While I haven't had the surgery, so I can't provide a direct answer to your question, I do have MN in my left foot. I started having huge problems with it that were bad enough to keep me from running and caused me to not even want to walk much. Went to the doc and got a series (3 I think) of the cortisone shots. With each shot, it would get better for a while and then come back after a month or so. So we started talking about other options like the inserts, alcohol schlorosing, and surgery. And then I started doing a bit of research on my own about the various treatments...

I soon learned that pretty much all of the treatments work for a small percentage of people and most of the treatments don't work for most people. Which ones may or may not work for you seems to be a crap shoot. My mother had the surgery some 20 years ago on both feet and swears by it curing all of her problems. But I still couldn't bring myself to it when the Cochrane review on MN interventions concluded "There is insufficient evidence from randomised controlled trials to assess efficacy of surgical and non-surgical interventions for Morton’s neuroma. More research is needed." And "Adverse events following surgery were common."

With that noted, surgery did seem to be the most likely to actually fix it for a sizable portion of recipients. At least two studies showed 80-96% of recipients had at least a 50% reduction in pain after 3 years. It also seems (but the lack of good studies makes it hard to say with certainty) that the exact method used in the surgery does make a difference in recurrence and relief. I'd recommend you take a look at the Cochrane review and I can PM you a copy if you want.

In addition to the "standard" resection or transaction of the nerve, there are some newer techniques to decompress the nerve in question which, at least according to the practitioners of those techniques but not backed up with any actual studies that I found, provide more consistent relief of symptoms.

Not particularly liking the odds of a surgery that stood a not insignificant chance of ultimately not fixing the problem, I started playing around a lot with my footwear hoping that I could find a magical fix. And I got lucky.

First I started with the doctor recommended ice and ibuprofen to reduce the inflammation in the area. A lot of my research seemed to indicate that, for many prople, the inflamation of the nerve is caused by compression of the foot and joints around the nerve. For me, it turned out that my tight across the forefoot bike shoes (as most are designed to fit) were probably one of the largest contributing factors. So I found some bike shoes with a lot more horizontal room in the forefoot that did't compress my metatarsils and toes. And I also found some running shoes which provided more width and less overall compression in that same area of the foot.

I think that my shoe choice provided the majority of the relief, but I also concentrated on small changes in my running form which provided less impact for my toes when they meet the ground. I had a forfoot/flat foot strike, but I really concentrated on not "slapping" my foot to the ground but instead more on pulling the foot back under me as it "gently" made contact with the ground. This is a gross simplification, but hopefully gets the point across. I've managed to get back to running and haven't had any significant pain from it since last February or March.

Similar experience to the above with two MN. Odds were poor on surgery and other interventions, so went the route of shoe and form modifications. They included:

--cut off the second (bottom) strap of my cycling shoe and stretched out the toe box to create plenty of room;
--substituted a soft running shoe insole for the hard cycling shoe insole;
--added metatarsal foot pads to all my shoes;
--moved the cleats as far back as would go, would use a mid-foot cleat if I could find an affordable one
--avoid a too far forward position on the bike, as this seems to aggravate it
--switched to a running shoe with plenty of room in the toe box, and properly sized (half size larger than the then current shoe) so that the flex in the sole properly lined up
--had the same "foot slap" as the above and eliminated that by working on run form (combination of foot and core strengthening and posture)

Had the help of a great sport doc and PTs with the changes. Within about three-four month period went from searing pain to virtually pain free.

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No coasting in running and no crying in baseball

inhave had mn in past, never surgery. i have gone to podiatrists for it and got shot one time which helped a bit. that was long ago. made sure enough room in toe box as i historically wore tight shoes and feet do seem to get bigger when doing long distance training.

do you have mortons feet? google and check it out. basically second toe longer which causes a cascade of problems. i have had other issues like bad back, itb, etc. when doing research for trigger points there was a section in a book that talked about morton's toe. what amazed me is the solution proposed by the trigger point folks was better than the podiatrists. you bascially support the big toe with a bit of lift. this was totally opposite as podiatrist before orthotics recommended a metatarsal pad where it was placed more in the center of the ball of the foot. while the doctor mentioned morton's neuroma, he never really talked much about morton's toe. and the orthotic he prescribed later, seemed to build support for my high arch and did not address as directly the dynamics of the longer second toe vs big toe.

