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• By far the most common cause is pressure from above. Shoe laces cross over this spot and press directly on the bump and nerve.
• Everyday (street) shoes often cause this problem – especially slip-on loafers and boots. Many times feet expand during warm weather exercise, when wearing loose fitting shoes. When cold weather arrives, the boots are suddenly too tight. Quality loafers and boots will last for years, but the feet change during this time. Many loafers press directly on the bones of the foot.
• High arches with high insteps are especially prone to pressure from above.
• Many people feel they need to tighten their laces because they feel more supported, which is not always the case. Tightening the shoe, right before a run, can aggravate the pressure on the foot, because feet will swell during a run. The foot slides toward the laces as it contacts the ground with each step. This repetitive pressing against the foot and nerve will trigger the pain. The shoes may not feel tight until after the first mile or so.
• Inserting a new orthotic can be a cause. In this case, the foot device raises the foot and the instep presses on the shoe. This may be only experienced in sports shoes. Shoes should be relaced from the very bottom when new orthotics are used. This may seem like a waste of time, but it prevents Yoga Injuries.
• Deeper pain is produced when one or more joints become irritated. This happens when the arch collapses or falls. These joints are like a bridge. The bottom of the joints are stretched and the tops are compressed together, and the pressure causes the bone to thicken, producing bumps on top. This is a good thing up to a point because it blocks further sagging of the joint. After a certain buildup, however, the pressure and extra motion damages the surfaces of the bones within the joint and the pain is similar to that of arthritis. This is a sign that a spur may be present.
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• When there is deeper pain in the joints and there is a bump on the underside, it is often due to the collapse of the “bridge,” with its supporting ligaments. During the gradual fall, the connective tissue pulls on the bones as the joints try to open up. This can stimulate bone growth with arthritic bone spurring on the bottom.
• The first treatment is to remove pressure from the top of the foot in this area. Wear open shoes or sandals during the day. Relace tie shoes so that the laces don’t cross on top of the sore area:
Put the shoe on and press on the tongue area to locate the sore spot. Take the shoelaces out and relace, starting at the bottom. When the laces reach the eyelets at the sore area, pass the lace into the eyelet on the same side as previous without crossing over where the sore area is present. Sometimes this needs to be done for two sets of eyelets because the pain is greater or the eyelets are close together. Relace normally above the sore area. This provides a square patch of the padded tongue of the shoe with no crossing laces over the sore area. If there is doubt about which eyelets are to be blamed, it is the pair just below or directly on top. It is not the pair above the sore spot.
• This elimination of top pressure can help the deeper pain, because the top of the foot is sensitive to any type of pain in this area. If the nerve is irritated, immediate relief may not occur. In this case, continue this lacing pattern for at least a week before trying another lacing plan. Nerves heal very slowly. A sign of progress is often a reduction of pain after the first mile or two.
• Deep pain usually requires support from below using good arch support. Mild cases may heal with better, more supportive shoes and perhaps off-the-shelf orthotics. Elimination of excessive pronation is helpful, but not usually adequate as the only form of treatment.
Pain that Is Deep Inside the Big Toe Joint BIG TOE PAIN