“Achilles heel”: an expression meaning “a weak or vulnerable spot.” Physically speaking, almost everyone has one. Most people are consciously aware of their own weak link and seek out advice on how to manage it. While any area of the body is susceptible, my “Achilles heel” has always been my feet. As I picked up running in high school, I developed burning and stinging pains that radiated from my metatarsals into my toes on my right foot. The local podiatrist diagnosed Morton’s Neuroma, a fairly common condition in which the nerve that runs between the third and fourth metatarsals becomes pinched and inflamed. Little did I know of the treacherous journey that was about to unfold.

The doctor recommended I stop running and put an over-the-counter orthotic into my shoe. That helped, so then he molded custom orthotics to my feet. They were clunky and stiff, but they seemed to reduce the pain. After a few months, though, the discomfort returned whilst running and playing in my orthotics. Another visit to the podiatrist ended with a cortisone injection in between my third and fourth metatarsals. That injection did nothing, and a series of following injections made the condition worse. By this point, I was rarely going barefoot, and spent most of my time in my stiff orthotics. This sufficed as long as the activity wasn’t too vigorous, which meant little running, jumping, or high-impact activity.

I was frustrated that I could not play the sports I used to love growing up, so I asked what the next step in the treatment plan was. My podiatrist gave me two options. The first was to live with the pain. The second was a simple surgery (in the words of my podiatrist). He would make a small incision on the top of my foot, then cut and remove the pinched nerve from in between my metatarsals. It would leave a small area of my skin without feeling, but I would be pain free. The surgery would entail spending three weeks off my feet, and three weeks easing back into normal activity.

At the promise that I could be pain free and fully functional in six weeks, I picked the second option. I underwent surgery in May of 2011 and began a painful recovery. The burning, stinging, shooting pain I had experienced was now exponentially worse. Instead of radiating down into my toes, it was radiating up my leg. I could feel the exact spot where the nerve was severed; it felt like a large knot inside my foot. The shooting pain would go into the arch of my foot, through the heel and ankle, up behind my knee, and sometimes even radiate into my hamstrings and glutes on the right leg. Any movement that stretched the posterior tissue set off that reaction. Medical professionals were perplexed by this, as sensations normally radiate distally, not proximally.

My podiatrist was not concerned about these pains, stating it was just my body healing post-surgery. He recommended that I start moving as much as tolerable to start getting back to my normal self. Now that I was able to bear weight on my foot, the pain intensified. He then recommended putting my orthotics back into my shoes. One of the main reasons I opted for surgery was to be free of those rigid orthotics, so it was irritating to be back into them. After the orthotics provided little relief, he was out of ideas and told me to give it time.

I gave it time, and I healed to the point where I could walk intermediate distances in the orthotics, but I was worse off than before the surgery. Any type of running and jumping was excruciating, and walking more than a mile began to wear on me. I never went barefoot, even around the house or in the shower; I always needed cushioning for the bottom of my foot.

Frustrated, I moved on to a different podiatrist. He prescribed a different brand of orthotics, which immediately made the issue worse. He also had me soak my feet in contrast baths, which was painless but not helpful. I had learned about injections which involved putting an alcohol solution into the nerve to kill the tissue, thus eliminating the pain. This podiatrist knew about the treatment and was willing to try it. Every ten days I would have a needle inserted into my severed nerve in hopes of killing the cells. It was all to no avail. Six injections provided no relief, so I was passed along to perform four weeks of physical therapy. My therapist tried a variety of modalities to decrease my pain, and she ultimately thought scar tissue was causing my problems. We agreed to have the podiatrist numb my foot with a few injections, and the therapist performed deep tissue work with a plastic tool to break up the scar tissue. The foot stayed numb until after I fell asleep that night. I woke the next morning to throbbing, radiating pain. This was the turning point where I went from being in chronic pain but functional, to being handicapped. I could hardly limp 50 yards before I had to stop, take weight off my foot, and wait for the excruciating sensations to subside before trying another terrible 50 yards.

Another trip to the podiatrist provided me with two options: I could either live with the pain or undergo another surgery (sound familiar?). I had fallen into such a depression from my physical problems and social isolation that I was having serious and frequent thoughts about suicide. Living with the pain was not going to be an option. I knew that I had to get another surgery, but I was skeptical of letting a podiatrist perform it again.

I researched and found an orthopedist that specialized in the foot and ankle. He concluded that surgery was necessary to address the problem, and he warned me to never let a podiatrist perform surgery. This was humorous because my podiatrist told me to never let an orthopedist perform foot surgery. I chose the orthopedist based on his words: “No surgery is ever simple and easy. Any time we cut into someone, it’s a big deal. Don’t let anyone tell you differently.”

I underwent another surgery in February of 2012, nine months after the first. When the orthopedist opened the bottom of my foot, he found the cut nerve directly under my fourth metatarsal. The nerve should have been tucked into soft tissue in the arch of my foot, not left to sit under one of my metatarsal heads. The second surgery entailed three weeks off my feet using crutches, and another five weeks getting back into activity. I had low-level laser therapy performed on the surgical site to assist the healing process. This recovery was immediately different and more pleasant than the first. The shooting pain up my leg was gone, and I was able to bear my own weight after several weeks.

