Neuritis of the foot
Are you experiencing unusual sensations in your feet such as pins and needles, numbness, a burning pain or the sensation of a rock inside your shoe? If so, there is a good chance that you have a developed a case of neuritis.
What is neuritis of the foot?
Neuritis of the forefoot is where the nerves between the long bones (the metatarsals) become irritated from increased pressure. The symptoms tend to start later in the run and may go as soon as you take your shoes off.
Causes of neuritis
The most common cause of neuritis of the Forefoot is from shoes that are too tight. This could be from across the width of the shoe, the length and even the depth of the shoe. As the foot exercises for a longer period of time normal swelling will occur due to increased blood flow. If the shoe does not have enough space to accommodate the enlarged foot, the nerves become entrapped and cause pain.
If the foot is quite flexible the small arch that goes across the foot (the transverse arch) from the 1st joint to the 5th flattens to create increased splaying of the toes. This can be harder to identify as it is not until the foot is fully loaded with running or walking that this splaying becomes visible. Repetitive loading of the transverse arch with the long runs of marathon training can contribute to neuritis. This may not present until the very late stages of a long run or even in the marathon itself.
Fitting shoes to prevent the pain
Ensuring you have the correct fit with room for the foot to expand should prevent these symptoms from occurring. Most shoes are shaped to have a tapered and slightly rounded toe box, but if a foot is not this shape then it is going to be put under pressure in areas that it is not used to. Typical variations in foot shape that can lead to neuritis include wide or square shaped feet, bunions, long second toes, high arches, and very flexible feet. More care is required when fitting a shoe to these foot types and luckily there now is a good range of shoe shape designs and widths to accommodate them.
For bunions, many shoes now are seamless across from the big toe joint to the 5th toe joint. Some shoes have offset the lacing path to alter the line of tension while deeper toe box designs have become a more traditional to allow for more toe room. For the high arched foot, a shoe with increased depth through the laced area is important.
Modifying the shoes to suit
When a perfect fit can not be found or a shoe has been worn for a while and can’t be returned, there are ways to modify the shoe. Re-lacing is an easy way to take pressure off different parts of the foot. Stitches around features attached to the uppers can be unpicked. Metatarsal domes are commonly used by podiatrists to prevent flattening of the transverse arch. For more complicated cases where the biomechanics of the runner are contributing to the injury, insoles or orthotics become useful to fill help fine tune the fit of the shoe and adjust movement patterns.
Neuritis of the foot can be a very unpleasant sensation, but in most cases, remedied relatively easily. The first step is to ensure your footwear is the correct fit. If this does not resolve the pain, book in to see one of the podiatrists at intraining Running Injury Clinic for more thorough investigation and management plan.
Keen to learn more about running injuries and training articles? Check out our monthly ‘From the Sole‘ newsletter, written by intraining Running Injury Clinic podiatrists, physiotherapist, dietitian and experienced running coaches.