My wife Erin is a source of much personal frustration. The frustration doesn’t stem from any particular aspect of our relationship (thank goodness!), rather I am frustrated with her as a runner. I just can’t seem to fix her.
I have to be honest – my wife was a serious runner long before I ever was. In fact, she was a runner when I first met her in college. However, she runs for very different reasons than I now do – she’s not competitive, she hates racing, and she’s quite happy just to do her standard 3 miles as a way to relax and cut loose for a bit.
The problem with my wife is that for the past several years she has not been able to run consistently. We’re not sure exactly when her problems started, but we think it was sometime after her second pregnancy. She started having right “hip” pain after runs, and it got progressively worse to the point where she was ready to give up the sport altogether in late Fall of 2010.
I knew from filming her form that she was a horrific overstrider, and she has issues stabilizing her right foot due to a large bunion on that side (she may kill me for divulging this, but all in the name of education!). At the time she was running in traditional shoes and Nike Free 5.0’s (the old version from a few years ago), and the Free’s were caving medially in a big way on the right. I thought maybe the combo of bad form and problematic shoes might have something to do with it. She thought maybe it was caused by holding our son on one side all the time (quite possible). I wondered if maybe it also had something to do with her yoga practice (it was made very clear to me that stopping yoga was not an option). If the alterative was not running at all, I suggested we try rebuilding her from from the ground up.
I bought Erin a pair of hot pink Vibram Fivefingers and put her on an extremely gradual buildup on the treadmill during the winter of 2010-2011. All was going really well – she was running pain-free on the treadmill, and she didn’t seem to be having much trouble adapting to the minimal shoes. This was very encouraging to both of us.
Unfortunately, problems with the hip started to re-appear when she started running outside again in the Spring. She continued running sporadically, but never in complete comfort. It was clear that whatever was causing the problem was ticked off by the move from the treadmill to running outdoors. I wondered if maybe trying a minimal shoe with a bit more cushion might help. That turned out to be a mistake – one run in a new pair of transitional cushioned shoes and she was in worse pain than ever. She called me a fraud of a shoe expert, and any running shoe with significant cushion now scared her.
Toward the end of 2011 (I think) she went to see my friend Brett who had developed a reputation for success in treating local runners with various injuries. He did some manual therapy and identified a few problem spots. The gluteus medius seemed to be the problem on the right side, along with a ligament issue in the pelvis and some tightness in the quadratus lumborum. Manual therapy seemed to help, but the pain jumped around from place to place for quite a long time. She continued to run, but still experienced hip area pain most of the time. What finally seemed to help was Brett’s suggestion to start incorporating sets of walking lunges at the end of each run. Her pain started to progressively lessen and we though we might be onto something.
As seems to happen so often with somebody who is injury prone, it wasn’t long before another problem cropped up. Erin had gone for a run on the trails behind our house and came back complaining that her foot hurt. She said she stepped on a rock awkwardly and I worried that maybe she had broken something in her foot (she was wearing trail shoes with a rock plate…go figure!). Over the ensuing weeks and months the foot pain would crop up any time she walked a long distance or ran, and I began to fear that she had a stress fracture. She had X-Rays which came back negative, went a period of about 5 weeks without running, and when she came back to it after the time off the pain immediately returned in her foot.
Eventually she mentioned to Brett that she periodically had numbness in her middle toes, and that this had been an issue long before stepping on the rock (I recall her complaining about it from time to time, but it had skipped my mind). He diagnosed her with a neuroma in the right foot. A this point she was walking and running almost exclusively in Altra Intuition 1.5’s because they made her feet hurt the least (I assume because they let her foot spread out so the bones wouldn’t squeeze on the neuroma). She also got a pair of Correct Toes from Brett with the thought that they might space things out even more and she was using those on runs as well. She was managing to run, but the foot still hurt. I thought maybe a softer shoe might be worth another shot, but one run in the Skechers GoRun 2 caused her knee to start barking, and that was that.
