Foot pain for 4 months — TMS or structural? Struggling to fully commit to TMS approach

E

eline

Peer Supporter
Hi everyone,

I have a long history of TMS and have resolved many issues using Sarno's work — including a dramatic recovery from bilateral plantar fasciitis where I was on crutches for months. I'm a skeptical, rational person so I wouldn't believe this if someone else told me, but it happened.

Four months ago I developed a nagging pain on top of my right foot (on the dorsum of the foot, near the front of the ankle, slightly medial.) during a ski vacation. It came on gradually during the skiing days, not from one specific moment. I ignored it and back home continued exercising (high intensity training), which made it worse. Eventually it hurt while walking too.

What's been done so far:

  • 3 different physiotherapists — no clear diagnosis. One suspected a stress fracture, one said just go run and squat, one suspected tendon injury and said avoid all pain
  • Echo: clean, tendons look fine
  • X-ray: no visible stress fracture
  • No swelling, no discoloration (also not in the beginning)
  • One clear pressure point on top of foot
  • Little pain when walking, more pain with rotating foot and push-off movements.
  • Each time I forget and rotate and push off, the pain increases for a few days
  • Today I went to my GP again who told me to simply rest. Which I already have tried a couple of times.
Why I suspect TMS:

  • Classic TMS personality — highly stress sensitive, tendency to suppress emotions
  • Pain started after ski vacation — I was anxious about an upcoming trip as a ski guide where I feared judgment from a more experienced colleague. I might have secretly hoped the injury would get me out of going. It did — I cancelled the trip with mixed feeling
  • Rest hasn't helped much (although I did not rest fully)
Why I can't fully commit to TMS:
  • One physio mentioned possible stress fracture (not confirmed)
  • Pain has increased recently, now also present at rest and increases with certain painfull movements for a few days
  • A friend (ex-physio) gave me a very painful massage on the painfull spot which made things significantly worse for weeks
  • Multiple conflicting medical opinions keeping doubt alive
My question: Has anyone dealt with foot pain like this and successfully treated it as TMS? And how did you deal with the lingering doubt that keeps the cycle going?

Im at a point where I am getting really really sad about this since for me sporting (normally 5 times a week) is super important and without it I get really cranky.

Thanks in advance.
 
"One physio mentioned possible stress fracture" (Not confirmed) - actually totally ruled out. Please see your x-ray comment. Work on the mindset that not everyone is a professional and that not everyone has the skill or ability to diagnose things like a break. It's important to remember that thoughts you have are not truths in the world. Yours just happen to be stuck and ruminating on one person you've seen when you aren't stuck on the other 25 people you saw about this. Notice this and simply keep noticing it. It's OK to have some doubt. It's OK to not be perfect about your approach to TMS.

Pain has increased: yes, you've been considering it might be TMS. The brain is sensing that you are on to it!
You have been paying attention and highly focused on the part of your body that is painful - that can create more and more pain because TMS is doing it's job!

Classic TMS personality — highly stress sensitive, tendency to suppress emotion OK that's a great point to add to your evidence list.

What stress did you have before the ski trip where you experienced some symptoms? What other stress do you have in your daily life? Sometimes it's not just one event but sort of a build up. The ski trip might have been icing on the cake. Your stress bucket completely filled up.

What are you currently doing for your stress: it sounds like all the chasing of medical treatments is creating MORE stress, and not less stress.

It's always good to remember that the "work" we do for TMS especially if you identify with the personality influences is ongoing through our life. If you found that journaling initially helped you overcome earlier TMS symptoms - then it's a great idea to keep some blank paper and a pen around and just journal either daily, weekly or every once and awhile. If you meditated, a regular and perhaps daily meditation practice might be a good option - make these things part of your normal life. I'm not sure what you are considering Sarno's ideas - many people think this is ONLY ignoring symptoms and carrying on with life the way we always did. That is not his prescription at all. He asks us first and formost to examine our emotions and most specifically our hard emotions eg. anger and rage which we are unaware of and not feeling.
How do you feel about your emotions? Do you avoid them like the plague? What other "proof" do you need from outside of yourself to feel more confident? What thoughts do you have about yourself in general: your confidence in yourself that you KNOW yourself?

Also consider that no matter if we are legitimately sick or have structure issues that Sarno's theories can really help us manage, and if things end up purely being TMS then you are already ahead of the game because you have been dealing with the stress, anxiety and OCD-like thinking that can come with TMS.

PS. Foot pain is = to back pain is = to digestive symptoms is = to chronic headache - if you arent' convinced you'll need to re-read Sarno and in specific The Divided Mind.
 
Cactusflower said:
"One physio mentioned possible stress fracture" (Not confirmed) - actually totally ruled out. Please see your x-ray comment. Work on the mindset that not everyone is a professional and that not everyone has the skill or ability to diagnose things like a break. It's important to remember that thoughts you have are not truths in the world. Yours just happen to be stuck and ruminating on one person you've seen when you aren't stuck on the other 25 people you saw about this. Notice this and simply keep noticing it. It's OK to have some doubt. It's OK to not be perfect about your approach to TMS.

