Hotfoot Part Two - Meeting with Dr. Tougas

The following blog post is not intended to constitute medical advice. It is simply a recounting of what I have went through with my hotfoot problem, what I tried to do to fix it and my experience working with a podiatrist. If anything, I would tell you to see a qualified medical professional sooner, not later if you have hotfoot or any other sports related ailment.

In March of 2009, I resolved to find a way, any way to get my hotfoot problem resolved. First of all, I had resolved to do Ride Across Indiana in July 2009, and I didn’t want to deal with a painful foot for a 160 mile ride. But more immediately, while for the last 3 years I had been able to put up with the pain and ride through it, my foot was now worse than ever. It hurt on days I rode or days that I didn’t. Every long ride was a new experience in suffering. It was clear, find a solution to the problem or stop biking. Completely.

In my last post, I talked about my experience with an Orthopedist in Richmond, VA. In the end, this wasn’t very fruitful. I still had the same problem, maybe a little better, but really the same problem. I think one of the things I did wrong was that I only went once. When the problem didn’t get better, I should have went back for another appointment and further examination. But one thing I have learned since is that I don’t think my examination and diagnosis 3 years ago in Richmond was very thorough. And that probably contributed to not getting the problem resolved then.

I needed a foot specialist, so I started looking for a podiatrist that specialized in sports medicine. Someone who specialized in cycling would be even better. I needed someone who wasn’t going just to examine me for 3 minutes, but someone who really understood what I was going through and could work with me to find a solution. Upon researching different podiatrists in the Appleton area, I found Dr. Tim Tougas at Northeast Appleton Foot and Ankle. Dr. Tougas is a board certified podiatrist with experience in sports related injuries. And he is a road cyclist. Jackpot.

I made an appointment and gave the receptionist the details of my condition. I also told her that was a cyclist that liked to ride 150-200 miles a week, and that was probably the primary cause. My appointment was on a Monday, and before I headed over, I put all the different cycling shoes in a bag with all the different insoles so I could explain everything that had happened. This time I was serious. I didn’t want a five minute examination, I wanted to get to the bottom of this.

I met Dr. Tougas and explained the whole history of the problem. I showed him all the shoes and all the things that had been tried. He put me into a chair and examined my feet, especially my right foot. He was able to put pressure right on the spots that were causing the pain. Dr. Tougas explained the problem I had was that the nerves between my big toe and second toe and the nerves between my third and fourth toe were inflamed, and this was causing the pain (he did not use the word Neuroma, but I think that is the medical term). The root cause of this was that the nerves were rubbing up against the bone, irritating the nerves, causing the inflammation and then the subsequent pain. He did an excellent job explaining all of this with the use of a diagram of the foot in the exam room.

The fix was simple. I needed a pad in my shoe to get that bone away from the nerve it was irritating. You often hear about the need to spread out the toes, as this will increase the blood flow and help hot foot issues. My issue was to get that bone away from the nerve it was irritating. Dr. Tougas marked the area on my foot with the worst pain with a magic marker, and transferred this location to one of my insoles. He then placed a foam pad on the insole and cut it to the appropriate size. He said this would result in immediate relief of a lot of the problem, because I wouldn’t be further irritating the nerve. He also said though, that once irritated, the nerves tend to take a long time to calm down, so it would be a couple-three months before I was fully recovered.

Overall, I was very impressed. Dr. Tougas spent probably 30 minutes with me. E asked about the type of riding I did and we talked about cycling. He quickly identified the problem and explained to me exactly what was going on and how we were going to fix it. He said we had the option of a cortisone shot as a short term fix, but it was really more important to treat the cause. I appreciated all of his information because I felt like I could be a partner in my treatment and recovery. And knowing what we were doing and why we were doing it, I could give him better information at my next appointment for how my foot was progressing.

Still though, I was a little skeptical. I don’t think that had anything to do with Dr. Tougas, but more with the fact that I had been going through this problem for three years. Could it be as simple as a foam pad placed in the right spot? I had had a few times where I would have some improvement only to regress again. So I really didn’t know what to expect. But that Monday I had my bike and I was determined to try it out. So even though it was only about 40 degrees, I went and did a 23 mile ride.

I was shocked. For the first time in 3 years, there was no pain. There was some discomfort because the foam pad felt a little high in my shoe (but he had told me this would probably be this way for a couple rides) but overall, for the first time in a long time, my foot felt normal. I rode a few more times that week, including a 90 mile ride around Lake Winnebago. Amazingly, I would say about 80% of my problem was solved. On the 90 mile ride, I had some numbness around mile 72, but this was a long way into the ride, and plus, Dr. Tougas said all this wasn’t going to go away overnight. But the improvement was remarkable.

The only downside of the foam pad is that it was not durable enough. Over three week and almost 600 miles, I wore the pad down to where it was providing less and less relief. I was still better than before, but I would say at the end of the three weeks, we were probably at a 60% solution. But overall, this was a very important step. We now knew we were working on the right problem. And we knew the solution. Get a pad in the right place to keep the nerve from getting irritated. Now it was just a matter of getting the pad to be durable enough so it wouldn’t wear out every three weeks.

I am planning at least one more blog post to cover what we have done from this point forward. But at this time, I want to stress, if you have a hotfoot problem, make an appointment with a podiatrist who specializes in sports medicine. Don’t let the problem go on and on like I did. In my case, I started getting relief the same day. Your case may be different, but a podiatrist is trained to understand how the foot works, and rather than you fiddling with shoes and cleats to fix the problem, they can tell you exactly what is going on, what is causing it and design a plan to address it. One of my major regrets is that I could have had my problem fixed 2 years ago if I would have been more proactive in going to a podiatrist.

When you go to your podiatrist, bring your cycling shoes. Be prepared to discuss how much riding you do and what type. This can help them to understand the cause of the problem. Ask lots of questions. Understand what is the cause of the problem and how they are planning to treat it. This may involve a pad in the shoe or custom insoles or orthotics. But you are the only one who knows how your feet feel. Knowing what you are trying can help you give the best feedback to your doctor so they can get you feeling better in the shortest time possible.

In part 3, I’ll talk about a more durable metatarsal pad and the decision to purchase orthotics.