I had been joking with Erin that since we’d tried almost every other type of shoe out there, I was going to get her a pair of Hokas. She thinks they look ridiculous and makes fun of mine all the time (I’ve only run in them once myself). But, one day my friend Nate came by and told her that he’d heard of people who have had success dealing with neuromas by running in the Hokas. As is typical, advice from non-husband is more likely to be heeded than advice from husband, and she told me to go ahead and buy her a pair.
Well, Erin has now done three runs in the Hoka One One Bondi B 2’s.I’m happy to report that they are the first three runs she has done in a long time that have not resulted in any foot pain. Her hip seems to be doing well too, with only a very minor twinge reported after one run (she continues to do her post-run lunges).
I think this story is also worth telling since to me it shows how difficult it can be to find the right shoe for some people, and also how chronic injuries can sometimes be really hard to resolve. We tried traditional shoes, we tried minimal, we tried stuff in between. We tried form change (she is no longer an overstrider, in fact she may have gone to far in the other direction) and various kinds of strength work. The Hokas along with post-run lunges seems to be working for now, so we’re going to stick with it and see how things progress.
I have no idea if this pattern will hold, but I’m keeping my fingers crossed – I need to prove to her that I’m not a fraud!
(Update 5/21/2013: It’s been a month since I posted this, and I’m happy to say Erin has continued to run in the Hokas 2-3 times per week and has not had any pain in her foot. It’s the longest stretch of pain-free running she’s experienced in quite a long time. Keeping my fingers crossed that it continues!)
About Peter Larson
Glad to hear she’s found something that works (hopefully for the long term). I’m glad you shared this as it’s not an isolated case, unfortunately. I’ve had many runners come to me for help because of a history of injuries. In addition to being frustrated by injuries, some of them have felt like failures because they tried the latest popular trends and it didn’t work for them.
I try to educate my runners to not be dogmatic in their approach to training and learn how to individualize their approach. What works for one person may not work for another. I’ve transitioned some runners from orthotics to minimalist shoes with no inserts and others I’ve taken out of minimal shoes and referred to a pedorthist to get custom inserts.
What I’m most impressed with is that you’ve been able to work with your wife in a coaching type capacity. Doesn’t always go smoothly ;-)
Your wife sounds like me! I have hip issues, made worse with pregnancy, finally saw a chiropracter who worked wonders, and I continue to diligently roll my leg to keep hip pain in check. I then started having numbness and pain in one foot, went to a podiatrist who x-rayed my foot to confirm a crooked toe causing a neuroma (this was all just from walking, years before I started running). I was prescribed orthotics (it has a little bump that pushes up on the neuroma to keep the toes from pinching), which I use only for running and hiking (I’ve tried runs sporadically without them, and OUCH).
Your wife’s neuroma may resolve with shoes, but if not a podiatrist may be able to help. (Also, a neuroma left untreated will eventually cause nightmarish pain up the leg and into the thigh, no fun for someone already suffering from hip pain). I have transitioned to minimal shoes, but will never stop wearing my orthotics with them. I know orthotics are often over-sold to runners with other issues, but they have their place. A good health plan will pay for them as medical treatment for a neuroma, mine set me back a whopping $15. (my podiatrist also steered me down the slope to much more minimal shoes, with a wide front, the NB 730, Asics Hyper speed are my favorites).
My wife had niggling hip issues for several months. She went through all sorts of stretching/massage/etc. to help relieve the pain, but it came back with a vengeance. In the end it turned out to be a torn labrum due the incompatible shapes of her femural head and hip socket. The shape of her hip joint has likely been restricting her stride for years, though the resultant pain only manifested itself recently.
My point is that sometimes an underlying genetic/physiological issue can be the source of running injuries. To an exercise biologist, you have a hammer to fix issues with, and everything looks like a nail. Maybe it ain’t the shoes or running form?
The hip issues were diagnosed by a doc, and I can pretty easily recreate the pain by palpating the glute medius, but didn’t want to get into that level of detail in the post :)
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
By the way, the technical term for ‘palpating the glute medius’ is ‘copping a feel’.
