daoswald

The maximum OTC dosage in the US is 400mg, if I'm not mistaken. That's enough to take the swelling down in my case. I know that depending on a person's weight, sometimes people will receive prescriptions for 600 and 800mg, but that should be under a doctor's direction.

I weigh between 183 and 186 depending on how much biking I've been doing this week.

The more biking I do in my Sidi's, the less I worry about the neuroma. It used to bother me from time to time. After switching from the too-narrow shoes to the Sidi mega's, the issue has cleared up, and the stronger I get as I train, the less I remember it ever was a problem.

As a matter of fact, the more I ride the less ankle, back, foot, shoulder, etc. pain I experience. Getting into better shape really has made me feel better all over.

Campag4life

Nice to hear a success story without surgery or alcohol injections. I have resisted even cortisone because of its spotty improvement and propensity to degrade the fatty pads that protect the metatarsal heads on the bottom of the foot. You reinforce that if the root cause is addressed and the chronic habit is changed, a riders foot can be restored to normalcy. We are about the same weight and thanks for the dosage on Ibuprofen. I have been taking 400mg with my breakfast every morning and my foot is feeling better each day. I am icing it as I type this...now more preventative than a reaction to pain. I will continue to do this in hope that nerve over time becomes more benign.

Aside from going to wider toe box shoe and properly supporting the foot such that it doesn't distort resulting in the toes articulating relative to the base of the foot (carpal tunnel of the foot) while pedaling....load path as discussed is critical. Neuromas effect high mileage cyclists quite a bit but distance runners are the most vulnerable because of the high impact loading. For those interested, perform a search about Chi running.
This basically is a technique that promotes mid foot versus forefoot loading...essentially the same principle as moving one's cleats rearward. Bottom line is if you are pushing hard on the pedals and highly pressuring your forefoot and your forefoot is flexing within the shoe and the ball of your foot is over the spindle, one is being set up for injury. Having the arch share some of the load helps immensely and basically takes the loading away from the toes which if they are moving with every cycle stroke, this rubbing if toes pressed together is what aggravates the nerve.

rbart4506

Just a quick update....

I had replaced my red Specialized BG insoles with the my old blue one to give me more arch support in my Sidi shoe and it did not work. This move caused the pain in my ankle to flair up big time. I think the excessive arch support was causing my foot to pivot on the arch and bend downward in an arc. I'm sure this was straining the tendons on the outside of my ankle.

I took last night off, since I had ridden 7 days in a row, and put the red insole back in. I did a my 25 km commute today and the ankle feels a lot better.

The neuroma has also settled down so I think I may have caused the problem to flair up when I carried the laundry and just maybe the shoes weren't the culprit. I'm sure the riding doesn't help the situation, but at this point it's not making it worse.

I do know that the Sidi's aren't perfect so I have been looking at D2 shoes. They are pricey, but not as bad as Rocket7's. Either way I think I'm going to be looking at either going with some form of a custom shoe or insole to get things right.

Campag4life

I wanted to update this thread to instill hope to those that suffer with a neuroma which is prevalent in distance cyclists and runners. I am indeed proof that this affliction can be turned around. I am making a lot of progress in about 2 months time. I owe it mostly to changing my habits. I am sure a cross section of neuroma suffers...perhaps not all...depending on the duration of nerve damage, resorted to surgery because they did not change their habits "enough". I am now cycling 30 miles without pain. I do it by riding on very large platform pedals and wide flexible shoes with a proper orthotic to support my foot. Pronation in tight shoes damaged my foot...cycling in Sidis with a narrow and pointy toebox.
Repeated ice...staying off the hills a bit...reducing intensity but still riding and now I have eliminated almost all pain in my foot. My goal this year is to continue to do what I am doing since it is working...and then clip in next year with new....perhaps custom shoes. A last thought that needs to be shared....move your cleats back NOW if you have any forefoot discomfort. I am cycling with mid arch or slightly in front of mid arch pressure on the pedals and I can still stay up with decent riders that are clipped in.
When things looked quite hopeless for me, I continued to try...and "changed my bad habits" which resulted in improvement. There is hope for neuroma sufferers but do not deny the symptoms of pain which are the result of poor mechanics like I did.
Hope that helps.

hrt4me

Thanks for the informative thread.

crash66

Awesome post Campag. Everyone needs to heed this advice.

