Ever had numbness in your toes when exercising?

Patients of mine who use the Stairmaster (probably the worst offender), elliptical, bicycle (including spinning), and even those involved in outdoor sports come to me concerned about their “sleepy foot.”

Before I get to what you can do to help it, let’s look at why it happens. The cause is the stretching of the tibial nerve as it comes down out of the leg, wraps around and behind the medial malleolus, and changes direction as it enters the foot heading out to the toes.

Tension on this tibial nerve is increased dramatically as a result of the increased arch depression forces when someone’s calf is too tight. Typically, I see that flatfooted people are generally more susceptible, only because the stretch of the nerve is even more pronounced.

Despite conventional wisdom, this isn’t a result of pressure from your body weight at all. It’s also not from your circulation being cut off – anyone who tells you this is quite simply misinformed! And it has absolutely nothing to do with diabetic neuropathy! It is a result of over stretching of the nerves – which is why standing is even a culprit. This is exactly where urban myth becomes dictum, so much so that even reputable doctors and reasonable sources just agree and keep it going. What a shame.

It makes me angry when I hear how other docs have recommended more “supportive shoes” or orthotics to reduce this effect. This stuff they recommend is expensive to say the least. Just experimenting with different shoes is about as effective. A heel lift is probably the quickest and most consistent change that will provide quick relief. Also, although it may reduce workout intensity, lowering your incline can help.

There is no doubt that this phenomenon is totally benign and is temporary. True, it’s a nuisance. If you stop the activity, the numbness does go away. If nothing else it is good to know this.

If you want the chance for the numbness to be reduced or eliminated for good, you need to stretch your calves…consistently. That means everyday, people! The nerve stretching at midstance – what’s behind the numbness for those who experience it – occurs in everyone with every step and even as we stand! Why? Because the longitudinal arch sinks towards the floor at midstance, which is natural in humans!

I know what you are thinking right about now. All too often at the point when I’m telling my patients how they’d benefit from a daily calf stretching protocol and why – they usually throw their opinion.

“But doc, aren’t I stretching my calves on the machine, so calf tightness can’t really be the problem, right?”

WRONG! Somehow, someway in the short five minutes since they were first introduced to this concept they have magically transcended to a higher level of understanding and they must inform me of such. This is where I pull out my favorite line, “If I agree you, then we will both be wrong”.

These repetitive exercises actually make the calves tighter. I’ve come to the conclusion that this false belief, that these athletic activities actually stretch your calves, is probably one of the major reasons for non-compliance with calf stretching. People often come back, explain to me that they didn’t add any stretching protocol to their regimen because they’re on the elliptical or Stairmaster, several times per week. But I tell them – like I’m telling you now – that’s quite simply all the more reason you need to take the time to stretch your calves. There is NO substitute!

Ever been told you needed more supportive (aka pricey) shoes or orthotics to alleviate the pain? Or have a topic you’d like me to address? Let me know @AngryOrthopod or on Facebook.

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