Exactly ;)
Pete, I am curious about the lunges your wife does. Are they reverse lunges or regular and any particular amount? I have minor hip/knee pain (no childbirth here) that I have spent the past year trying to self ‘regulate’ and if adding something as simple as lunges to my post-run routine could help I would rather give that a try before I go see a specialist. I also have a pair of Altra Provisioness shoes sitting on my doorstep since I have bad pronation that hasn’t been resolved by going minimal (Merrells & Vibrams). I am hopeful they help but I don’t mind trying new things since I want to get back to my half marathons (hip/knee pain seems to start at mile 8).
I’m not sure of the terminology, but I think they’re just standard forward walking lunges. She said she does about ten on each side after each run. As for pronation, it may or may not be related to your problems. Pronation in and of itself is not a diagnosis, but in some cases can be a contributing factor to an injury, but firm links between overpronation and specific injuries have been tough to find.
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
Fwiw, lunges make my neuromas flare up big time. My podiatrist said to avoid them.
Thank you, Pete! I figured that was one of the nice things about the provisioness, you could take out both, just one, or none of the inserts depending on your needs. I have my fingers crossed, I have about 7 miles in them so far and things feel pretty good. The true test will be the long run home one night.
Good luck, hope they continue to work!
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
Hi Pete, congratulations on the career change! Has your wife tried balance board work to help with the hip issues? I know Dicharry is a big advocate in Anatomy for Runners. I picked up a bongo board about a month ago, and have been doing about 15 minutes/day on it. Some minor PF pain cleared right up and hips and legs have felt better than they have in years. Not trying to advocate for any particular brand, but from personal experience I’m now a balance board convert and a big believer that they really do help to clear up hip and leg muscle imbalances.
She has not tried that, but she’s a yoga instructor so she’s strong as heck and spends a lot of time on one leg. That being said, her balance on the right is compromised by her bunion, so that is an issue and one that might not be easily overcome since it is a structural issue.
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
I was just reading something that was discussing yoga and hip issues. Basically the yoga wasn’t strengthening a specific muscle and a little different exercise was thrown in to ensure it was brought back into the fold so to speak.
I’ll see if I can’t figure out what I was reading it in. May have been the book “what comes first cardio or weights” which is an interesting literature review of the current science of exercise.
I have that book, but haven’t read it. Will have to give it a look. I’ve only done yoga once, so far from an expert on the topic :)
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
Chapter 6 – under Where is my “core”, and do I need to strengthen it?
Talks about a women who did Pilates and Yoga 6 days a week but couldn’t do a 1 legged squat (great runner exercise) Hip and pelvic muscle weakness causing instability. Goes on to talk about studies and not just a single individual. One study found that hip muscle weakness is a good indicator for injury potential.
Cool, I’ll check it out. Thanks!
Sent from my iPad
I wonder if Correct Toes will help with the bunion. I’m dealing with the same thing. I just placed my order!
She only wears them when she runs. I know people who love them and have had before and after Xrays taken showing a difference, but I think you’d have to keep them on all the time for that kind of change.
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
Thanks for the info! I may try keeping them on all the time. I’ve got Altras, after all. :)
They came in the mail, and it’s going to take some getting used to! Also got Injiji socks, which sort of do the same thing. Both of those seem like they’d spread the metatarsals enough that met pads would be redundant, but time will tell. Here’s my “before” Correct Toes pic! The scars from my neuroma surgeries are clearly visible on my left foot.
Erin wears injinji socks with them too – helps keep the rubber from rubbing on the skin. Met pads arrived today, we’ll see how they work for her!
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
Fingers crossed! At this point, I can’t imagine wearing the socks AND Correct Toes. My tooties don’t spread that wide!
Tootsies. Ha!