to make long story short. there is website mortonsfoot.com that has some remedies and they have worked for me. while i can still feel a little bit of the neuroma on occassion, i have been able to able to function much better and i am no spring chichen. currently 64 and have dealt with it since mid 80's.

there is a poster, rroof on this site that might can address the issue much better. i merely add this as maybe an inexpensive test before the surgery.

good luck

After suffering from a serious/large MN for years and managing with shoe choice and inserts, I finally had the surgery 2 years ago. Other than some numbness in the region where the MN was cut out, my foot is 100% back to normal. Zero regrets and a true life-changing event. I had tried the shots and also a treatment to freeze the nerve, but it was all temporary relief. Obviously, this is N=1, but y mlogic was that the MN was so painful, the chances were low that the surgery would make it worse.

I was only off the bike less than 2 weeks, although I remember violating dr's orders on that a bit. I can't remember how soon I could run, but it was probably a month +. I think I was in a boot for 3-4 weeks, but can't recall for sure.

Pete -

A very common problem. In my practice, I'd wager less than 5% of suffers with a TRUE Morton's neuroma (it is frequently misdiagnosed) fail to respond to *something* and elect to undergo surgery (either decompression or nerve resection). The problem is (as you have read, with a very good post as well) people respond to many different things. When you comb the literature, they are simply reporting statistics, using a visual analog pain scale or AOFAS forefoot pain scale, telephone interview, etc. to "success". A skilled specialist should be able to tailor treatment a bit better than trial and error based on the likely etiology of your particular reason for the intermetatarsal nerve entrapment (i.e. long 2nd met as mentioned, compensated forefoot varus/prontation issues, simple shoe gear changes - common in women, but also in cyclists that few docs understand).

Having said all that, nerve resection surgery (done properly) does have the best likelihood for LONG TERM resolution. And for the type-A in us, most are back to running way before 4 months with a dorsal approach resection. Perhaps some others on board that have undergone surgery will respond (though I'm sure you will get more posts regarding "other" treatments).

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

We've treated the issues with a number of different options and used ultrasound to confirm the presence of the neuroma in both feet. The one in my right is fairly large and definitely is the bigger issue... I'm getting new orthotics this week and will probably run for 2-3 weeks in them to see how they are. I've also got some time set up to get custom cycling orthotics. I may put the surgery off until mid-late March so I can see if the new orthotics help make things more manageable.

In terms of my running style, I've always been a bit of a forefoot runner so the shift into Newton's was easy. I really work to run light on my feet with no "slapping" as mentioned by others above..

I went the same path....had it done. Wish I'd a had it done 6 yrs earlier...I feel great, much less pain then those F'n alcohol injections.

Pete, please consider having a nerve release/decompression instead of the traditional surgery. Although two people here have reported success with the traditional surgery (neurectomy), from the many people I have spoken to and read stories about, the traditional surgery isn't that successful, even in "skilled" hands. The reason? When a neuroma is simply cut out, the "new" nerve ending will try to grow back to where it came from (that's how our bodies are programmed), and when it does, it very likely will run into scar tissue, scar tissue that was formed during the creation of that neuroma and scar tissue from the surgery itself. It will then try to insert itself into that scar tissue. When it does, it develops what is known as a "stump" neuroma. A stump neuroma is more painful and much worse than the original condition. I know. I've had four of them done, and each one became a stump neuroma. I had to have more surgery about 8 months later just to correct the other surgeries. I saw a peripheral nerve surgeon (Dr. Lee. Dellon at http://www.Dellon.com) who cut through the bottoms of my arches, released the stumps, divided the nerve branches, and reimplanted the "new" nerve endings into my arch muscles, so they would not grow back and would not grow back into scar tissue creating stumps. That was 4 months ago, and so far, so good. It seems this worked, although I believe I have a possible 5th neuroma (not common, but not unheard of either) that I will have to deal with.

