The Phantom Heat’s Arrival

It begins without a shadow. Most physical pains are understandable from a mechanism-of-injury perspective. A box triggers a back protest. A marathon injury sparks a joint’s agony. With injury, there is a receipt. But burning the forefoot, or “metatarsal fire,” is a different beast. It behaves less like a physical injury and behaves more like a phantom, haunting an individual shoe at its own whim.

One minute, everything is fine. Walking in a store or sitting at a desk. In the next, it feels like someone placed a burning piece of coal inside. There is no redness, no bruising or swelling. No one can see the burning coals through the skin. And no evidence of injury exists to capture. To the world, someone is just standing. In the zone. To the individual, there is a burning fire in the foot. It is a localized event. And almost random to the outside world.

The ‘pain point’ is arguably the most unfortunate part of such an experience and also its most prominent. It creates a state of almost permanent hyper-vigilance. You can never settle into your own body, as you are always subconsciously braced for the next flicker of heat.

The Limits of Diagnostic Criteria

An unprecedented age of ‘high-definition’ medicine has emerged. We have neurologic imaging that provides insight into individual nerves and laboratory evaluations that can quantify and qualify an elemental level of a substance. Though advances have been made at unprecedented rates, when patients experience burning in the forefoot, they often feel like they are encountering a ‘black box’ when seeking explainable and justifiable care in a healthcare system dominated by metrics. Modern healthcare architecture favors the acute and the obvious, the broken or the bleeding, and the measurably diseased. It is not constructed for the ‘disturbing.’

The ‘Threshold of Seriousness’ is a pertinent starting point. If you are not limping and your foot is not ashen, and you are not functionally incapacitated, you fall into the ‘Functional Gap’. A burning foot, as vague as it sounds, is not worth a specialist’s time. To avoid the advancing of a formal diagnosis, ‘watch it’ is a common recommendation along with ‘reduce your stress.’ Secondary suffering is the social pain of being disregarded. The effort to differential diagnose Morton’s Neuroma from a circulatory dysfunction, or a peripheral neuropathy is likely to be both cost prohibitive and burdensome.

Most people accept that asking “why” is more of a burden than the actual pain.

The Philosophy of the Pill

This brings me to pills, which are viewed as a sign of failure to heal and a lazy approach to high-end wellness and the “root-cause” approach medicine. We are instructed to “repair the posture” or “realign the gait.” However, taking a pill is a form of quiet rebellion. It is an act of defiance to a temporary nervous system issue that blocks the flow of work during an afternoon.

The burning pain that occurs disrupts numerous aspects of my life, whether that means getting work done, eating, or anything else. When the pain disrupts my life, it is not a mask; it is a way of taking control of the situation. I choose to take a pain reliever, and I do that because I want to have control over my own time, and not let it be taken by my body and the burning pain. I am at war with the pain, and the pill is a temporary peace treaty. My issue is not with losing the focus to the pain, but most relievers shut up the burning pain for a few hours so I am not using my time to be present and get things done. I don’t have the time or luxury to be a medical enigma. My living my life means I need to be able to walk to the car without pain.

The Mental Load of the “Quiet Scan”

Usually, I don’t tend to feel the random pains of my body each day, as my mind treats each of these as an important system notification, and initiates the appropriate background tasks. Neurologically speaking, each of these random pains initiates an involuntary process. Even when my feet feel cool to the touch and normal, I still subconsciously feel the pain of my feet burning and have to calm myself: “don’t think about it, don’t think about it.”

The mental load of negotiating with the pain before it becomes a visible disturbance is the real exhaustion of those who suffer. People who suffer from “invisible” illnesses, such as myself, do not only suffer the act of the actual pain, but the mental load of engaging with an invisible enemy. Having to always have an “exit strategy” is formal “invisible” pain as a type of disability. When people go to an event, I look for chairs not because I’m tired, but I’m doing it of my own private frontline position in the event of a “disturbance”. This constant, hidden emotional pain preparation is something that people with “predictable” health issues do not seem to deal with; people who know when and why their body will hurt.

The Trouble with Saying ‘I’m Fine’

Experiencing bodily pain that other people cannot see, pain that isn’t serious enough to be visible, often results in a social isolation that can be psychologically damaging. A person in a leg cast, for example, is given social sympathy and recognition. However, when my forefeet are burning, I am expected to be active and engaging with people. A part of my brain is literally preoccupied by a “screaming” pain stimulus and I am supposed to perform at my best. “Silence syndrome” can occur, in which the individual suffering from pain becomes silent to avoid social perception of being overly dramatic, or having a chronic illness, or the ideology of being a hypochondriac.

While that pain is still there, and I have the discomfort that comes with hiding an injury, I have to do it to avoid the social stigma associated with injury. I have to do it to avoid the perception of whining or complaining. People have to learn to deal with the discomfort and injurious pain that often result from mental and social pressure. Every time a pain stimulus is masked with a painkiller, every time the stimulus is rendered silent, the person hiding the stimulus is managing a psychological injury.

The Reclamation: Beyond the Diagnosis

The most radical thing I can do in a battle of the permanent ‘cure’ is to accept the ‘truce.’ Quality of life, in my view, is not the absence of all pain. It is the ability to focus on what I truly enjoy.

When I use pain control to address a singular disruption, I am reclaiming agency from a healthcare system that doesn’t entertain the ‘minor’ stuff. I am stating that my day—my work, my family, my peace—is more important to me than the mysterious ‘whatever’ that is underpinning the feeling. Unraveling the ‘why’ of the burning sensation in the forefoot may never happen. It could be a wiring fault, a leftover from a previous injury, or an undiscovered biological enigma—who knows. But in recognition of the experience and the name ‘Ghost in the Shoes,’ I am bringing the pain out of the shadow. And I am aware that I am not the only inhabitant of this ‘Middle Ground.’ There are a lot of us, a lot in the ‘quiet’ who hope to just keep the pain ‘fire’ at a tolerable level long enough to live a meaningful life.