As a veteran of three neuroma surgeries, I don’t think Hokas are the answer. I’ve kept my neuromas at bay for several years using $1 metatarsal pads: link to myfootshop.com…. These are the same ones my podiatrist billed me $8 each for! The video shows how to place them proximal to the weight-bearing surface. My guess is that your wife will be able to run in any shoe with properly placed pads (alliteration unintentional).
Thanks for the tip Brian! Arch pads were Brett’s first suggestion, would certainly save some money :) Hokas are working, but they look funny and aren’t cheap!
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
Are the pads re-usable? Can you stick them to the shoe insole?
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
You can! If the shoe has an insole, I stick them underneath. If not, I stick them on top. Sometimes I swap them out after a couple hundred miles, and sometimes they last the life of the shoe. Alternately, you can stick them right on your foot, but that’s not cost-effective long term.
Thanks again Brian!
Sent from my iPad
As a person who has done both, sticking them to the top of the insole works better for me. The book I mentioned above shows how to glue a band aid sized strip of foam insole to the insole of the shoe. You will have to experiment with how much cushion is needed. She should be able to tell if her mets are lying flat. The book is really not well written but I think the treatment is spot on. Good luck!
Thanks, ordered some pads so we’re going to give it a try.
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
Is the pad placement the same for Morton’s Toe and Morton’s Neuroma? They are two different conditions.
I don’t have any expert knowledge to offer but I have read that also. It makes sense to me that if a neuroma is present it may be mortons toe causing it. That should be easy enough to figure out. I have read that mortons toe causes bunions and I have read that bunions cause a neuroma. I don’t think the root cause is understood by most, they just see you wearing tight shoes and see that you have a bunion and that’s it. These are the same folks who only know how to offer you orthotics or surgery. Sometimes, as in my case, some exercises and maybe a simple little pad can solve major problems and major money.
I can’t speak for myself but I’ve had several marathoner patients also become neuroma pain free with those metatarsal pads, so I think there really is something to them.
I’m no doctor, but I am really happy that my recommendation is working so far. I use my Hokas when I’m beat up or when my PF flares up and they help me a lot. It doesn’t seem to be a very accepted shoe among your readers, but in the Ultra world there is a lot of (anecdotal) evidence of them helping people get back on their feet when other shoes have not. Please keep us posted how Erin does (and tell her I said Hi!!).
Thanks Dr. Nate, you can bill us at your convenience :)
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
You can pay me in multiple denominations of size 10.5….
I had hip and IT Band problems on both sides and after 6 months of trial and error I finally found out it was from muscle imbalances and weaknesses in my legs mostly in my hips. I starting lifting weights (I do Crossfit which uses your hips a lot) which made my legs a lot stronger but they also got a lot tighter. I had to add in Yoga several times a week to balance out the strength training. Now I can run any distance in any shoe (Road Glove, Mizuno Wave Universe 4, Altra The One) pain free. I know your wife does Yoga which is good maybe she should try a weight lifting routine (squats, front squats, hip thrust, dead lifts, etc).
Unfortunately time is the limiter with a little guy in the house, but I agree that incorporating more intense strength work might be of benefit. We need a home gym!
Sent from my iPad
Goodness! Your wife sounds exactly like me! I mean EXACTLY. I may have to try out that Hoka – and I always do lunges before my runs, so I’ll give post run lunges a try as well. Thanks for the tips!!
Hip or foot issues for you?
Sent from my iPad
Both. I’ve seen Chiropractor for the hip issues and she cannot pin-point the problem. Maybe bursitis, more likely tendonitis. But she did narrow it down to being focused in the Glute Medius, I’ve been using a combination of stretching, rolling, strengthening and somatic exercises to try and manage the hip issues. Over the past 2 months (since I returned following an injury) I have experienced less severe pain in my hips.
I run in Skechers GoRun, because that is the ONLY shoe wide enough and with enough arch support for me. My foot problems are extensor tendonitis and big toe joint pain – which, after this post of yours, I researched and believe might be some sort of sesmoiditis. I’ve ordered Dancer’s Pads (which I had never heard of before, and will see if that relieves the pain.
