GP #2

So I had my GP appointment and the outcome is that I’ll be having an ultrasound scan on my right foot (not my left, because I don’t know, budget constraints?). This is OK really, the injuries are symmetric enough, although not 100%. First space is worse on the right, third space is worse on the left. Maybe I should have gone for the left. I don’t know. Probably makes no difference.

I don’t know what the waiting time will be but I guess 4-8 weeks plus another couple of weeks for the results to get back to the GP, which is fine really.

So now I will have to think more seriously about treatment. The MN on the right foot is probably not currently worth treating because it’s not affecting me much, although it does seem worse now than it has been for a long time. The MN in the left foot has been more painful and I may be tempted to try an injection, assuming there isn’t a conspicuous absence of a neuroma on the ultrasound. The pains in the first interspace are less clear; as they are relatively new I am yet to see whether they are actually problematic. They may subside over the next couple of months (the nerve feelings seem to have subsided, but there’s still discomfort at the metatarsal heads). I’m very curious to see what the ultrasound shows here, as neuromas in this space are supposedly unusual.

There’s still a big unknown in how everything will handle running from here on. I’ve had four weeks out now but I’ll start again this weekend. I have retired my Altra shoes as I suspect these exaggerate my pronation due to being inherently unstable, which likely triggered the first space problems. I bought some more supportive Asics, which I might rotate with my neutral pair. I have time to experiment with this a bit.

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So… I have a GP appointment after all.

It turns out I can book them online now, which is convenient.

I’m triggering the new ‘nerve’ feelings less by accident but I can still reproduce them when I push around my metatarsals. That’s probably an improvement but I seem to have developed a big increase in general discomfort and soreness in my feet. Some of the soreness is around/under the offending metatarsals, so, OK, that’s not a big surprise, but the other discomfort is pretty general and vague.

I probably won’t run again until after the appointment because that shuts down any “have you tried not running for a few weeks?”. It will be four weeks on the day of the appointment.

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I learnt a few things this week:

1. A neuroma between the first/second toe is not called a Joplin’s neuroma as I said previously; a Joplin’s neuroma is actually on the medial side of the big toe and is very different. Regardless, the consensus seems to be that 1st interspace neuromas are very rare for reasons no one wants to specify, such that other diagnoses are more likely to be correct even when nerve ‘feelings’ are involved (I think because inflammation of other structures can put pressure on nerves).

Whether this is true or not I don’t know, but I’m not too interested in this kind of speculation right now, because, firstly, I’ve had a light week and it feels a bit better (but maybe I’ll change my mind this week when I resume my normal walking volume), and secondly…

2. …The second thing I learnt, thanks to filming myself running, is that I have been (over-)pronating much more than I realised.

Barefoot: Right foot is fine, left foot pronates a bit more and might just be into over-pronation territory, but not by much.

Shoes (all of which are neutral): In my Asics and New Balance I’m more stable than barefoot and fairly neutral. In Altras I’m less stable than barefoot and overpronating on both feet noticeably. That’s right, the right foot goes from neutral-ish to overpronation.

I’m very surprised that this is possible, but here’s an interesting and detailed article by someone observing neutral shoes making him overpronate much more than barefoot; his theory is that some shoes absorb force unevenly and your foot will follow the motion of the shoe, or perhaps in other words, the shoe itself is overpronating.

I was running in the Altras (exclusively) for just under six weeks before I noticed these issues, so there is an obvious hypothesis here.

So, OK, I suspected over-pronation from the callusing on my feet, but seeing it in video is useful because it clears up some confusion in my mind over how much stability I want in a running shoe. I have been pushing towards less to try to promote natural mechanics, but at least in this case, what I’ve ended up with is certainly not my natural mechanics.

Current plan: rest for another week, maybe two, then try running again with more supportive shoes. GP appointment if it gets worse during any of this or if after two weeks it doesn’t feel good enough for a test run.

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After much poking, prodding and thinking, I am now reasonably sure that on top of everything else, I have in the past 2-3 weeks developed another nerve issue, this time between the first/second toe in both feet. I mentioned this in the previous entry but now I’m more sure.

The sequence of events in the last few weeks goes something like this:

1. Slight increase in sensitivity of the previously quite dormant morton’s neuroma in my right foot
2. Discomfort in both feet in the 1st/2nd interspace area
3. A lot of general leg stiffness (resolved a bit with stretching), probably due to squatting 3 times a week
4. Right hip soreness while walking
5. Right inner knee pain as a result of squats last weekend
6. Fast paced 5k last Wednesday
7. On Thurs/Fri/Sat it crosses the threshold from “minor irritation I’m barely aware of” to “maybe I should be paying attention to this”.

Today I noticed that I have a callus along the medial side of each big toe which makes me think I’ve started pronating a bit. The right callus is noticeably thicker which fits with the right knee pain and the right foot being more affected. This would be very late stage overpronation, i.e. a rotation at toe-off, which also fits with a fast run suddenly making it worse.

