Sciatica and Foot Problems

[Frank_B]

Will,

I had some free time this afternoon, so I dropped into that PT place by me and they had an opening (and a squat rack). I told them what was going on and they did a bunch of things to check on my lower back. No problems there.

I had them all a little stumped, but one of the head PT guys came over and gently rubbed a spot about an inch below the medial side of my malleolus. It was tender as hell and I felt a sharp jolt from that spot up into my big toe.

The jolt didn’t cause pain to wrap around to the lateral side like I’d felt before, but at one point he did move my foot in a way that made the lateral side of my lower leg feel like an extremely deep stretch. It felt great and then a bunch of those muscles started spasming lightly. He mentioned a possible tarsal tunnel impingement, and then he did some sort of manipulation with my foot that made a pretty significant pop in the bottom middle of the arch. It felt great.

They gave me a bunch of stretches to do, which is fine. They feel great. I trust your judgment, though, and wanted to know your thoughts on this “diagnosis,” and whether you might alter any treatment protocol and/or anything I need to do in the future to help prevent this from happening? Arch supports? Modify how I lift? Just do the damn stretches? I’m open to your suggestions and advice and I really appreciate your time.

[Frank_B]

Will you humor me and try place the Superfeet green into your lifting shoes and trying it with those in there and tell me if there is any noticeable difference?

Yes, sir! I have Do-Win’s. I’ll give it a shot as soon as possible. I haven’t gotten a chance to visit Pete yet, but if you’re cool with it, I’ll be more than happy to squat with the arch supports.

[Frank_B]

Hey Will,

Thanks for being patient with me.

So I went and squatted yesterday with the arch supports in. I can definitely say that it’s nice to have your entire foot in contact with the surface area of the bottom of the shoe. At the very least, I feel like it gives me some added proprioception and I’m finding it easier to distribute the weight more evenly my foot between heel, big toe, and other toes. Before, I felt like my big toe and arch were doing a lot of extra work.

That said, 24 hours later and my foot and lower leg are pretty pissed off at me, and I didn’t even load the bar. The big toe is extremely sensitive to the touch and the nerve “ache” is rising up from the medial side of my ankle and into my calves. The Lateral side is fine. I will say that the strap on the shoes felt like it was crushing the top side of my foot, and I barely had it tightened. The other foot felt fine even with the strap pulled tighter.

Also, I encountered that pretty gnarly feeling in my hip that feels like bone grinding on tissue. That made my right hip tighten up, and now it feels like that’s pulling the medial side of my knee tight. It’s not painful or debilitating today. Just annoying and noticeable. I only bring that up because that’s basically what happened to me when all this started and I’m just trying to provide detail that might help.

I benched and deadlifted. No problems there. I also deadlifted and pressed earlier in the week with some Nike cross trainers (Metcon 3) with no discernible issues.

[Frank_B]

Just wanted to update:

I’ve figured out that without arch supports I had a very nasty but subtle tendency to shift the weight onto my heels, yet force my toes to drive up into my shoes by somehow flexing the arch of my foot as though I were extending it. That’s hard to explain, but it was causing me a ton of problems and I didn’t notice it until I had more proprioception with the arch supports. I think this was straining the hell out of my arch and other structures of the foot as the weights got heavier. Long story short, it wreaked havoc on my lower leg.

That said, I do have a very sensitive nerve in my foot that is simply pissed off at this point. It’s a very slow recovery but it is getting better. It’s just ridiculously slow.

Physical therapy does seem to help to some degree. It’s not entirely useless as some would have you believe. Then again, I’ve made it clear I won’t be doing toe yoga and they seem happy to accommodate and throw some more difficult exercises my way.

Thanks Will. I appreciate your help and support.

[Will Morris]

Just wanted to update:

I’ve figured out that without arch supports I had a very nasty but subtle tendency to shift the weight onto my heels, yet force my toes to drive up into my shoes by somehow flexing the arch of my foot as though I were extending it. That’s hard to explain, but it was causing me a ton of problems and I didn’t notice it until I had more proprioception with the arch supports. I think this was straining the hell out of my arch and other structures of the foot as the weights got heavier. Long story short, it wreaked havoc on my lower leg.

That said, I do have a very sensitive nerve in my foot that is simply pissed off at this point. It’s a very slow recovery but it is getting better. It’s just ridiculously slow.

Physical therapy does seem to help to some degree. It’s not entirely useless as some would have you believe. Then again, I’ve made it clear I won’t be doing toe yoga and they seem happy to accommodate and throw some more difficult exercises my way.

Thanks Will. I appreciate your help and support.

Do you have a Morton’s Neuroma?

[Frank_B]

Do you have a Morton’s Neuroma?

I am absolutely not an expert, but I don't believe so. In the picture below, I swear I can feel every nerve fiber circled in red during things like putting on socks or (the worst) putting on a pair of sweatpants. When I plantar flex my foot to put them in the legs of sweatpants and the rough fabric touches that part of the toe, I feel the entire thing light up. It gets my attention every time. That is very annoying, but I can live with it. What gets my lower leg jacked up is when I wear a shoe and the laces are even the smallest bit too tight around the area circled in green. This can cause problems all the way up the side of my leg and will often times make my entire lower leg feel like a lead weight. Believe me when I say that it doesn't take much pressure to trigger this. Even a low cut pair of ankle socks that are too tight can trigger it. Early on, the area circled in blue was often pretty painful with a lot of tightness shooting into the arches of my feet. The best way I can describe it is a severe cramp in the arch of my foot. That has mostly subsided with the arch supports now living in every one of my shoes.

The term "tarsal tunnel syndrome" gets thrown around quite a bit in PT, but I can't say I have an honest diagnosis at this point. I also haven't really asked for one as I'd rather focus on making progress rather than dwelling on what's wrong with me. I'm down to mostly good days with a few bad days mixed in. That indicates to me that I'm healing and it's my understanding that nerves are aggravatingly slow. Some example PT exercises I've done: Pull a weighted sled utilizing the balls of my feet, barbell calf raises with increasing weights, a few calf and anterior lower leg stretches, and good old toe yoga. I don't seem to have a problem doing those exercises, but as I sit here typing with my work boots on, I am in pain from the tongue of the boot touching the area circled in green. I have been squatting with mixed results. Some days it's fine. Other days... Not so much. Pressing is fine. Benching is fine. Deadlifts are ok, but I'm having issues with my arches only using socks. I'm still trying to figure that out. Is there anything else you might recommend? I'm all ears and I greatly appreciate any help, advice, or insight you can offer.

Thanks Will.

Nerve - Copy.jpg

[Will Morris]

Compared to the other foot, does the involved foot appear to have more translucent skin, is it mottled in appearance, or do you have more or less hair on that foot and ankle than the other?

[Frank_B]

Compared to the other foot, does the involved foot appear to have more translucent skin, is it mottled in appearance, or do you have more or less hair on that foot and ankle than the other?

As best as I can tell, the two feet are surprisingly symmetrical with no abnormalities like you describe.

[Will Morris]

Pain with light touch (such as the tongue of your boot or a sock or a bed sheet) is a classic sign of Complex Regional Pain Syndrome. Some desensitization training may be in order here.

[Frank_B]

Pain with light touch (such as the tongue of your boot or a sock or a bed sheet) is a classic sign of Complex Regional Pain Syndrome. Some desensitization training may be in order here.

Interesting. How do we desensitize it? I’m hoping the answer is as simple as “get back under the bar” and not “slowly perform reps with a blowtorch to get the area used to extreme discomfort.” :-)