Sesamoiditis
Good luck working through this, it’s been a long road for my wife but she has been persistent and I’m optimistic right now. She just ran again after I posted this and again had no pain. Maybe the Hokas are worth a shot?
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
Maybe – but they are rather pricey. I have VERY wide feet, and I
noticed that they only come in B width. I do love my GoRun shoes and
have been rather disappoined that Skechers has not offered any of their
newer shoes in a wide. If I can find a store that carried the Hoka’s,
though, I will try them out. I could say I’d never pay $175 for a pair
of shoes, but I once said I’d never pay $80 for compression bottoms –
and now I have 5 pairs :)
Oops! accidentally signed out of disqus.
You might also check out the Altra Torin – super wide and lots of cushion, though not quite Hoka width. Also much cheaper.
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
thanks for the advice. I happen to be making a trip to a local running store tomorrow to register for a race. I’m pretty sure they carry Altras – so I will try them out!
Pete: I wanted to share this video with your wife. This exercise really helped my hip pain and I still do it before every run. I’ve even stopped in the middle of a run to do it (ha!)
link to youtube.com…
– My blog: http://flamingjuneruns.blogspo…
I’m completely unqualified to give advice, but I used to get some aching in my right hip during very strenuous hikes (sometimes, but not always). I came across an article that talked about exercises to do to help avoid common sports injuries and started doing the recommended exercise for the gluteus medius and my hip hasn’t bothered me since. It could be a coincidence, or it could be that I just haven’t been hiking as much lately. Anyway, to do the exercise you lie on your side, rotate the top leg so the toe points toward the ankle of the bottom leg, and raise the top leg, then lower and repeat. Start with no weight and try to work your way up to 2 sets of 50 reps with 5lb ankle weights (according to the article — I’m only up to 2.5lbs so far).
The diagram from the article is here:
link to imgur.com
The original article (now virtually useless because the diagrams have disappeared) is here:
link to mensjournal.com…
You are qualified by experience in my boom, sometimes that’s the best type of qualification you can have. Thanks for the tip. Looks kind of like a modification of the clamshell exercise.
Sent from my iPad
So your wife has a bunion hein ??? Are you going to sleep on the couch and to do yourself laundry for a week ??
Joke aside, have you check if your wife has lot of lateral movement, especially the lower body (hip, legs, feet) ?? These could create lot of torque (moment) at the joints. Women has larger pelvis than men. These could create lot of stress in the hip and in the knees if her legs were not “strait” (angle of the hip, the legs and the soil is not zero). Sorry to be too technic, I’m an engineer.
Yes, lots of video taken, I’m a very analytical guy too. And yes, she does appear to have some hip drop which tipped us off to a possible problem with the glutes. I think she may be on to something about holding our son on one side all the time, hip seems to have improved as he,s grown and does not need to be carried as much.
Sent from my iPad
I wondering how you made the choice of Bondi vs Tarmac. I have recommended the Tarmac to two female friends, only to have both of them replace the Tarmac with the Bondi! In both cases it seems to be the Tarmac upper, which has some rather rigid features which caused some discomfort. The Bondi definitely has a more refined upper. My concern is that the outsole of the Bondi will not last long. I have a pair with only 30 miles which is already showing signs of wear. One the other hand, I have Tarmacs which are still going strong at 300 miles.
There’s no doubt in my case that the Hokas reduce foot pain. It’s really amazing! I’m even doing my interval training in the Hokas. This product is a real foot saver for sure.
Please keep us updated on your wife’s Hoka running and how well the Bondis hold up!
where does she run?
if she’s on the street a lot, maybe it could be due to being on one side of the road too long…just a thought considering, you know, roads being slanted and all
We’ve tried trails and road, makes no difference.
Congrats on going full-time Peter :-)
The HOKA’s has two significant features – the massive amounts of cushioning and the massive rocker.