I don't have foot issues, all my issues are upper body, but developed in exactly the same way--repetitive overuse with poor mechanics, although mine started with an acute accident.

I had a slow speed crash 4 years ago, broke both elbows and a wrist. Went back to my desk job 7 weeks later (2 weeks after have a couple screws put into my right elbow), and tried to resume my normal duties with next to no range of motion in my arms. Was doing PT and working, but kept getting burning sensations in both arms that I thought was tendinitis from the breaks. It wasn't.

Basically, what I was dealing with was Carpal Tunnel, Radial Tunnel, and Ulnar Tunnel syndromes, all brought on by trying to force my body to do what it wasn't ready to do yet, repetitive motions all with bad posture on top of existing damage. Also, the fall probably worsened a pre-existing condition I likely had called Thoracic Outlet Syndrome, which really is the root cause of all the other things.

Now, 4 years and 2 jobs later (I haven't worked in the last two years), I'm going into my fourth year of physical therapy, hoping I can work again some day.

Listen to the man. Don't try to work through nerve issues, the damage can be permanent. Try conservative treatment first, surgery if you feel you've exhausted everything else. And if you can't find a way to improve your form and fit on the bike, don't ride. It's not worth messing up a career, or not being able to play with your children the way you'd like.

rbart4506

Just got back from a visit with a pedorothist and she feels that I am probably developing a slight neuroma. She did notice that my fourth metaseral joint was slightly out of place, it's sitting a tad lower. Besides that I have a fairly normal foot, but slightly narrow.

I mentioned the concern I had about the shape of the Sidi last and she thought that might have something to do with it, but didn't seem to concerned. She felt that getting a proper orthotic insert in the shoe would probably help. Duh, I could have told her that...

So with all that said I think I'm going to have to look at some new shoes....Again!

Personally I think the orthotics slipped into my Sidi is not going to be the answer. I can't see how she is going to be able to construct an orthotic that will properly mesh with the shape of the Sidi sole to get my foot into the proper position. Not to mention that my big toe is nicely jammed in the shoe right now so adding an orthotic will probably make that worse.

I guess I'm going to be giving Don at D2 a call very shortly and see what he has to say...

Campag4life

rbart,
A wonderful production shoe is the top of the line Specialized S-works. Specialized gets it..metatarsal button to keep interspaces wide.
The boa dial promotes strong heel retention for even narrow feet.
Try that shoe on at your LBS and you may really like it. I won't ride Sidis again.

LAWMAN

I had surgery for this over 20 years ago, before I got into serious cycling. my doc said mine was mostly just bad luck in picking my parents. I made him show me what he cut out, it was pretty interesting--lots of scar tissue on that nerve, I could see why it hurt so badly, there is not much extra room in the feet.

the recup. from the surgery was no fun, but the pain before it was agonizing when it flared up, so no regrets. I still get a slight twinge from it once in awhile, but nothing like it was.

rbart4506

Yup, tried them....Liked the last, but too much volume and the ankle area came up to high and bit into my ankle bone something fierce...

BTW I currently use the Specialized BG (red) insole with one shim in my Sidi's right now...

Honestly I've tried every off the shelf shoe I can find and the Sidi is the only shoe that comes close to fitting my foot. Only problem is the shape of the the last doesn't work...

I had kidded with my wife, when I had the Specialized S-Works, that if I could only get the Sidi upper with the Specialized sole I'd be in heaven...

Thought I would add this here instead of adding to the thread

I made the call to D2 and have a fit kit coming...

One more 120km ride on aching feet was enough for me...

I'll post up once I get the shoes...

Campag4life

Yeah...shoe nirvana is difficult to achieve to be sure. Biggest fear I have ordering custom is not being completely in love with the fit either The allure of so called custom doesn't necessarily guarantee a perfect fit as you know.
The one thing about custom I do like however is the option of customizing cleat location. If you have any presence of a neuroma you would be well served to mount your cleats more rearward. Hard to do this with a production shoe...Speedplay has a special plate that will allow about 13mm rearward location... but many of the custom makers offer to relocate the mounting holes in the floor of the shoe.

