The physio trip was interesting. He spent a lot of time poking my ankles and said he was confused. Apparently, when I’m standing up normally, I tend quite strongly towards supination (underpronation). He said that usually when people are like this, their ankles lack the mobility to overpronate so that’s not their issue. But with me, the movement is there, and I have a strong callous on the inside of my big toe which suggests I am overpronating. He seemed to think it was a bit unusual.
He did all the poking and pressing based diagnostic tests for a neuroma, but couldn’t get any of them to be positive. This matches my experience with the podiatrist years ago – he did all the tests, they were negative, and then goes “well, I still think you have a neuroma”. The physio was less sure. It’s not really that important unless someone is proposing cutting into me, though maybe at some point I should go to the GP and see if I can get some imaging done on it.
Anyway, the outcome is that he wants me to 1) Stretch my calves a lot, because he thought they were resisting even at a neutral foot angle. He said the lack of movement in the calf could be compensated for by my metatarsals and my ankle (i.e. pronation). And 2) get some insoles to support my foot more. He put me on a pair of insoles and seemed to think that everything aligned better when I was stood. I was a bit worried he was going to try to sell me some ridiculously expensive insoles, but he actually just gave me the name of some and said “you can buy these online for about £10”. So I have.
I’m still getting numbness though. Even after having a few very easy weeks, which in previous flareups was always enough to settle it down.
I’ve been running a lot again. Today I did another half marathon distance, because I got to 16k and thought “why not?”. My foot/neuroma has been behaving better, but after the long run this morning it’s been twinging a bit. Not badly, it’s just sometimes when I move my ankle around a lot I get a pin prick feeling in the ball of my foot.
It’s a bit frustrating because I don’t know how to treat it. I don’t want to stop running and I’ve always said that if it gets that bad then I need to get it treated properly. Okay… but actually right now I think that would be a bad idea, because I’m getting other discomfort around my ankle which probably means my biomechanics are a bit off and I should sort that out first. I don’t think that my hip strengthening did much. Well actually maybe it did, but nothing that helps my foot.
I still seem to have a lot of tightness in my inner ankle, which Dr Google tells me is my tibialis posterior muscle/tendon. This is responsible for foot stability during the gait cycle, it holds the arch strong and counteracts foot pronation, so if it’s not working properly, the foot flattens too much. Also, interestingly, this tendon actually connects to the metatarsal heads. Hello. Meaning that dysfunction here could be pulling the metatarsals out of alignment and potentially putting more pressure on the nerve? And not only that, but when I’m sat down and it tightens up, it could be pulling my metatarsals together and putting pressure on the nerve?! Maybe.
And indeed when it was twinging earlier, a bit of stretching of my ankle did seem to alleviate it.
It’s just frustrating to feel like you’re on the edge of injury though. I want to run tomorrow (just a few km slow) but it probably depends how it feels when I get up. Or I could have a lie in?