When a runner has two injuries, like a neuroma on one side of the foot and bursitis on the other side of the foot, which one is worse, and which one should you pay attention to first? That’s a great question and that’s what we’re talking about today on the Doc On The Run podcast.
I recently had a call with an injured runner and he’s got a couple of different problems. One of them is that on the outside of his foot, between the third and fourth toes, he has a painful neuroma and the other problem is that he’s got bursitis.
The most common place to get bursitis in your foot is around the big toe joint on the inside of the foot, the arch side of your foot or what we call the medial side your foot and it’s where the bursa or overlying the bone, the metatarsal head starts to get rubbed and irritated in a shoe and if you have a condition like bunions, well, that bone sticks out more.
The bursa gets squished more in the shoe and it starts to hurt. So, if you have pain in your foot and it’s limiting your activities, you’re always trying to figure out what you should do, how much you have to stay off activity, what you have to address first? And when you have two problems, this can be difficult to figure out. There are really a couple different ways that I think you can go about this process.
The first thing to think about is which one is worse in terms of the pain? So, if one of them is way more painful than the other, I would probably start with that one first. If the bursa is really, really inflamed, you might want to do something to calm down the inflammation in that bursa, take all the pressure off the bursa and get it to calm down first. But if the neuroma is significantly more painful, well, that you could obviously start with that.
The second thing is the way I think about this, when runners call me is I say, “Look, you’ve got to think about which is worse in terms of the consequences of not actually fixing or resolving that problem completely.”
Let’s talk about the bursa. If you have an inflamed little sac in your foot, the bursa, and it’s inflamed and it’s irritated and you don’t treat it, well, the consequences of not treating that is that not only can it cause pain, you can actually get some scar tissue forming within the bursa that actually makes it thicker, more prominent and more prone to irritation later and in that case, if you don’t address it, it might get thick enough that you need to have surgery later to remove it. But the surgery is very unlikely to cause long term problems.
The reality is, is that the consequences of not treating the bursitis are not really that big. Now, the neuroma’s a different story. So, if you have a painful neuroma and you irritate it, things change in the nerve. So, you start out with a little swelling around the nerve, and then you get some fibrosis or additional collagen forming within the nerve. You get additional nerve endings that start talking to each other and making noise, the way that nerves do and that can become a thing that causes chronic pain.
Now you can always treat that later by removing the nerve or destroying the nerve chemically. But if you do, sometimes when we remove the nerve surgically, you actually get a thing called a stump neuroma, which is actually more painful than the original neuroma and it’s much more difficult to treat.
If you have an equal amount of discomfort on the bursa and the nerve, in that case, I’d probably consider treating the neuroma as the highest priority, because it’s most likely to cause the biggest problems long term and then the other thing is the interference with your goals, which one is worse?
Let’s say you’re running and you’ve been training for a marathon or an Ironman, and even though your doctor tells you, you should skip the race, you still really want to do the race, well, then you have to think which one is actually most likely to interfere with you actually finishing that race?
If it’s the neuroma, that’s more likely to interfere with that, well, you want to address that first, but you have to think about those things, which is worse in terms of your consequences, the amount of pain that you’re having, as well as the sort of current circumstance, like which one implies that it’s worse?
If you have a lot of pain that implies that that problem is worse, if it’s more painful than the other. But you always want to focus on the worst problem first or the one that is going to be way worse in terms of long-term consequences if you do not treat it appropriately now.
Now, if you like this episode, please like it, share it, send it to one of your friends who’s a runner and I’ll see you in the next training.