I suspect my focus should be on my hips. I did some bodyweight fire hydrant exercises this morning and, much to my unsurprise, found both hips very sore. Then I spent five (painful) minutes foam rolling my outer hips and outer quads/ITBs and subsequently found the fire hydrants very easy and with no hints of soreness. Interestingly, I also felt looser in just wandering around the house.

This wraps up everything. My hip abductors get tight and stop firing effectively, my knee starts to collapse inwards and my foot collapses too. The effect is broadly the same whether it’s squats or running. So this is the Occam’s razor answer.

Problems working against this are: why are the nerves in my feet so sensitive anyway? Lots of people pronate far more than I do to no real negative effect. If it’s mechanical, why am I not getting PF or sesamoiditis or any of the other myriad common foot injuries? Well, I am unqualified to answer those.

Current plan: I will take a few weeks out of running (and squats! well, weighted at least) and go to my GP if it doesn’t improve. I don’t expect much help if it is mechanical, but in the back of my mind is the possibility of a more general neuropathy. I did have blood tests 2 and a half years ago with the first neuroma for diabetes and other things I can’t remember, so it seems unlikely I have anything that would show up there. But…

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Neuroma (+ more?) updates

Just to document this…

Left foot: Occasional sharp-ish but not particularly intense pain in my forefoot around the base of the big toe when I put my weight down awkwardly. About two weeks ago my gait while walking started feeling a bit forced; hard to explain why it felt that way but my hips and hamstrings were quite stiff and probably causing some resistance to natural movement.

Right foot: Not exactly pain, but unusual feelings around the same place as the left foot and going towards my toes sometimes when I start to walk, usually resolves itself after a few minutes. Strangely, it’s when my heel hits the ground rather than at a stage in the gait cycle when the forefoot actually does anything. This started 3 weeks ago and seems to have reduced in the last week. Sometimes when I wiggle my toes around, specifically e.g. first toe moves downwards to touch the ground and second toe moves upwards off the ground, I get a feeling at the spot on the inner side of the tip of my second toe which feels like a click, but I speculate that it might be a very temporary loss of sensation (numbness) in that particular spot, because just occasionally, it lasts a little bit longer than a click and that’s how it feels.

The idea of having 4 neuromas starts to push the realms of credibility, so hopefully these two things will fall into the category that 99% of these kinds of things do in that they’ll sort themselves out in the next few weeks, but somehow I foresee a GP appointment in my near future…

I will continue running this week but 1) I’ll switch to my Asics (slightly more supportive) and 2) I’ll probably take next week and the week after off if I’m still dissatisfied. The timing is OK. The weather has suddenly become much colder and the nights are pulling in.

Right knee: Somehow I injured this doing squats last Saturday. This is totally irrelevant to my feet (probably?), but it’s probably not a bad thing to have taken some forced time out because I think the weight training is to blame for the fact my hamstrings and hips became quite stiff, and it means my barbell time became foam rolling time.

Oh yes, and the actual real, existing neuroma update: Feels OK. It’s definitely improved over the last month. It’s still there but I’m not irritating it, so hopefully it will desensitise itself now. So, as long as I haven’t just swapped it for another neuroma somewhere else…

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Yesterday there was some news that wages are increasing as a result of brexit skills shortages.

On the pro-leave side people were quick to say that it shows brexit is a success and that EU immigration definitely has suppressed wages. There are three problems with this which are pretty obvious past a cursory glance:

1. Short term pay boosts won’t persist over the medium term if lowered EU migration results in less domestic demand. For example one industry cited was transit drivers, but if our migration slows down then the growth in demand for people wanting to receive deliveries will also slow down. This means over the medium term wages would revert to the mean, so a sudden uptick is both completely predictable and completely meaningless. We have to wait at least a couple of years to see if any new rate of wage growth is sustainable.
2. The report actually said “highest wage growth since 2015”, which is hardly a great measure of success, especially when you consider that in 2015 we supposedly had more downward pressure on wages due to migration than we do now.
3. The articles didn’t give any real figures, so we don’t know if wage growth is higher than inflation or not. The last time one of these reports came out various news sources reported it as a great success, but the figures showed that real wages were in fact still declining.

This piece of news was completely devoid of any actual content. I find it frustrating that news like this gets a lot of attention on social media because it is essentially a bunch of people pretending to use facts to support a position they have arrived at without the aid of facts. They can fool themselves, but…

Reminder: The EU accounts for almost half of our exports and unless we secure a frictionless trade deal, wages will take a nose dive simply due to reduced prosperity.

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I am really baffled by all the Jacob Rees Mogg stuff.

In the 2017 election you had to get to the age of around 50 before you had more chance of voting for the Tories than Labour. There seem to be two schools of thought on this coming out of the Conservative party. The first one is “we’ve tried nothing and we’re all out of ideas”, and the second one, being pushed by JRM supporters, is “That’s awfully low, let’s see if we can raise it to 75”.

JRM is an eloquent and talented orator. He also occasionally writes articles in the Telegraph. If you have heard him speak and think he’s insightful, it’s worth reading his writing to cure yourself of this misconception. Verbally, he is able to hide a lot of weak logic behind strong oration skills. In writing, it’s much harder to mask these things.

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