body is falling forward.
So,
at first, I think, you need to change the way you place your foot on the ground relatively to the body, so that the body weight do not overload this part of the foot. The foot should be as much as possible under the body (hips) while landing on the ground and the foot muscles should be relaxed, even if it doesn't look comfortable for you. This will make it impossible for you to land on the lateral side of the foot, but only on the ball of the foot.
Second, you need to strengthen the foot muscles by using different exercises. It could be simple hopping in place with the jumping rope (barefoot, on the wooden floor), running barefoot, jumps on the grass, and the sand.
You can also do local strength exercises for the foot with a rubber band, free weights, your partner's resistance, which will help to reduce muscle tension.
Using the
Pose Method running drills is very helpful because those are the exercises where the
foot placement is defined very precisely.
Keep running as much as your pain allows you. Try to keep your foot relaxed in running and do not push off.
Maintain high cadence and short time of support at any (slow or fast) running.
Third, it is useful to take a massage for the foot and have hot bath with sea salt, which also helps to reduce swelling and inflammation.
Changing the shoe size is OK, if they are really narrow for your feet, of course.
Dr. Romanov
- Micheli Lyle J. with Mark Jenkins "The Sports Medicine Bible", Harper Perinnial, 1995, p.79.
- Athletic Training and Sport Medicine. American Academy of Orthopaedic Surgeons, 1991, p.437.
- Kent M. The Oxford Dictionary of Sports Science and Medicine, Oxford University Press, 1996, p. 283
