Today on the Doc On The Run Podcast, we’re talking about why a neuroma will pop or click after you run.
I was just doing a telemedicine visit with a runner. This was a runner who had a neuroma and wanted to get a second opinion. She was confused about something that was going on that she thought it was a little funny. She said that she has a neuroma, a doctor has seen it and diagnosed it. She’s pretty sure it’s a neuroma. She’s pretty sure it’s not a plantar plate sprain or a metatarsal stress fracture, or one of the other conditions that can seem like a neuroma. And she was getting this weird popping and clicking when she was running. So she said that she saw the doctor, he gave her some metatarsal pads and she was still running on it and really wasn’t bothering her that much.
But she really wants to train for her race. She really wants to keep up her fitness and she doesn’t want to just sit around, waiting for it to get better. So she started ramping up her mileage again. And she said, the weird thing is that when she goes out and just does short runs, if she runs three miles or maybe five miles, it’s not really that much of a problem. But what she noticed was that when she was doing hill runs and when she was doing really long runs, it seemed like, at the end of those runs, and even afterward when she was at home walking around in her home, she would notice this sort of popping or clicking sensation in the foot. And she was wondering what that was.
A neuroma is a swelling within the nerve. And if you keep letting it swell and you keep irritating the nerve, eventually it develops little bits of scar tissue in and around the nerve that makes a lump that takes up additional space. Then it can actually cause lots of different problems. But one of the things that happens with a neuroma as it swells is that it can actually move back and forth underneath this ligament we call the intermetatarsal ligament and the intermetatarsal ligament is just a band of tissue that goes across the bottom of the foot, at the ball of the foot, connecting all of effectively the metatarsal heads together so that your foot doesn’t splay out like a duck when you stand up. That ligament is on the bottom of your foot. So when you have the nerve that runs under the ligament, between that ligament and the ground, basically, and it gets swollen, it develops into a little knot or a little lump.
If you’re doing hills, for example, your heel comes further up off of the ground, and that lump moves back and forth across the intermetatarsal ligament. If you’re doing long runs and you’re pounding the heck out of it and your form starts to fall apart and you’re pronating a little more uncontrollably, then in that case, the nerve can get bumped around and aggravated and pinched between the metatarsals with all that abnormal motion and it makes it more inflamed.
And then it swells up just a little bit more. So then after those workouts and you’re at home, and you’re walking around, and you go up the stairs or you’re maybe stretching and moving the toes in a way that actually pulls the nerve across the intermetatarsal ligament, then it can create a popping or clicking sensation as it actually moves back into place in its normal position. But it sort of bumps across the intermetatarsal ligament and it makes this popping or clicking sensation.
So that is really why that can happen and that’s why that might be happening in this particular circumstance with this runner, when I was doing the second opinion telemedicine visit. So, you really want to make sure that if you have a neuroma, first of all, that’s the right condition. So if you don’t really know if you have a neuroma, either see a doctor right away and figure it out, or you could sign up for the Ball of Foot Pain course where I actually go through in excruciating detail about how I would explain to you how I would diagnose it if I was sitting in your living room. Now this is something you can do pretty simply. And in fact, a lot of times, truthfully, when people call me for telemedicine visits like this, I end up showing them some of the animations and videos sections of the course that help you understand what is going on and how you can tell the difference between one condition and another. But you can usually figure this out on your own.
If you see a doctor it’s not really difficult to diagnose a neuroma, but you’ve got to do something to get it under control, because if you just ignore it and you just let it get bigger and bigger, it will get more and more scarring, it will get worse and worse. And then eventually some doctor’s going to talk you into surgery.
Sign up for the Ball Of Foot Pain Course For Runners so you can get back to running.
If you have a question that you would like answered as a future edition the Doc On The Run Podcast, send it to me, and then make sure you join me in the next edition of the Doc On The Run Podcast. Thanks again for listening!