Hello,

About 10 years ago I started a light running regimen, and after about a year I began having pain behind my left big toe. I visited a podiatrist, who xrayed my feet and diagnosed me with bunions in both feet. I was told I had lost a fair amount of cartilage in my left big toe joint, and as a result I would always have decreased mobility in that joint. My podatrist made me some custom orthotics, and told me that without them I'd likely need surgery eventually.

I wore the same pair of industrial-strength kevlar orthotics for the next 10 years. The bunion pain went away completely, but I stopped running shortly after getting the orthotics due to problems with my IT band, and gradually dropped off my excercise regime entirely.

In December 2008 I lost my orthotics. I decided to see how things would go without them. About the same time I went from zero exercise to light walking. I had no real problems until I started the Portland Fit schedule, walking (not running), in hopes of possibly walking the marathon. In the last couple of weeks I've felt dull pain and tingling/numbness behind my toe. It isn't constant, and it's only minor discomfort, but I'm worried about where I'll end up if I continue.

Asking around, I've heard a lot of conflicting information about orthotics. Should I seek out a referral to a podiatrist through my insurance, and see about getting a new pair of expensive prescription orthotics (which my health plan will not cover)? Or should I keep up my workouts, keep on icing my toe, and see how things go? Should I try some over-the-counter orthotics? Any info would help.

Other info: I'm male, 35 yrs old, 230 pounds, 6'tall. I've got a good pair of shoes hand-selected by the folks at one of the local running shops. Other than the usual minor aches and pains and the bunion thing, things are going great so far.

Thanks!

aljrunner

It is difficult to yield accurate information to you without thoroughly evaluating your condition. Here is some general advice.

At this point in the game, you may wish to seek some custom orthotics. Had we this conversation a few months ago, I would have suggested differently, and put you through a very vigorous lower extremity/ankle/foot conditioning program.
In saying as much, not all custom orthotics are the same.

If you have a podiatrist in mind, go with the intent of explaining you are a runner in training for a marathon. The design of the orthotic will be different, than just for the usual "day to day" grind.

That being said, you are still due for some lower extremity, ankle, and foot conditioning with the orthotics as well.

I highly suggest getting evaluated so a definite course of action could be put in place. Stop by the tables and keep us in the loop as to what you choose to do.

Cheers

Dr.Greg

Good news--despite arthritis from the lost cartilage, I've been able to get back in gear with custom orthotics, and at 30K I'm now experiencing less pain than I did at 5 miles! Thanks for your earlier advice.