Several years ago, I began feeling a mild numbness in the ball of my left foot, especially while running. I noticed it came on stronger when I ran on a hard flat surface, such as a road or sidewalk, and less so when running on trails or grass. Upon becoming aware of this, I did what any serious runner would do: I ignored it.
In the weeks that followed, the numbness evolved into a mild shooting pain. So I ignored that, too. My only excuse is that I was stuck in a mindset of thinking that the more I ran, the stronger my feet would become and I just had to tough it out until my muscles recovered and the pain went away. After all, I had recently completed a running workshop taught by none other than Correct Toes inventor and podiatrist guru Dr. Ray McClanahan. I now knew how to run with a proper gait that would reduce impact load, so on some level I probably believed I was impervious to injury. This numbness would surely go away as long as I kept doing everything right with my running form... except that didn't happen. As you can probably guess, the pain ended up getting worse. Much worse.
My denial came to a shattering end when I was out on a brief run and the pain became so bad that I literally limped home, mostly hopping on one foot. I also began feeling the pain while just walking, especially on hard flat floors. Every time I put weight on the ball of my left foot a sharp pain would shoot upward as though the ground was electrifying the nerves just below my toes. If you ever had a toothache when a glass of cold water hits a nerve in a sensitive tooth and the pain shoots through your whole head, it was kind of like that in my foot. I finally had to face the fact that I had a bona fide injury and it wasn't going away on its own.
I accepted the fate that I would need to book a doctor's appointment, but in the meantime decided to do a little research on Dr. McClanahan's website. His site lists a variety of articles about different foot ailments as well as tips on how to treat them naturally. A description of capsulitis brushed upon my symptoms since it describes pain centralized in the ball of the foot, but my pain felt different. Capsulitis is inflammation of a joint that leads to the feeling of stepping on a small pebble, and it is often accompanied by swelling or redness. As described above, my pain began with numbness and quickly became sharp and electrifying, and there was no swelling or redness involved. I was about to give up when I stumbled upon a word I had heard many times before, but never really understood: neuroma.
What is a Neuroma?
Simply put, a neuroma is a painful enlargement of a nerve. In feet, this happens most often in the nerves between the bones of toes in the metatarsal region (ball of the foot).
A neuroma, or enlarged nerve located between metatarsal bones in a foot.Neuromas can be created when a metatarsal nerve is deprived of bloodflow after a foot is pinched or compressed for an extended period. Or they can be the result of a nerve that experiences prolonged friction from either unnatural foot compression or a malformed metatarsal pad.
So what causes neuromas? As you can probably guess, shoes with tight, tapered toe boxes are considered to be a main culprit. When shoes push the toes and ball of the foot close together they create that compression around the affected nerve. In addition, shoes that feature toe springs (a shape that forces toes to point upwards) and raised heels can also exasperate the situation. We're not talking about just women's heels, but any shoe that has an elevated heel, and that includes men's conventional running shoes and dress shoes.
As explained by Dr. McClanahan in the video below, when both the toes and heel of a foot are elevated, the ball of the foot, which contains a natural metatarsal pad, is pushed outward and that metatarsal pad moves forward. When this happens, that natural padding no longer protects the metatarsal nerves upon impact while walking or running. This results in excessive pressure and friction hitting the nerve with every step, which very much sounds like the electrifying feeling I experienced.
It is worth pointing out that neuromas can also lead to a feeling of stepping on a small pebble, or feeling like a sock is wrinkled under the ball of your foot when nothing is actually there. This overlaps with the symptoms of capsulitis, but it was not something I experienced myself. Other people may feel a burning sensation from their neuroma.
If you have ever heard the term Morton's Neuroma, that is a neuroma specifically located between the 3rd and 4th toes. Neuromas can, however, occur between other metatarsal bones in the foot. I can only assume some guy named Morton really liked dealing with them in that one location.
Treating Neuromas Naturally
There are two trains of thought for treating neuromas: a traditional conventional approach and a natural conservative approach.
Traditional conventional treatment of neuromas uses injections of cortisone or alcohol to reduce the swelling in the nerve, but these do not change the conditions that caused it to enlarge in the first place and do not prevent it from happening again. Orthotics may also be prescribed to ease the pain, but do not actually treat the neuroma. In extreme cases, surgery can be used to remove a portion of the nerve, and this often results in permanently limiting function of the foot. These were all options I wanted to avoid.
Instead, I consulted with one of Dr. McClanahan's associated physicians who practices natural conservative care. She confirmed that my pain very likely resulted from a neuroma, but also had some good news: there were simple, non-invasive treatment options I could do on my own. These natural treatments could not only relieve the pain, but also reduce the swelling of the neuroma and prevent it from returning.
These are the steps she recommended:
- Wear shoes with wide toe boxes and flat soles
- Wear toe spacers, such as Correct Toes
- Apply metatarsal pads to the insoles of my shoes
It turns out that many cases of neuromas can be resolved by following these three simple steps, so let's take a look at them.
1. Wide Toe Boxes and Flat Heels
I already have a closet full of Softstar's ultra-minimalist shoes and wear the Primal line almost exclusively, so I was already one step ahead of this one (pun intended). Dr. McClanahan himself helped us test the first prototypes of our Primal sole shape when it was in development. The shoe reviewers on his website have called it "the widest toe box on the market." Take that as you may, we consider it a compliment.
It should go without saying that a wide toe box is necessary to prevent compression of the toes and the ball of the foot. If you place your foot on top of a shoe (or, if you can remove the insole, step on that) then your toes should fit entirely within it. If your toes flow over the edge then that toe box is too tight.