If you do go custom, please post a review if you would as many of us are in the same boat.

Campag4life

I think you touch on a key contributing intangible...genetics or pre-disposition. Yes cycling or running can perhaps exacerbate a neuroma but no doubt genetics play in and the difference between those that are afflicted versus not...are not completely environmental. I am foregoing surgery at all costs and have been doing well since changing shoes and habits a bit.

waldowales

I have had a neuroma for over a year now, I have the custom orthotics from a podiatrist, I wear wider bike shoes with the cleats as far back as possible. I still am unable to walk more than 3 or 4 miles without pain. I used to walk 5 to 8 miles twice or three times a week, to help stay in shape. I consider surgery to be the last resort, because of the dismal success rate. Would those of you who have had the surgery mind sharing which procedure you had and how well it worked out?

Campag4life

If conservative treatment including icying, proper orthotics, roomy shoes etc has run its course with limited success, you may want to consider alcohol injections.
I would definitely pursue that route prior to surgery. I also am not a fan of cortizone because of what it does to the fatty tissue that covers the metatarsal heads which you want as a cushion.

Bontrager

I inject corticosteroids before alcohol. If your doctor doesn't know what s/he is doing or gives you more than 3 injections in about 2-3 months then you'll notice a loss in fat pad, in my experience.

Surgery doesn't necessarily mean removing the nerve branch. We have methods to decompress the neuroma. Be very careful picking your dr. Education for podiatrists varies widely.

twocoasttb

Damn. Many thanks to the OP for writing this up. Recently, I've had the following happen. After running a few miles on the treadmill my right foot felt like it was going numb. And while on the bike I've had the sensation of my sock bunching up (between my toes). I've also felt the 'rise in the shoe' symptom mentioned in the article. I've been shrugging it off, but I'll pursue this...

Campag4life

Could you please elaborate for the community here what methods are available to decompress a neuroma?
Also, any techniques for determining which podiatrist may be best or is it a lottery?
Thanks.

GerGa00

What your saying is great and all true. Thats why it sucks to have wide feet. I am a runner and Its hard to find wide shoes but they are there and still extra wide shoes have a narrow ***** toe box..what the *&%$.
Most people have toes that are narrow/ scrunched together..but why? Because they grew up with shoes that do not properly fit.
Shoes suck.

unkchunk

Thanks for the thread Campag4life. I have a wide foot and that usually means that I have to get a larger (ie. longer) size shoe. Sliding the cleat back with a longer shoe, only puts it in the the forward position of what my normal shoe size would be. So in reality, the only to really put the cleat back is to drill new holes. If I try to slide my feet forward, then my toes get scrunched.

The Specialized BG have been better for me. I'll see if I can try some Sidi Megas for fit. But I'm guessing it's going to come down to getting custom shoes. If I have to end up spending that kind of money all bike shoe companies can go suck eggs.

Campag4life

I believe you are going to have to at least choose a production shoe that is made in a wide width. I believe there are others beside the Sidi Mega out there. That isn't my problem...I don't have a wide foot...pretty average forefoot width and if anything maybe a slightly narrow heel. Reversibility in my experience isn't working for me in spite of conscious changes. I have read this to be the case with many other neuroma suffers. It takes a lifetime to develop neuromas and don't believe mine will go away without more invasive measures...its frustrating really. I am even starting to develop one on my left foot and I am getting intermittent shooting pain in right foot still after all the conservative measures I have taken mentioned previously. I also don't clip in presently and ride platform pedals pushing in the mid arch area which btw works pretty good...even for spirited riding...just not a good scenario for racing. I believe I will be heading to a pod next for the alcohol injections to try and kill the nerve between 3rd and 4th interspace in each foot. Short of surgery, I believe this to be the next step. Not all surgeries are successful which is a problem unto itself but for every successful surgery, all have exclaimed that they wish they had their surgery before going through all the BS to compensate or bandaid their pain....something to consider as you search for the best shoe/cleat combination...the root cause will still linger and affect other aspects of your life. The nerve damage in my experience is not easy to reverse...still living with mine.

sherbornpeddler

6000 miles this year so far. I get painful after 60 miles but sometimes I can go 100 without much discomfort. Sliding cleat back helps. I have Shimano carbon sole, custom heat molded and lots of ventilation and forefoot space.