Unfortunately, the story is not over. For the previous nine months I had heavily favored my left foot, which was now beginning to hurt exactly like my right one had – in between the third and fourth metatarsals. As I was able to do more on my feet, it was the left foot which began to be the weak link. This was devastating, and I continued in my depression. I had been through hell, and I was still stuck after years of pain. In my right foot I have had over 20 injections and two surgeries under anesthesia; I did not want to go down that same road with my left.

This got me doing vigorous research on foot health and what could be done, conservatively speaking, to manage the pain. I could not take back any of the decisions I had made regarding surgery, but I knew there had to be a better way to treat my feet. I observed that on both of my feet, my fourth metatarsal bones sat lower than the other bones, leading to increased pressure on that joint. I inferred that the dropped metatarsals could be creating a shearing force on the nerve, causing the burning and tingling sensations. I learned that this dropped metatarsal was probably caused by wearing shoes all my life. Shoes wear out in the middle quicker than around the edges, causing my feet to bow down for years, leading to a change in anatomy. Also, almost all shoes pinch the toes together, aggravating the nerves already under tension. Finally, most shoes have a raised heel which places more pressure on the metatarsals than on the heel. I have come to believe that these three components were the true cause of my problems. Shoes, arguably designed to protect one’s feet, deformed mine and caused atrophy and dysfunction. Do not be fooled into thinking only high heels are the “bad” type of shoes, either. Most pairs of shoes in your closet could be directly correlated to any type of foot dysfunction you may experience. None of my doctors ever said a thing about the detrimental role shoes played in the development of foot problems.

Through my research and experimentation, my feet are pain free in the metatarsal area today. I avoided the same fiasco in my left foot through the following methods:

First, toe socks help create space in between the toes and help align the toes into a straighter position. My favorite brand is Injinji. Regular socks compress the feet slightly, which could aggravate pinched nerves.

Second, I wear Correct Toes. Correct Toes are silicone toe spacers that can be worn inside of shoes (proper shoes) to align the foot in its anatomically correct position – in which the foot is widest at the ends of the toes, not at the ball of the foot. Correct Toes are simply amazing. A podiatrist named Ray McClanahan invented Correct Toes. His website, www.nwfootankle.com, is the most helpful resource for foot health online.

Third, I learned from Dr. McClanahan’s website about metatarsal pads. These are small, teardrop-shaped foam pads that are placed inside shoes to keep the metatarsal heads in their proper place. They lift and separate the bones to recreate a natural arch.

Finally, the shoe itself is important. Shoes should be widest at the ends of the toes, flat from heel to toe, and flexible. Avoid shoes with narrow toe boxes, raised heels, toe spring, and those that are very stiff. Altra and Lems are my two favorite shoe companies. Altras are fully cushioned, whereas Lems are minimal.

Another principle I learned from Dr. McClanahan’s website was the idea that “you were born with perfect feet.” The traditional podiatric view says our feet are defective and need orthotic arch support to function. McClanahan, however, teaches that strengthening your bare feet through specific exercises and walking barefoot helps restore natural foot health and function. I began taking barefoot walks through the forest two to three times per week to let my feet function in their natural state and build strength, fat pads, and calluses. I have to be careful during my barefoot walks as my feet are still vulnerable, but these walks are invaluable in helping with my foot health.

I was misinformed by my podiatrists. I was told on two occasions that I only had two miserable options – live with pain or undergo invasive surgery. This was wrong, and I learned the valuable lessons that even doctors are human and that there are still many mysteries within modern medicine.

Learning and implementing Dr. McClanahan’s methods for healthy feet have helped me regain my function and health. I go barefoot around my house without fear of pain. I take long walks in my Altras on a regular basis – some days I only go out for an hour, but on weekends I sometimes take day hikes in excess of 10 miles. I can run and jump if I need to, though I have not taken up distance running again.

Morton’s Neuroma & Metatarsalgia conservative treatment plan review:

  1. Wear toe socks
  2. Wear Correct Toes
  3. Wear shoes that are:
    1. Widest at the toes
    2. Flat from heel to toe
    3. Flexible
  4. Place metatarsal pads inside proper shoes
  5. Walk barefoot as much as tolerable, and perform foot strengthening exercises regularly

 

I share this information so that you can be empowered to seek out the conservative methods that will help correct your metatarsal pain. If you are someone with a different Achilles heel, use the ideas from this essay to explore the options for your particular condition. Do not believe someone when they say that you have to live with your pain. Sometimes surgery may be necessary, but seek out varied opinions and do your own research. I blindly followed the advice of my doctors because I believed they knew what was best for me. No one knows what is best for you except you, so take control of your own healthcare decisions and be well-informed on your personal abilities and limitations.