Arch Pain Switching to Minimalist Shoe

author : AMSSM
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Member Question

So, since my beloved go-to shoe brand has changed its shoe, after reading the bruhaha about the minimalist shoe, I decided to give it a try. Now I have a foot issue with my arch area. The foot actually feels like there is a blister on it, but nope, no blister, not even red.  It just feels like a blister. It is not really painful, but the feeling is ever present now at work, barefoot, all the time. I think it's probably due to the lack of arch support when I had been wearing "cushioning" shoes in the past. Is this anything to be concerned about?

Answer by Dr. Michael Cassat, MD
Member AMSSM

While there are certainly arguments for and against a minimalist shoe type, I will try and avoid rehashing those here. From your question, I take it that you were previously not running in a minimalist type shoe, and now have been. Typically when I discuss that type of change with a patient, there are a lot of factors that go into the methodology as well as the timing of that transition.   If you are somewhat biomechanically sound in your running, and have no history of injury, that transition can happen faster than someone with previous injury. If not, a very gradual transition, or continuing in a more supportive shoe is recommended.

In the case of your current injury, the change in your shoe type is very likely to be the culprit. Traditional running shoes with a large forefoot to heel differential (drop), tend to promote a heel-first strike. They control pronation throughout the contact period with the ground, and dissipate force through their extra cushioning. Minimalist shoes do nothing to control pronation, and often have very little deceleration of other than that which the arch of your foot naturally provides.

The current problem that you are describing sounds to be more of a neuropathic type pain, meaning caused by irritation of the nerve. In this case, likely the medial plantar nerve, a branch of the larger posterior tibial nerve which supplies sensation to a portion of the sole of the foot. A somewhat rare condition, called Jogger’s foot, or medial plantar neuropraxia, can be caused by entrapment of this nerve in the foot. Even with a normal arch of the foot, rapid change of footwear to a less supportive type can lead to greater stretch in this area, and more irritation to the nerve.

Diagnosis of this condition typically requires a high index of suspicion as there can be considerable overlap with other conditions causing pain in this area, such as plantar fasciitis. It is often diagnosed by careful history and exam. Typically the pain will follow the pattern of the medial plantar nerve distribution, and can be recreated by tapping in the area of the nerve (Tinel’s test), which will cause pain in the same pattern. X-rays and sometimes an MRI may be used to exclude other conditions that can mimic this problem. The diagnosis can be confirmed by placing local anesthetic in the area of the nerve and determining if the pain is relieved.

Treatment of this condition involves identifying the predisposing factors, and correcting the associated biomechanical issues. A period of relative rest is often indicated until the pain resolves, followed by a gradual return to running volume. Occasionally, despite rest and biomechanical changes, the pain will persist, leading to the need for further treatment. Options can include local injection of a corticosteroid, or surgery to remove the tissue causing nerve compression.

Overall prognosis for this condition is good, especially with prompt treatment. Best of luck with your recovery! 

Dr. Michael Cassat, MD
Sports Medicine Physician
http://www.drcassat.com
Twitter:@drmichaelcassat


Dr. Michael Cassat, M.D. is a primary care sports medicine physician for Arkansas Specialty Orthopaedics.Located in Little Rock, Arkansas, he provides expertise in the non-surgical treatment of athletic injuries. Dr. Cassat focuses on fitness, prevention, and a rapid return to activity.

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date: December 5, 2013

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AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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