Looking for advice: shifter toe pain

[sib]

The diagnosis is in, kinda:  doc thinks it was a case of gout brought on by the stress injury from upshifting to often and too vigorously with inadequate boots.  It's been a whole week and the pain and swelling still haven't completely subsided, but are very much better than at the worst.  Relief required a serious opiate, hydrocodone, plus an anti-inflamatory, colchicine.  When it was measured, my blood uric acid level was high, but not extremely so, therefore the gout diagnosis remains uncertain.

Anyway, I'll be getting a new pair of boots soon, with hard (probably steel) toe caps.

Many thanks for all the advice and informative comments.

[Tobit]

I had a similar pain problem,  Dr. diagnosed it as arthritis (a cousin to gout).  Celebrex is now my friend.  My pain was at the ball of the foot and I was blaming it on my boots.  At 69 I'm too young for this crap!
Peter Y.

I was thinking arthritis.  Aleve is my friend when my knees and hands flare up.  As far as toes, do use the heel-toe shifter.  The only bike I've had one on was my '90 Cal III Touring and I quickly fell in love with stomping my heel instead of fishing my toe between the floorboard and shifter.

Check your linkage too.  Speaking for my own bike, the LeMans IV which admittedly has an entirely different shifting linkage, upshifting is like moving a well oiled spring with my toe.  No crunch or other hard motion. 

"Inadequate" boots or other footwear don't help.  Fwiw, I've moved away from "motorcycle" boots to a good high-topped hiking style waterproof work boot.

Tobit

[pehayes]

Take it from one who suffers the occasional attack.  It was GOUT.  When a big attack hits, you'll be looking for a hatchet to chop it off.  Too much uric acid in your blood stream.  The acid forms microscopic crystals, like glass needles.  Those crystals can't make the u-turns in your toe and they begin to shred surrounding tissue.  I'd bet the pain was the worst in the knuckle of your toe.  Takes some serious dietary and lifestyle changes to keep it under control.  Usually subsides in a day or two and then totally after a week or more.  The diet changes are very odd.  Some otherwise healthy foods are high on the list of taboo.  Leafy greens like spinach, whole grains, etc.  Top two are scallops and asparagus.  No alcohol, no coffee, no sweets.  Basic rule: if it tastes good, spit it out!  Sorry.

People who don't get gout are not cognizant of the pain level that can be generated by one toe.  I once found a website that listed a wide variety of ways to commit suicide.  One of the suggestions was to find a person with a gout attack and then step on THEIR toe until YOU stop breathing.

Patrick Hayes
Fremont CA

[Kent in Upstate NY]

Make sure you get wide boots. That extra amount of room for your toes can make a lot of difference.

[Steve Scott]

I feel (literally) your pain. I'm a gout sufferer too. I envy those who can pinpoint a trigger for their gout attacks, diet and weight loss made no difference at all for me. Indomethacin worked quickly and effectively the first few times, but not as well lately. I've had the best luck so far with just plain old water. Apparently chronic dehydration, especially when accompanied by strenuous exercising (cycling, speed skating, out-of-position welding in a 130F whey-drying tower for entire 8 hour shifts, wrenching on Italian motorcycles, etc.) can allow uric acid levels to get out of control. Just my $0.02

For those who haven't had the pleasure of a gout attack, a heel-toe shifter wouldn't work. Downward pressure on the toe area is intolerable too. In fact, when mine is 'hot', I can't stand a bedsheet on it. A sock is possible but only slowly and carefully, and a shoe is out of the question. Boots? I wouldn't even want to think about putting a boot on.

Kidney stones... When they get stuck in your ureter is when you get to enjoy the legendary on-your-hand-and-knees-can't-talk-puking-your-guts-out-on-the-waiting-room-floor pain! Even if it scrapes a bit, finally passing a uric acid stone after a few days of that is like.. the best day ever!

[pehayes]

I feel (literally) your pain. I'm a gout sufferer too. I envy those who can pinpoint a trigger for their gout attacks, diet and weight loss made no difference at all for me. Indomethacin worked quickly and effectively the first few times, but not as well lately. I've had the best luck so far with just plain old water.

A couple of other homeopathic relief remedies include lots of cherry juice and eating 8 bananas a day.  I don't know what the cherry juice does, but the potassium in the bananas serves to buffer out the uric acid.

Patrick Hayes
Fremont CA

[sib]

A couple of other homeopathic relief remedies include lots of cherry juice and eating 8 bananas a day.  I don't know what the cherry juice does, but the potassium in the bananas serves to buffer out the uric acid.

Patrick Hayes
Fremont CA

I imagine those 8 bananas/day would keep me on the toilet instead of the motorcycle seat, so, in a way, yes, a fix for my shifting toe problem, but not the one I'd prefer.

