Nerve pain - bottom of foot

[Breeden850]

I focus mainly on xc marathon, and ride gravel when the trails are wet. I come from MX and have only been racing MTB for two full seasons. I have been battling foot (nerve) pain in the bottom of my foot for a little over a year after beginning structured training. I have been able to manage the issue with stretching and time off the bike when it gets bad.

This winter I was determined to commit to a TR plan and hopefully start 2020 season much stronger. After only a couple weeks of SSB LV my foot flared up real bad so I decided to take some time off. After taking a month off the bike and symptoms not really going away I went to a family doctor. She had no explanation for my symptoms so she sent me to a physical therapist. The PT was fairly confused as well after ruling out Morton’s neuroma and (kind of) plantar fasciitis.

Symptoms: It starts as a warm/burning sensation right behind my smaller toes on my left foot. This usually begins about 20-50 miles in to a ride or an hour into a hard trainer ride. The burning will start radiating throughout my foot and intensifying slowly and eventually almost brings me to tears. (Mostly angry tears.) These symptoms are a broad description due to them being very inconsistent.

Things that help: rest, stretching the calf, massaging the bottom of my foot (by hand or lacrosse ball), icing/massaging calf

The only gains I’ve made so far are that I have an extremely tight left calf. My PT discovered some severe knots in my calf along with some bruising. He tried “dry needling” to relieve the knots on my calf. This gave me instant relief. I did Baxter on the trainer the same night as a test (per his recommendation) and it felt amazing. After that I started over SSB1 LV and went almost 4 weeks with no issues. I continued to do all I could to make sure my calf didn’t tighten up again. (Foam rolling, stretching, trigger point therapy on calf and foot, ice, heat, wearing a plantar facilities brace to bed). At about the 4 week mark the same symptoms came back.

Now I am back to where I started, taking more time off the bike. I’m getting very frustrated because I desperately want to get strong before the season starts and I feel like all the gains I make end up going right down the drain. Does anyone have any new info or advice? I am going to try moving my cleats but I have low hope that it will help.

[scottmarlowe]

Well, I was going to suggest Morton’s neuroma but I see you had that ruled out.

Still, have you seen a podiatrist? What you’re describing sounds a lot like a Morton’s neuroma. I only say that because that’s what I had about 4-5 years ago. It got so painful that I had to walk off the trail a couple of times rather than even ride back to my truck. It finally took surgery to fix it.

[Alaric83]

When I first started cycling I was using SPD’s on the road and eventually started getting nerve / hot foot type pain. Went away entirely when I switched to road pedals.

If you’re not already you may want to try road cleats for the indoor rides.

[Mark_Rebuck]

I second the “get a second opinion on Morton’s Neuroma” advice. I’m lucky that mine is controllable with metatarsal pads and wide toebox shoes. But my podiatrist warned me that it will likely get worse over time, and eventually we’ll have to do something about it. (That was 17 years ago, so… I got lucky that the metatarsal pads and shoe choice are still keeping it at bay)

[Breeden850]

I have not, and the reason is because I have heard/read that all they want to do is sell you insoles and they rarely work. I see insoles as more of a crutch that a fix. BUT, I have been thinking a lot lately about trying one just to see what they say. I have also been recommended to see a chiropractor which I might try first.

[Breeden850]

Im currently running egg beaters and I have tried the wider crank brothers pedals with more of a base (can’t recall the name) but they didn’t seem to help. I also put the plastic spacers on my egg beaters for more support. This does sound like something I should and will try though. Thanks.

[robbo1234biking]

I had a similar experience to @Alaric83 and swapping to road pedals and shoes seems to have alleviated the issue. I would def give it a go. I also use an insole which seems to help.

[scottmarlowe]

Mine might have suggested insoles initially but I’d already tried that on my own so we skipped that step.

The first thing we tried was draining the fluid between my toe bones with a needle. That was about as much fun as it sounds. We tried that twice but both times only provided temporary relief.

The final solution was surgery where the doctor removed the nerve that had built up a hard casing around it from between my toe bones. There was a risk of losing some feeling permanently but that wound up not being an issue for me. There was about a 4 week recovery period where my foot was too bruised/tender to do anything other than walk, but once past that it was such a huge relief to get back on the bike with no pain.

[Alaric83]

Stiffer shoes may help also (which if you try road pedals you’ll probably get by default).

[mellowdave]

I know everyone already said it, but I dealt with the exact same symptoms and mine was indeed Morton’s Neuroma. I didnt need surgery, but I am still having some lingering effects, though nothing so severe as to take me back of the bike. Mine developed post hip surgery, during my Physical Therapy period, gate changes, different weight distro, etc.

[coke]

Try loosening your shoes. You can keep the part around the top of the shoe tight, but loosen everything toward the end and ball of your foot. I used to get severe pain in my feet until I discovered this. I’ve also found that on long rides my feet can swell a little, and I’ll sometimes need to slightly loosen my shoes even more.

Stiff shoes also help.

[Breeden850]

Thanks everyone for your insight. I really appreciate it. After reading your comments I decided to go ahead and make an appointment with a podiatrist for next week. It can’t hurt to get a second opinion from an “expert.”

[Breeden850]

Question for those who have been diagnosed with Morton’s neuroma… Did any of you have knots/tenderness in your calf?

[mellowdave]

I absolutely did and do. I think its related to stiffening of the foot to avoid the pain, not directly to the neuroma itself. I do yoga every single day, and it makes all the difference with those random stiff muscles, and such, but if for some reason I miss a few sessions and I spend time on my feet, I will inevitably have a stiff calf at least on the left leg, which is where I have the issue.

[Breeden850]

I read something today that said knots in your calf can cause MN like symptoms. Was tossing around the idea that my calf issue could be caused by something completely different which is causing the foot issues. I just need to give up and let the doc figure it out

[scottmarlowe]

I did not. Just extreme pain in my foot, like someone was stabbing it with a knife.

[chiefhiawatha]

I had a chronically tight calf muscle on one leg and while visiting a running store for some gels, tried a theragun on the calf. I walked out of there after using it and thought wow this feels pretty great.

Couldn’t justify the price of the actual theragun on a whim so I bought this:

Massage Gun Muscle Massager Deep… https://www.amazon.com/dp/B07TWFK7JW?ref=ppx_pop_mob_ap_share

Few minutes here and there with it has really made quite a difference. And it feels good on quads and glutes too.

[bitpuddle]

Just because you didn’t mention it, having a very good fitter take a look at both your position relative to the BB and your shoe/cleat position might be worth the money. If both doctors rule out nerve issues, taking a closer look at physiology might uncover something.

I experienced a fairly drastic before/after when I got insoles that supported my feet properly.

[seth.frankel]

I’ll add another voice for the need for a second opinion on the neuroma. Either a foot specialist ortho surgeon and/or an excellent podiatrist should look at this. No disrespect to the PT, heck, I’m married to one, but the inner workings of the foot is not in every PT’s expertise.

I suffered with a Morton’s neuroma for years and had it surgically removed many years ago. I found that no number of custom foot beds and cortisone injections had real benefits. My surgery was through top of foot and I was on crutches for more than a month. No fun, but life has benefitted for two decades since then. Best medical, life changing decision I‘Ve ever made.

[Breeden850]

Update!

I went to a podiatrist at the end of January. He took x-rays and diagnosed me with flat feet and pes planovalgus deformity. I asked about MN and he said the symptoms can be similar, but he doesn’t believe I have it.

He made me a pair of custom molded arch support inserts and they have helped a lot. It’s obviously going to take time to get to 100% but I have continued my TR plan and have had very minimal pain.