Pain has increased: yes, you've been considering it might be TMS. The brain is sensing that you are on to it!
You have been paying attention and highly focused on the part of your body that is painful - that can create more and more pain because TMS is doing it's job!

Classic TMS personality — highly stress sensitive, tendency to suppress emotion OK that's a great point to add to your evidence list.

What stress did you have before the ski trip where you experienced some symptoms? What other stress do you have in your daily life? Sometimes it's not just one event but sort of a build up. The ski trip might have been icing on the cake. Your stress bucket completely filled up.

What are you currently doing for your stress: it sounds like all the chasing of medical treatments is creating MORE stress, and not less stress.

It's always good to remember that the "work" we do for TMS especially if you identify with the personality influences is ongoing through our life. If you found that journaling initially helped you overcome earlier TMS symptoms - then it's a great idea to keep some blank paper and a pen around and just journal either daily, weekly or every once and awhile. If you meditated, a regular and perhaps daily meditation practice might be a good option - make these things part of your normal life. I'm not sure what you are considering Sarno's ideas - many people think this is ONLY ignoring symptoms and carrying on with life the way we always did. That is not his prescription at all. He asks us first and formost to examine our emotions and most specifically our hard emotions eg. anger and rage which we are unaware of and not feeling.
How do you feel about your emotions? Do you avoid them like the plague? What other "proof" do you need from outside of yourself to feel more confident? What thoughts do you have about yourself in general: your confidence in yourself that you KNOW yourself?

Also consider that no matter if we are legitimately sick or have structure issues that Sarno's theories can really help us manage, and if things end up purely being TMS then you are already ahead of the game because you have been dealing with the stress, anxiety and OCD-like thinking that can come with TMS.

PS. Foot pain is = to back pain is = to digestive symptoms is = to chronic headache - if you arent' convinced you'll need to re-read Sarno and in specific The Divided Mind.
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Thanks for your response!

For me so far for all my other TMS symponts, the trick to healing was simply "knowing it is TMS" with 99 percent certainty and resuming normal activity. That is all. So I am pretty sure this will work too this time, the problem is only that I am not 99 percent convinced yet. This because the other times, I kind of "caught" TMS on moments when I thought: Now I have you! For instance the pain started to move around, of the pain got worse from doing nothing. All stuff that would't make sense if it was a real injury. But right know I haven't been able to say: "haha TMS, you are busted!" yet. Thet pain does get worse after moving and only then, so it aligned with what would happen if it was a real injury. So that's why I still think it could be a real injury.

Good suggestion for reading The Divived Mind, I only read his other books. Is there much difference?

Yes I have had X-ray but also heard that X-ray doesn't show minor stress fractures, for that you need an MRI so that's why it is hard for me to rule out the possible stress fracture. Which is like expensive, hard to get and has long waiting lists.

And yes I had/have a lot of stress, I moved to another city one year ago ecause I couldn't really afford a house in my own city, where my work/friends/social network/great city/lots happening is, to a more boring city. I find it hard to settle and miss my old vibrant city a lot and that causes quite some stress alas.. Try to talk about it and doing some stress relief. But the thing is, the best stress relief for me personally is... exercising. Which is hard right now. I stopped played squash which is my absolute favourite sport but hurts a lot and with my HIT training I skip the running parts.
 
JanAtheCPA said:
Another great response from @Cactusflower

Did this include a structured workbook or program?
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No just reading his books a few times and journalling about the pain, and saying: Haha TMS what you are doing right now is ridiculous and doesn't make sense at all (e.g. when the pain started to move around)
 
eline said:
No just reading his books a few times and journalling about the pain,
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I would suggest starting our free Structured Educational Program, which will address the emotions that Dr. Sarno is actually talking about. Knowledge is great, but in our experience (mine is 15 years of observation on this forum) the "knowledge cure" alone works for a while, but under the stress of maturity (home ownership! etc) and with the rather extraordinary circumstances of the last decade, our emotional conflicts create a lot more stress than our brains think we should be allowed to experience - and they ramp up the TMS mechanism and make it MUCH harder to just "think" away with the knowledge alone. Journaling "about the pain" is definitely not deep enough for the kinds of existential stress we're talking about.

The SEP is free of cost, of ads, and even of any kind of registration. You just do it, with a commitment to brutal self-honesty about unconscious emotions that most of us would much rather not get into (because our brains literally think we will get eaten by predators if we're worrying about emotional stuff). It's on the menu at the main page of tmswiki.org. Be sure to review ALL of the recommended introductory materials, and do NOT try to rush it.

Also, the Divided Mind was "my" Sarno book. It's got chapters from six other medical/mental health practitioners.
 