After everything I have gone through with MN these past four years, finally, I am starting to find relief. I had four neuromas, two in each foot. I've had custom-casted orthotics; metatarsal lifts; (1) cortisone shot (the doc stuck the needle all the way through my foot when he HIT the nerve--not a pleasant experience, I assure you); (16) alcohol sclerosing injections; (5) sessions of anagesic shockwave therapy with (8) numbing injections every other session; cryosurgery with (12) numbing injections and four incisions between the fine webbing of the toes and cryoprobes inserted; traditional surgery of all four neuromas; and resection with reimplantation of all four neuromas. All of these injections created more and more scar tissue.

A nerve release/decompression involves cutting the ligament between the toes to free the nerves. I was asked previously if I thought this surgery was drastic. After much thought and experience with MN, I can honestly say, no. A nerve release is not drastic. What is drastic, in comparison, is cutting away the nerve/neuroma.

If you do have the traditional surgery and find that it didn't work for you, please consider finding a doctor who is well trained (Dr. Dellon developed the technique) in doing resections with reimplantation of the nerve ending, as I described here.

Whatever you do, I wish all the best for your outcome. I know what it's like to live with this, and it hasn't been fun.

Please join us at MN Talk at www.MortonsNeuromaTalk.com. It's a new forum dedicated to just this one condition, and there are no others out there that are. There are forums dedicated to MN AND other conditions but not just MN. At MN Talk, you can find a lot of valuable info about different treatment options and learn what types of surgeries to avoid, so you don't end up suffering like I have, and you can talk to others about their experiences as well.

Exhaust all nonoperative methods before surgery. Bummer that the alcohol ablation did not work! My recommendation is to try it again, making sure that the needle is guided by ultrasound.

I agree. Had it done on the left. Results are awesome. Fast recovery. No pain now. Eventually I'll have the right done.

They were done with ultrasound. I was amazed that it didn't hurt as much as I thought it would.

One of the best decisions I ever made. I suffered about 8 years and tried everything possible non-surgically. nothing worked. I couldn't run more than 3 miles without excessive pain and without running there was pain 24/7. Choice was surgery or never run again and try not to walk much. Did the surgery in 2005 in the winter. Raced the next season. Have done marathons and IM since then. I'd much rather have numbness than the constant pain.

Good luck in your decision. It was totally worthwhile for me.

I have had the surgery on both feet (twice on one foot) and I still have Mortons Neuroma. I got a slight improvement (especially when running) but still find cycling over 3 hours or so very painful. I have to have several stops to get my feet up off the ground.

As a previous poster said, the nerve grows back (at least for me it did) so you end up with the same problem.

I was off running for about 12 weeks. No weight bearing at all for the first week or so.

Good luck. I am always interested in other people's ideas so I will watch the thread!

I talked about Morton's Neuroma surgery, and alternatives to it, in a recent podcast. Not transcribed yet, but here's the audio link:

http://www.bengreenfieldfitness.com/...rt-rate-variability/

Hope it helps,

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Ben Greenfield

Nutrition & Human Performance Advice
http://www.bengreenfieldfitness.com

Yep, maybe you can send him one of your "Superhuman Encoder" the science in that thing will fix that Neuroma right up!

I had two neuromas at once in the same foot. They resembled two small tumors on the MRI. I lived with them for a few years with orthotics and wider shoes - particularly for biking. Hot weather made it more uncomfortable. I had two cortisone injections. The first one helped; the second didn't. I finally had them cut out after my first IM race in late 2005. I'm pretty sure I was back to full workouts within four weeks or so- sooner on a stationary bike. I know I ran a marathon in March about four months after the surgery.

The pain is basically gone except during long rides on very hot days. I do have numbness in the foot, but I've trained for and done five IM's and about seven marathons since then without orthotics or pain.

You might try wider shoes, first. That might make surgery unnecessary.

Good luck!