My LBS advised ventilation, good bike socks to aid ventilation and double check fitting (pronation and position on bike). Do not over-tighten the main arch or forefoot straps. That collapses arches quickly.
I am trying several different inserts and added padding.
Rigid plastic with good metatarsal support worked for a long time (~3000 miles.)
Soft inserts made it worse. Green Specialized with too huge main arch; I'd never wear them except in the biking shoes. they are at risk of causing knee strain and tipping my foot over but they do take a lot of weight off the front.

Hiking boots with rigid soles never gave me a problem until this year with a 50lb pack going down the mountain.

My podiatrist gave me metatarsal pads to try. In the right position, magnificent. Hard to get the sweet spot.

Off the bike, penny loafers, sandals, barefoot is taboo. Jogging shoes and tie shoes with padded soles and insoles hold bones in place and give a chance for recovery.

Who has a gizmo to measure hot spots before and after remedy, capture the cure and allow copy exact insoles to be made used and replaced as often as needed?

mandovoodoo

Very interesting. Especially Chi running and the S works shoes.

I've had minor flareups over the years, and had a plantar fascia tumor early in the year. Cycling shoes don't bother me. Nothing bothers me now. But I had trouble for a long long time. I kept getting fitted with stiffer and more supportive shoes, and my feet got weaker!

So I don't wear shoes. I wear sandals and custom fit moccasins. If I must wear shoes, I have super wide toebox Keene shoes. My feet seem to be very strong not wearing shoes.

Unless I'm cycling. I have oversize Sidi with slight fiberboard wedging under a set of fairly stiff medium thickness arch supports that I've skived to give a bit of a cross arch under my forefoot. And trimmed to counter the Side sole's "dish." I have my cleats all the way back and use pedals that allow a bit of rocking float. All that and I never have a problem, but it took some time to get it right.

Not wearing shoes is the biggest thing. I have running shoes for running. I'll backpack in running shoes. But as much as possible, I don't wear shoes. My feet are substantially wider than they used to be after years in formal dress shoes!

That fascia tumor thing isn't fun. I may have to cut a hole in my arch support to avoid any pressure there. Would have already except for not noticing except when my shoes are already on!

sherbornpeddler

I can not go without shoes. It feels likeall my weight is on a few bones and the padding is gonzo. I weigh more now than when I was a kid. If padding is like the hair on my head, it has just thinned out considerably. If it were like my stomach muscle I could jump on gravel.

It would be be interesting to do a rating of relative effectiveness.

sherbornpeddler

Working with my LBS, I moved my shoe position forward relative to the pedals and ow my shoe can intersect teh front wheel during a track stand kind of manuever. Minor deal but disconcerting on initial discovery.

Shimano heat molded shoes allowed plenty of room for more substantial insoles. I was impressed with Specialized insoles and their 3 choices of insoles.

I am in the hunt for customizable insoles. I want to place position and amplitude of main and metatarsal arch pads then seal the deal with a Spenco-like cover.

Campag4life

Mando wrote something quite profound and worth repeating:
I kept getting fitted with stiffer and more supportive shoes, and my feet got weaker!
I know it is heresy to not wear cycling shoes on this forum but my feet have recovered because I currently ride in flexible Nike tennies with a raised metatarsal pad and large platform pedals. Feet have muscles. I can still keep up with my friends who are strong cyclists but not competitive racers. My feet when pressing on the pedals almost feel like they have never felt better. It is almost massage like because the foot arch is stretching...the opposite of what happens when developing a neuroma...the foot collapses on itself crashing the metatarsal heads together inducing nerve damage. The best cycling shoes I have descovered are the new Specialized S-works. They are state of the art in terms of fit and closure and foot bed to keep the foot from collapsing. I will likely go to Speedplay Zeros and move the cleat back with their optional cleat relocation plates. I use mid arch pedaling away from the balls of my feet and my feet haven't felt this good cycling in 5 years.