Ball of foot pain, top of foot pain, swelling, numbness, extreme cold sensation in foot

by Travis
(Calhoun, Ga)

I am a triathlete, so I run and ride bikes a lot. Not so much in the past few months. I used to have a problem with chronic achilies tendonitis that lasted about 18 years. Fixed problem with silicone heel cups. I finally was able to run. 6 months later after logging 20-30 miles a week running and 100 plus miles a week biking. I started having pain in the ball of foot area on both feet. It started out under the third metatarsal. Within two moths the pain spread medial and lateral to encompase 2-5 metatarsal area. No symptoms at all under first metatarsal. While running pain gets worse, then toes go numb except big toe no problems with that one. On to the biking, my bike shoes like most others, have a hard carbon fiber plate on the bottom so not flexible at all. While biking pain starts out the same as in the foot under the third metatarsal area and radiates outward. However, during biking my toes don't go numb there is an extreme pain in all toes. The pain in the toes would be similar to being hit in that area with a hammer. Now there's pain across entire top of foot, and the foot is swelling. This last part has been ongoing for about two months now. My foot goes either real numb or extremely cold. I have tried various foot inserts and have rested a lot. I only run once a week now approximately 6 miles if I can take the pain that long. I haven't biked in over 3 months. It hurts just to walk on them, and the problem is consistantly getting worse. I have taken up to 6 weeks off with no running or biking and it's still getting worse. No discoloration.

RESPONSE

Hi Travis,

It seems that you have two issues going on here. The original problem in the ball of the foot and a new second problem in which the whole foot gets numb and cold.
I am concerned about the second problem more so than the first because in a worse case scenario it could be a more dangerous problems.
Obviously, I do not have the luxury of examining you, but the cold and numbness in the foot may be a sign of compartment syndrome, which in its simplest terms means that the muscles in the lower leg are swelling so much from exercise that they are cutting off the circulation to your foot/feet. As you can imagine, that is not a good thing.
Compartment syndrome is a potentially dangerous condition and for that reason I would suggest you seek medical attention before exercising again in order to have that ruled out. There are lesser conditions that might mimic those symptoms, but you absolutely need to make sure that you do not have compartment syndrome.
As far as the numbness in the forefoot and toes, that sounds like a Morton's neuroma. Because all your toes with the exception of the great toe are going numb, my "guess" is that you may have multiple neuromas.
Certainly running as well as wearing narrow bike shoes could bring about the formation of neuromas which are essentially entrapped nerves in between the metatarsal heads that enlarge from the friction of exercise, to produce the type of pain that you are experiencing.
Fortunately, the neuromas only seem to bother you while exercising because many people will have the pain regardless of exercise or not.
This too has to be confirmed by a doctor. The only thing you could try on your own would be a slightly larger bike shoe for cycling. As far as running, you could try an arch support with a metatarsal pad built into it in an effort to "spread" the metatarsal bones to take pressure off the nerve. This is not my first treatment for neuroma, but it is something you could try on your own.
In any event, please see a doctor in order to rule out compartment syndrome as your symptoms do concern me.

see related article....compartment syndrome

see related article....Morton's neuroma


Marc Mitnick DPM
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