Foot numbness with Running

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Hi All,

Please help. I have been working with a fellow who develops foot numbness with running after about 2miles. This is bilateral in nature. He does not have any vascular issues. This has been going on for about 10 years and progressively getting worse. His main complaint is numbness on the lateral side but will involve the whole foot (plantar and dorsal) distal to the mortise. My thoughts are nerve compression, but where? If it is just tarsal tunnel then many of the dorsal signs do not make much sense.

He also states that 2 minutes on an elliptical and his feet are completely numb!!

Any thoughts??

Eric

 

Eric:

This is what I call transient forefoot compression neuropathy caused by continuous excessive force on forefooot and is quite common in people who regularly use the elliptical trainer. Have the patient lean backwards onto heels while using the elliptical trainer, give him heel lifts and have him do gastrocnemius and soleus stretching exercises three times a day. The pain should gradually get better. If it doesn't then try foot orthoses with the anterior edges left 5-6 mm thick to reduce the ground reaction force plantar to the metatarsal heads. Good luck.

 

Same thing happens to me on the step machine and elliptical cross trainer - takes ~20 mins to happen. I put it down to a lack of a swing phase on those types of equipment (it does not happen on treadmill or running). I have found nothing that helps, except stopping.

 

Thank you both for the replies. So, from my understanding of anatomy I would guess that this is due to mechanical pressure of the digital branches of the medial and lateral plantar nerves. In that case, why would calf stretching as suggested by Dr. Kirby help? Would using a met pad help decrease this from happening? If we were able to shift the pressure a bit more proximal then maybe the compression would not occur.

So, that takes into account the plantar surface numbness, what about the dorsal surface numbness. Could this potentially be due to mechanical traction put on the superficial peroneal nerve due to the mechanics of the foot at push-off? For example, the client I am referring to presents with an adducted forefoot relative to his rearfoot at the moment of toe-off. Could this posture produce a traction force that results in paresthesia?

 

This seems like an easy way out. I think we need to explore the mechanism. It seems to be mechanical in nature.

 

Eric:

Dorsal numbness can be due to shoes being laced too tight. You must also think possible chronic exertional compartment syndrome. Have him go on the elliptical trainer just with socks on, no shoes, to see if the symptoms change. It would be helpful if you could get more history on what makes the numbness come on and when it does come on, where the sensory loss exactly occurs in the foot.

 

The numbness comes with running after about 2 miles. He states that sometimes the numbness will come if he stands statically too long. Mostly he has complaints on the entire plantar surface and the lateral dorsal side to about the third toe. On a side note, when he uses a recumbent elliptical he does not get the numbness.

So, I think this has to do with the forefoot pressure as suggested by Dr. Kirby in the earlier response. While exertional compartment syndrome can play a role I would expect to see these symptoms a bit more on the recumbent elliptical.

So, if it is due to the forefoot pressure then would off-loading the forefoot help?