The rocker might well be important for helping those with injuries to the forefoot that are sensitive to flexure of the toes as the rock will largely do away for the need to dorsaflex the toes on toe off effectively immobilizing the toe joints, and will prevent localization of loads that one would normally see.
My guess is that once the injuries are healed going back to normal shoes will be fine, but one would probably need to ease slowly back in to steadily increase flexibility and ability to handle the high local loads.
If the rocker/immobilization of the toe joints is important to your wife then looking for other shoes that also have a significant rocker and low flexibility at the metatarsal joint would be useful.
As a person who is also struggling with some of the same issues I will tell you that she likely has Mortons Toe and if you just apply the pad as described in “Why You Really Hurt: It Starts in the Foot” then she will be feeling even better. Andrew was right on as well as Robert.
As a chiropractor, I often see the gluteus medius/QL pelvic dysfunction. I often trace it back to a foot misalignment, which sounds likely considering the bunion. The toe numbness is possibly a metatarsalgia due to a loss of transverse arch (yes there is more than one arch in the foot). Find a chiropractor who can adjust feet, work on the foot muscle firing patterns (such as one foot balancing), and consider a metatarsal pad. Or even an orthotic with a metatarsal pad already in it. There is no reason you can’t work on both structure and function simultaneously. Good luck!
My friend Brett, the guy who has been working on her, is a chiropractor. Mostly been doing soft tissue work on the foot. Unfortunately her bunion is so severe that there may be little that can be done when it comes to her foot. It’s unilateral and she’s had it as long as she can remember, might be a congenital malformation.
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
You are right to suspect holding a child. Protruding the hip forward and lateral is pretty common for the weight support. On a different note, I myself run in a minimal shoe, yet I think it’s not for everyone. Ask your Chiro what he thinks about Footlevelers orthotics. That’s what I would likely do with a bunion.
Thanks for sharing this Pete – my wife has just taken up running and this is my biggest fear, that we’ll come across an injury issue that becomes frustrating and impossible to figure out. Husbands are bad coaches/advisors even if we have knowledge in the field, and every runner is different, so I try to minimize my advice to directly answering the questions she asks. I was shocked when she went to a shoe store and came home with Brooks Pure Cadence – I thought for sure she’d get shoved into an overly supportive shoe – so at least we’re starting off on the right foot shoe-wise! Hope the Hokas continue to work for your wife.
Pete- I am a certified athletic trainer and have been reading your blog for a few years now. Which foot is the neuroma in? I assume right judging from the comments. I have had a few athletes deal with that problem. Sometimes the metatarsal pads work well, sometimes not. I have, on occasion, made a larger pad with more of a gradual thickness change that extends under 3 metatarsal heads as opposed to one. Again, sometimes it helps, sometimes it doesn’t. Now, let’s combine it with a bunion. If she has any significant splaying of the 1st met. head the neruoma doesn’t stand a chance. There would be too much constriction from the two problems to allow enough space in most shoes. (One basketball player wore her adidas casual street shoes for a few games because they were the only shoes her feet didn’t hurt in.) Short of reduction surgery and a clean out of the neuroma at the same time the problem will always be there. (I’ve been told that bunion reduction is probably the most painful surgical procedure to have so let’s assume last case scenario only.)
The excessive pronation makes sense to me, as well, with a bunion. Valgus deformity, altered intrinsic musculature function (i.e. flexor/abductor hallucis anything.), weakening musculature, overpronate, tendinitis/tendinosis, travel up the kinetic chain (gluteus medius), overcompensation of gluteus medius from knee dropping excessively towards midline, etc. etc., etc., you get the point.
It sounds like she is starting to take care of the problem. Glut. med. strengthening, soft tissue manipulation. Don’t let her forget about foot/lower leg strengthening either. It will need it with the bunion and overpronation. If you want any exercise ideas for either area, shoot me an email and I can send them to you. If the hoka’s are working don’t change that for now and have her be very cautious and alert to any sign of the pain coming back. The last thing she needs is for it to transfer to plantar fasciitis or the patellar tendon.
