Tying the knot: Avoiding numbness on the top of the foot

Dear Running Doc:

For the last year, when I go out for a run of four miles or more, the top of my foot hurts and I get a numb feeling that spreads to the tops of my second, third, and fourth toes. My doctor did an MRI, which showed nothing. I researched the Internet and found that lacing my shoes may be the problem, but the methods I and my local running store know didn’t change the symptoms. Do you think the tightness is the problem? And if so, any suggestions? — Johnny J., Bronx, NY

Thanks for the question, Johnny. This sounds like a problem I see in the office quite often, and my patients are relieved to know that just changing the tightness of the running shoe can make a difference. Given your negative MRI (probably overkill if your doc has seen this problem often enough!), I think shoe tightness is the probable culprit.

The pain and numbness is simply caused by pressure of the tongue and laces on the top of your foot and is impinging a nerve. This nerve becomes inflammed as you run. Ice and elevation, along with an anti-inflammatory like Advil, Motrin, or Aleve should relieve your symptoms quickly.

Now the issue is prevention. Be sure your running shoes fit properly. Did you get them fitted at the end of the day, when your feet are more swollen? Be sure they are one thumbnail’s length longer than your longest toe and the toe box and heel counter fit properly. If you have orthotics, did you check the fit with the orthotic in it?

Once you’re sure the shoe is properly fitted, then lacing becomes the issue. Everyone, unfortunately, is an experiment unto themselves. Recently, a patient of mine taught me an outstanding knot that he “stole” from his sailing experience: this worked for him and you may want to try the “Nelson Knot,” which I named after him:

• Start the knot like you normally tie your shoes: Cross over and wrap one lace under the other to make a knot, then wrap under and over again a second time; then pull.

• Create two “rabbit ears,” one with each lace; cross over and wrap twice.

• Pull the ears tight.

“Nelson’s knot” is as strong, if not stronger, than normal double knots. It seems to relieve the pain/numbness problem as well. An added benefit is that it is super-easy to undo….just pull the two ends of your shoestrings and the whole thing comes apart.

Hope this helps.

Lewis G. Maharam, MD

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Lewis G. Maharam, MD, is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running Doc™, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series . He is Medical Director of the Leukemia & Lymphoma Society’s Team in Training program. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.

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