[redrider90]

Your describe pain but leave out important diagnostic indicators that would help with a treatment/prevention.
Are you experiencing pain on the top of the toe from pressure of the shifter or are you experiencing pain in the big joint called the 1st MTP joint?
If you are experiencing joint pain then most likely the source is overuse or arthritic. This is a result of pushing the joint into its end range as you pull up with your forefoot. If the problem is caused by excessive pressure from overuse then you need padding over the toe.
A solid boot that has a strong sole will provide a thick interface that reduces pressure on the top of the foot. Also a solid thick soled boot is stronger and will resist bending when shifting.
Another thing you can do is tape the toe with athletic tape or a couple of bandaids.
If your pain is on the bottom of your foot under that ball of the 1st metatarsal then you could very well have a different problem. There are 2 tiny little bones call sesamoids on the bottom (plantar) surface of the foot that when inflamed can cause considerable grief. If this the your problem it is a result of the shifter forcing the top of your foot into the shoe and putting pressure on the bottom of the "ball" of you 1st metatarsal resulting in sesamoiditis which is an inflammation of the tiny bones.  That is a more difficult problem to fix (I suggest icing it for starters. In fact ice will help for all of the above.) 
One more source is the large tendon called the extensor halluci longus which is the muscle tendon that picks up you large toe. That tendon can become inflamed from overuse or inflamed from excessive pressure from the shifter mechanism. Again taping might help if this is the problem.
I never could understand from the thread where you are experiencing pain. I may have missed it or maybe you were not explicit where it hurts. But It would be helpful to be precise about where the pain is and how walking makes it worse.

[redrider90]

For the last couple years I've had to move my leg to up-shift and my foot didn't hurt at the time. Eventually my leg started to hurt on and off. I was getting al sorts of advice at the gym as to how to stretch it out. Nothing helped and it slowly got worse. Big toe and inside of my left foot didn't hurt much but was always had pins and needle's like it was sleeping. Then I noticed when walking the left foot kinda flopped down. I couldn't stand on m heels. Went to Mayo Clinic(I live in Rochester) and two weeks ago I had surgery to remove some of disk to keep from putting pressure on nerves between vertebra 5 & 6( I've got one extra). Leg pain was immediately gone . If anything don't wait. I waited long enough that some of the damage done to foot and leg may be permanent. I have to wait up to two years to find out. I have heel toe shifter with pegs and couldn't shift without it. Thinking about adding floorboards to my California.

You are describing something totally different than the OP. The motor nerve that fires your anterior tibials muscle was pinched in your spinal cord. The foot slap was a result of the inability of the anterior tibials muscle to be innervated because the electrical impulse was not able to fire the muscle due to nerve impingement that lead to a lack of blood flow.  The leg pain was a result of a sensory nerve that was also impinged by the disk. It can take quite a long time for you to recover the motor nerve to heal.  But from what sib is describing it is nothing like what you have experienced.

[Penderic]

Oooh Ooooh! The new shift sock colors are here!




They are only a couple of bucks each ... cheap! I guess they wear out fast. The more expensive ones have better materials and styles ... some have ribs for more comfortable shifting.




Im gonna order a bunch and test em. I worry if makes it more difficult to shift. Hmmmm. 

[sib]

I'm the OP, and I can now report that after a whole month, things have mostly resolved.  The precipitating event was probably my getting a new V7-II bike back in May, which has a shorter shift throw and abrupt stops at the ends of the shifting range, compared to my previous '13 V7.  I must have been trying to shift it like the older 5-sp, and overstressed my foot.  There's still no definitive answer on what the actual medical diagnosis is, but the solution for me was a new pair of boots with a hard toe area.  (Just to be thorough, I'm still taking allopurinol in case part of the original problem was gout.)  My previous boots, Alpinestars S-MX1, were very comfortable but the toe area was quite soft.  My new ones are First Gear Mesh Lo boots. They have a very hard toe area that I can use for upshifting without putting any concentrated pressure on my big toe joint.  The boots are also very comfortable.  My only (minor) complaint is that the top velcro flap can get in the way and make tightening the laces a bit inconvenient.  Now I'm in the market for  pair of cool weather boots, higher and warmer, but not necessarily waterproof (I'm a wimp, when it rains, I take the car).  I'm looking at Sedici Lorenzo ($128) and Dainese Grip ($220) boots, both sold by Cycle Gear.  Recommendations?

[Tom]

I have some Rescue Tape that can be wrapped around the shift lever.  It's a silicone tape that can be used other purposes too.  Different colors and at Ace Hardware.

http://www.rescuetape.com/