I went the acupuncture route - between the toes where the neuroma was located and then also in the lower leg - both posterior and anterior. That made a huge difference for me. I thought I was going to have to get surgery. I tried cortisone shot, which did not help at all. But the acupuncture probably cleared it up 75% or more with the first few treatments, and I'd say after a summer of doing it, it got it to 90%+ healed, which is where I am now. Do I still feel it? Very, very occasionally. But it's not a limiter in any way.

If you haven't given acupuncture a try, that's my first suggestion. I know people for whom it has not helped, certainly, but it's cheap and easy and non-invasive (long term, anyway, that first treatment feels pretty damn invasive!).

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"Non est ad astra mollis e terris via." - Seneca | rappstar.com | FB - Rappstar Racing | IG - @jordanrapp

Thanks for all the responses... Today when picking up my new orthotics my podiatrist and I were chatting about surgery and we talked about where the pain in my foot was. He wanted to try an additional alcohol shot a little higher (around 1cm further up). Well I can say it hurt like hell (more than any other ones), but shortly after I noticed that the pain in my foot was much lower. Not counting my chickens yet, but it could have been that I killed a good portion of the nerve but didn't get all of it. We are going to monitor it for a couple more weeks and see what happens. Tomorrow I'm going to go for a short run to see how it feels but even walking around on my hardwood floors, I can feel a huge difference.

I had surgery to remove a neuroma in late October and did not have the good fortune that many on here have had. About 6 weeks after my surgery, the incision wouldn't heal and kept getting infected so they went back in to discover that the internal stitches had not dissolved. I'm now 5 weeks after that second surgery and have been biking for 2 weeks and just got on the elliptical yesterday for the first time. I had hoped my foot would feel pretty normal by now, but I still have pain while walking and experience lots of "hot foot" after being on my feet for a while and strangely at night. I bet it will take another 2 weeks before I can run so thats 3 months after the initial removal.

Before the surgery I was very optimistic about a quick recovery but have been disappointed by how long it has taken. I tried cortisone and acupuncture first with no success so thougth this would be the best option. I wouldnt say I regret the surgery, but be prepared for a potentially long recovery with LOTS of time on your couch!

Good luck!

Little update... Yesterday I had the additional alcohol injection slightly higher on my foot. It was an instant change. My foot was a bit sore last night after walking around on a hardwood floor, but I don't expect an overnight change. Today, I went out on what was going to be a 4ish mile run. The first 3 miles was fast (right around 7min/m pace + or - a bit), and my foot was feeling great. I decided to continue to see how my foot would hold up. At about mile 5-6 my foot was a bit sore, but far from in pain. Considering a couple of days before I was in pain at mile 3. At the end of my run, I finished 7.3 miles at about a 7:07min/m average pace. Considering I haven't been running much recently, I was very excited. I'm sure my foot will be a bit sore tomorrow, but I'll go back to zone 2 training for the next few months and see how it goes before electing for surgery.

I got mn several years ago in conjunction with a bout of pf and a bunion (of all things). I am not a doctor, but I found huge relief by getting wider shoes across the board: biking, running, work, play. Any compression in my forefoot or "pointy toes" in my shoes brings on first the bunion pain and then the mn pain.

OP's problem seems more severe than mine, but other sufferers may want to consider the wider shoe route before engaging in other more invasive therapies. This does present a problem for me when buying shoes for cycling, work, or special events because apparently women are supposed to have pointy toes and heels, but I am able to work around it by choosing "sportier" shoes and taking them off when at my desk.

I struggled with MN after the Chicago Marathon 2011 to the point where it was hard to walk. At my sports doctor's recommendation. I switched to wider biking and running shoes. Finished Racine 70.3 and the Chicago Marathon in 2012 with very minor discomfort.

Hi
I've had 4 morton neuromas removed and now feels like all have come back - feels like walking on large blisters. Can you give me the name of surgeon who took our your neuromas?
Many thanks. Julia

First, I have read rroof for a lot of years on slowtwitch and really respect his advice on feet.
Having said that, I have slightly deformed foot and had my neuroma removed 15 years ago after injections, tapings, and inserts did not help. Surgery was the answer for me. Again n=1
I always advise not to take medical advise from the Internet.

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Team Zoot So Cal