Last question. Has she had an MRI or CT to determine diagnosis? David (below) has a good point about hip impingements being a possible cause as well. An orthopedist who knows what he is doing needs to take xrays at specific angles in order to see femoral neck/head deformities of that nature.
Wish her luck! I know it can’t be fun. Sorry for the long post. Those problems need more attention then a comment in a blog post but I would be more than willing to offer any help I can.
Craig,
Thanks a bunch for the detailed comment. She has been seeing a chiropractor regularly (my friend Brett, practices more like a PT). she has also seen a physiatrist a few times. He did the imaging on her foot and also worked with her on the hip issues, but no imaging on the hip as yet. I agree that the bunion may be a significant part of the problem. She was wearing the Altras because they were one of the few shoes that provided enough room to accommodate it, and even then you can see the bunion protruding out the side of the shoe. It’s pretty severe.
The bunion was my first thought when she had the hip issues. I could see the greater pronation really clearly on that side, as well as the medial movement of the knee, hip drop, etc. That was my initial stimulus to start working on form and asking around about glute medius exercises. Exercise prescriptions are best to come from someone other than the husband though :) when she started doing the post-run lunges the hip really started to get better, but then the foot issue appeared (seemed to be an acute onset due to stepping on the rock, which is why I initially suspected a fracture).
She doesn’t seem to get foot pain much from regular walking, mainly from hiking with weight on her back (e.g., our son in a pack) and running. As long as the Hokas continue to work she will stick with them. She’s not one to need to run big mileage, about 10 miles per week for relaxation and aerobic benefit is all she wants, and if the shoes allow that we may be good as long as things don’t get worse.
She has looked at surgery for the bunion, but like you point out she has not heard good things about it so that would be a last resort. When Brett works on her feet it does seem to help, so that’s a plus as well.
If things take a turn for the worse, I’ll definitely get in touch about those exercises.
Thanks again!
Pete
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
Thanks for sharing this experience. I hope that the Hokas continue to work for her!
Another option to look into if the hip or foot pain start lurking again is the work of Dr. John Sarno MD. I have a runner friend that had seemingly unresolvable chronic back pain (pain location doesn’t matter) and he immediately got better after reading his book Healing Back Pain. It’s “Mindbody” stuff so you need to either be desperate and/or open to that sort of thing. http://www.healingbackpain.com
Whenever I have knee or hip pain, I wear Hoka bondi B’s for a few days and the issue clears up. Using a combination of Hoka’s (4mm heel drop) and Vibrams for 6 months naturally transitioned my strike to a midfoot strike and I am now injury free doing 40miles weekly mostly on standards Mizunos.
Beware..,Hoka’s initially firm bouncy EVA midsole wears out very quickly to become spongy and unstable . Its difficult to notice. With heavy use you will need to replace every 3 months or risk serious injury. Compare your old shoes with a new pair in the shop to know when you need to replace.
Thanks for the advice on midsole breakdown, makes sense. My wife continues to do well in them!
—-
Pete Larson’s Web Links:
-My book: Tread Lightly: link to ow.ly
-Blog: https://runblogger.com
-Twitter: link to twitter.com
-Facebook Page: link to facebook.com…
-Discussion Forum: https://runblogger.com/forum
It is common for runners to get hip pain and instabilty from soft tissue injuries to the hip. These are not evident from x rays and require an MRI Arthrogram to diagnose. If the hip pain continues see a hip specialist who can exclude or diagnose a labral tear or hip impingement.
A year update, do you or your wife have any updates on her running? I’ve experienced similar pains while running and am considering Hokas. Is she still healthy and running? If so, is she wearing her Hokas?
Yes, she is still running. still doing well. She’s running in a mix right now – Hokas, Altra Torin, and Saucony Virrata. Her foot really hasn’t bothered her much at all since we changed shoes, but she’ll occasionally have twinges from her hip. Hard to know if that’s from running or the fact that she’s a yoga instructor and is teaching and taking classes 4-5 times per week. But nothing has halted her running.