Hi everyone,

First of all, sorry JanAtheCPA for not responding earlier — I thought I had but apparently I didn't!

Quick update for everyone:

After months of struggling, something shifted. I finally got my "busted!" moment — twice in one weekend. Once when I called my ski guiding company to sign up for next winter, and literally within one minute of hanging up my foot started throbbing intensely, something I had never experienced before. And once during an emotional conversation with a friend about suppressing emotions — same thing, sitting still on a terrace, suddenly intense throbbing out of nowhere.

For me personally, that kind of undeniable evidence is what works. Not journaling about emotions, not the structured program — just catching TMS in the act. That's always been my pattern with previous TMS symptoms too.

After that I resumed almost all activity — running, squatting, everything. And wanted to also start squash soon. My foot stil hurt a bit but it didn't get worse by exercising.

But now I'm having a setback.

The last few days the pain is back strongly. What happened: I need to book a ski trip and non-refundable hotels for the coming months, and the stress around that could be a possibility to have triggered a flare. At the same time I've also ramped up my sports again after a period of rest, so I genuinely can't tell if this is TMS using sport as an excuse, or normal adaptation pain from resuming activity, or a real injury after all, or a combination.

My question:

How do I handle a setback like this when I've already had my "busted" moment but the pain comes back anyway?

And a genuine question I'm wrestling with: is it possible that there was a real underlying injury (the orthopedist mentioned sinus tarsi syndrome and gave me a cortisone injection), but that the worst of the pain — the throbbing during emotional moments — was TMS amplifying it? So not purely TMS, but TMS on top of a real but minor structural issue?

Thanks in advance.
 
"setbacks" are common. Whatever this "busted" idea is, it will benefit you to drop it.
As you understand more of the role of the TMS phenomenon, you'll understand why we sometimes get pain. Sometimes that just takes a lot of repetition. You face the triggers to deal with the triggers and they might feel emotional and/or physical.

First thought: OMG, HERE IT IS AGAIN (freakout mode, panic, anxiety - this heightens the nervous system to put you back on high alert. Now your brain has to offer some extra added protections to keep you from all those emotional responses that are "difficult".
Offer: "oh, here you are again, hello. I hear you. What's up?" we usually do the panic thing first, but then you can take a breath and remind yourself this is familiar, and ask yourself what is going on. How do you feel? - You started to inquire when these current sensations started and relate them to very specific events.
Now think about how you FELT about it all. Your emotional response might be to resist the emotions and hard feelings surrounding a trigger, and then slowly over a time (hours, days, weeks - whatever) your body ends up expressing itself to you.

So how do you deal with the current situation: you see the cycles, you notice the resistance, you have compassion and kindness towards yourself, your body and when you have triggers understanding that you still need to do some work - that you are learning the skills to feel your emotions, to soften your reactions, to have kindness and compassion to where you are in life and that you don't need to engage in the things (eg. the "personality traits" Dr. Sarno names) with such intensity. Now to answer your "injury" question. How would a conversation on a phone cause you injury unless it was a mental/emotional "injury"? I mean you were not standing on your head, doing somersaults or climbing a cliff when talking to them, right?
Our brain will simply try and search for the "answer" that best keeps you safe. If it's keeping you safe from your difficult emotional world then it's going to offer you "solutions" that have nothing to do with the stress emotions can cause. Simply asking "what am I feeling" can help us (not always give us an immediate answer) re-focus back to the body, back to allowing the sensations of emotions, letting in the things we resist and offering kindness and compassion to the things that trigger us.
 
@JanAtheCPA and @Cactusflower have answered your questions extremely well.

I'll just add my experience as a long term TMSer who has had many relapses (setbacks, as you call it). Knowledge and acceptance that what you are experiencing is TMS is an important first step in recovery and initially may be all you need. However, it becomes clear over time that it is not enough to maintain recovery. You have to dig deep and uncover and face the emotional component--the WHY do I have TMS. It's difficult and dark and unsettling but it needs to be done for the majority of us.

The SEP is a great recovery program and free on this site. I've done it a couple of times, as well as other structured recovery programs. It takes a daily commitment for a period of time for them to work. You will learn so much about yourself. Try to enjoy the journey.
 
Others have suggested doing "deeper work" and I'll make another point which I am not sure has specifically been stated. Many people have "relapses" of the same symptoms, or different ones which occur months or years after a successful TMS intervention and often when this successful intervention was more like yours: reading and insights, and "ah ha's." When this happens, the direction is to come back to what you did before: the education, insights, ah ha's and add deeper emotional work, however this works for you.
 
Ellen said:
However, it becomes clear over time that it is not enough to maintain recovery. You have to dig deep and uncover and face the emotional component--the WHY do I have TMS. It's difficult and dark and unsettling but it needs to be done for the majority of us.
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Spot on! Was going to type this but perfectly said :)
 
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