Tapered toe box (left) compared to a wide toe box (right).All my shoes also have flat zero-drop soles, which means the soles are the same thickness from the heel to the toe. So I can safely check those features off my list, too. When I say "flat zero-drop soles" I'm lumping two issues together. Shoes to be avoided are those that have (1) thick, elevated heels and (2) toe springs, or a shape that forces toes to point upwards at all times.
A shoe with elevated heel and toe spring (left) compared to a shoe with a flat, zero-drop sole (right).For more information about shoe qualities that help restore natural foot function, which are found in all Softstar shoe designs, check out this guide:
Minimalist Footwear 101If you are interested in our Primal shoes with extra wide toe boxes then these are the shoes currently available in that line, with more currently in development. It is worth noting that not everyone needs this much space for their toes. Other non-Primal Softstar shoe styles are narrower than these, but still offer wider toe boxes than most conventional shoes.
2. Toe Spacers/Correct Toes
Toe spacers, as the name implies, are simple accessories that slide onto your toes to keep them spaced apart. It is recommended to wear them gradually at first and slowly build up to regular usage.
At Softstar we often use the term "toe spacers" and the brand name "Correct Toes" synonymously, and for good reason. While there are other brands of toe spacers on the market, Correct Toes are by far our favorite. Developed and worn by Dr. McClanahan himself, their design is based on scientific research with a long list of case studies to back it up. Not only are Correct Toes flexible enough to be worn in shoes during intense activity, including running, but they are also adjustable through trimming or adding shims. This means they easily accommodate feet of all shapes and sizes. Many of the cheaper knockoff brands of toe spacers we see emerging on the market are not designed by doctors, lack evidence of effectiveness, are too clunky or inflexible to be worn comfortably while moving around and cannot be modified to fit unique feet.
Learn More About Correct ToesI was no stranger to Correct Toes. For many years I had encouraged people to wear them after hearing so many testimonials from both our customers and Dr. McClanahan's patients. I never thought I would have a need for them myself because I was gifted with naturally-shaped feet that were already widest at the toes. Seriously, I'm actually the foot model when Softstar needs a photo of healthy feet. That's literally my foot on the left:
Regardless, I was more than happy to try them out, especially if there was any chance they could save me a hefty medical bill down the road. The idea behind this treatment is simple: before discovering minimalist shoes I wore conventional shoes with tapered toe boxes for over 30 years, which compressed the nerves in the ball of my foot. Despite my naturally wide toe splay, those nerves experienced friction that left them enlarged. Correct Toes would then gradually reverse the damage and alleviate stress on the nerve by slowly stretching my metatarsal bones back to their natural positions.
3. Metatarsal Pads
Not to be confused with the biological metatarsal padding in the ball of your foot, these metatarsal pads are thin foam pads with adhesive backings that can be applied to the insoles of shoes.
If decades of wearing cushioned heels and toe springs had caused the natural cushioning below my metatarsal arch to push forward, then foam metatarsal pads correctly placed in my shoes should gradually pull it back to its natural position. This would, in theory, allow the natural cushioning in my foot to once again protect my enlarged nerve from the excessive pressure it felt with every step I took. Like Correct Toes, it would also help restore the natural shape of my foot.
A word of caution for anyone using metatarsal pads: it is important to make sure they are placed correctly in the insoles of your shoes for them to be effective. If they are too far forward or too far back then they will not provide the beneficial outcome. It just so happens that Dr. McClanahan also has a video about proper use of metatarsal pads:
Our website also provides more helpful tips for finding the correct placement for metatarsal pads, even in shoes that do not have removable insoles:
More About Metatarsal PadsSo How Did It Work Out?
I'll admit I was a little skeptical that I would see a significant change since I was already wearing the recommended shoes and my feet already had a natural shape. Nonetheless, I gave it a shot and acquired my first pair of Correct Toes and metatarsal pads. After getting everything positioned correctly, I went out on a short walk/run around the block to try it out. I found myself wondering how many days or even weeks it would be until I noticed a difference, if any.
It turns out I didn't have to wait very long at all because the difference was IMMEDIATE. My pain was gone. Completely and instantaneously gone with the first steps. Not even a trace of it was left. My short run around the block turned into a couple miles, and I only stopped then because I decided it was best to heed the instructions from Correct Toes about taking time to gradually adjust to wearing them.
I can't promise that other people with neuromas will experience such an instant success. As Dr. McClanahan mentions in the video above, treating neuromas by these methods can be a slow and gradual process and it could take weeks to see results. This is especially true for people who have had neuromas for many years. Despite ignoring my neuroma for as long as I did, I was fortunate to deal with it within a few months of its appearance.
Now, several years later, I rarely feel the pain even when I don't wear Correct Toes or metatarsal pads. It will return if I spend a lot of time running on pavement without the toe spacers or pads, but I have learned with experience what I need to do to avoid reaching that point. At first, I wore Correct Toes every single day because if I walked down a sidewalk without them then the pain returned immediately. After a few months, however, I noticed I could go several days or even weeks before feeling the pain. Now I wear them only when running or hiking, and that's enough to keep the pain away the rest of the time.
If you think you are suffering from a neuroma then I strongly encourage you to consider these gentle treatments before undergoing any invasive medical procedures, but please also keep this disclaimer in mind:
I am not a doctor and I cannot prescribe any medical advice. I can only share my story and hope others will benefit from it, but nothing I say is meant to replace advice from a medical professional. If you do seek out a professional opinion for foot pain, which is recommended, then I encourage you to look for a doctor or podiatrist who practices natural conservative treatment instead of resorting directly to injections, orthotics or surgery.Trouble finding a podiatrist in your area who practices natural conservative care? You may benefit from a remote consultation with Northwest Foot and Ankle.