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People who have had surgery for Morton's Neuroma
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I'm interested in some opinions on this. I've been out of running for the last 6-7 months with a foot injury. I've had x-rays, mri, diagnostic ultrasound, nuclear bone scan, etc. I've seen >>5 doctors - sports med, podiatrists, and orthapedic. From what I gather, I most likely have morton's neuroma, although none of the tests show this clinically. I've had 2 cortisone shots (1 ultrasound guided), both which were completely ineffective. I still feel a sharp pain in the middle of my foot every time I land with any impact. At this point, I'm considering surgery, but as a last resort. Here's a list of stuff I've tried and haven't tried...

Tried:
Metatarsal pad - tried this and it gave some relief, but not the answer.
Less barefoot walking around the house - same thing.
Ice - not sure that icing helps at all.
Physical therapy - seemed to help my strength, but more injury prevention for next time, not helping the injury I had.
Boot - I spent about 4 weeks in a boot trying to stay off it. This made my forefoot feel better, but also gave me achilles tendonitis (went away in less than a week). In the long run, I don't think this helped.
New (wider) shoes - This may have been the most effective thing I've done. I got wider running shoes and wider cycling shoes. Both seem to help, but still don't seem to make the problem go away.
Cortisone injection - ineffective.

Stuff I haven't tried yet:
Lacing the shoelaces upside down - seems silly, but the silly stuff has worked best so far.
Acupuncture - I've had > 3 people recommend acupuncture. Not sure if there is real science behind this. Most doctors completely dismiss this.
Shockwave therapy - looking to learn more.
Radiofrequency - looking to learn more.
EPAT - looking to learn more.
Alcohol injection - worried about permanent numbness and many of the same concerns as surgery. If I'm going to go this route, I'd rather lose another couple weeks (with surgery) and be sure that it's effective.
Surgery - my understanding of this is that they physically remove the nerve or nerve bundles that are causing the problem.

Concerns re: surgery and alcohol injection:
Is surgery a guarantee to eliminate the pain?
If you have surgery, will you be able to run again?
What are the side effects? Will there be permanent numbness or anything else that would make running more difficult?
What is the recovery?

I'm interested to hear opinions from any doctors (sports, pod, ortho) out there who are familiar with this, and also from anyone who has had any of the more aggressive treatments that I haven't tried yet.

_______________________________________________________
John Kenny, Pro Triathlete, USAT Certified Coach - http://www.frenchcreekracing.com
Philly Masters and Open Water
Swim and Multisport Events
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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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I delt with this a couple years ago, my MN felt like a small sharp rock under the balls of my feet between the 3rd & 4th metatarsal. Went to my first podiatrists and he sold me $425.00 custom orthotics which were totally ineffective and waist of money. Went to my second podiatrists and he recommended alcohol injections, had five in each foot one week appart and my MN totally went away and that was 2.5 years ago. No numbness. I will warn you though, these injections hurt like hell!!! but for was totally worth it.

Good Luck!
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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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Try everything, have sugary, 4 mo.s for recovery.........
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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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I've had two flare ups of Morton's neuroma within the past two years. Your case is obviously much more persistent and serious than mine was, but here's a suggestion.


I tried pretty much everything you did: wider shoes, rest, ice, NSAIDs, metatarsal pad, an athletic therapy app't and minimizing barefoot walking. One thing that you didn't mention that I found more effective than everything else was a tapping/padding technique. It took some experimentation to get things right. This is the procedure I used:


Using athletic tape, tightly secure the 3rd toe to the 2nd toe and the 4th toe to the 5th toe. This should create a v-shaped gap between the 3rd and 4th toes (I assume that this is the location of your neuroma.). Cram a lot of soft padding in this gap and lightly hold it in place with more tape. The tape shouldn't compress the toes together at all. For padding, I used women's makeup remover pads which were conveniently wedge shaped and very soft. Keep this on 24/7 (even at night) and change it when the padding gets squashed or the tape starts to give. This virtually eliminated the sharp shooting pain I felt when toeing off. Good luck!

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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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I had symptoms that lasted even longer than yours that I was too stubborn to take care of it. Ultimately went the surgery route after using some of the methods you tried using to alleviate the pain. In my experience, the recovery wasn't as bad as I was told it would be. I was on the bike, indoors only with foot on top of the shoe (trust me, you don't want to have your foot inside anything for the 1st week.), after one week. I was running and swimming by day 16 post surgery. I had the surgery on both feet at different times and the recovery was the same for both. To answer your questions:

1. I don't believe there is a guarantee but with the research I did, I did not have anyone say that it didn't eliminate their pain.
2. Running again is a guarantee. It feels amazing to do it again once you've had this painful thing removed!
3. No side effects that I know of. I do not have any numbness. I just don't have pain in that area.
4. Recovery-see above.

On another note, my doc said there is always a chance that the neuroma can grow back. He told me it was something in the 20% range. I had my surgeries in 2003 and 2004 and nothing has grown back for me. Good luck.
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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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My only concern with your post is that you had a nuclear bone scan and MRI for a VERY common pathology.

This sends off an alarm bell that whoever ordered that (assuming somewhat competent) they thought you had something else. The good news is that they (bone scan that is) are negative I assume and rules out some of the bad possibilities. A Morton's neuroma should be more of a clinical diagnosis, sometimes seen on MRI, but not always depending on how the MRI cuts fell.

I don't do many neuroma surgeries any longer since they usually respond to some type of conservative treatment, but some don't. The surgery has been done since the turn of the century, so plenty of follow-up ;-) You will be able to run/resume activities as before and most do not notice any numbness at all. There are 4 nerves that innervate each toe and you will only be "missing" one of them (on the adjacent sides of the 3rd and 4th toes). The biggest complication of surgery would be a "stump neuroma" (recurrence) which is not that unusual. Of course, this takes years to form and then you are no worse then before anyway.

ETOH (alcohol) injections can accomplish the same thing by sclerosing the nerve and I find them effective in about 70% of patients. I generally recommend this for type-A athletes over surgery since you can "train through" treatment. They do hurt to get, but only for a few secs - not much worse than your previous steroid injection. Drawback here is the lower success rate (vs. surgery) but no real side effects at all other than some more lost time dealing with your neuroma.

Cryo or radiofrequency ablation accomplishes the same thing as ETOH or surgery. I don't do because if it "gets that far", I prefer the resection surgery since it is more predictable (we don't have good long term data on Cryo/radio/etc.) and minimal dissection/trauma (assuming surgery from the top, not the old fashioned plantar incision).

Hope this helps some!

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: People who have had surgery for Morton's Neuroma [rroof] [ In reply to ]
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For the most part, I agree with rroof; however, I'm much more reluctant to excise the nerve. Should a "stump" neuroma develop following excision, it may actually be worse off than the original neuroma and much more difficult to treat; revisional surgery isn't something anyone wants to go through.

It sounds like most conservative measures have been attempted; I personally don't do ETOH injections so I can't provide personal experience.

For my patients that ultimately get to the point of requiring surgery, I will always offer them the option to have an Endoscopic Plantar Digital Nerve decompression...this is a minimally invasive procedure entailing release of the overlying deep transverse intermetatarsal ligament and can alleviate pressure on the nerve, without actually damaging the nerve (similar to the minimally invasive carpal tunnel release). Approximately 80% of patients will have symptomatic relief and you avoid the risk of developing a stump neuroma. In addition, you haven't burnt any bridges and can always excise the nerve in the future if necessary.
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Re: People who have had surgery for Morton's Neuroma [rroof] [ In reply to ]
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rroof wrote:
My only concern with your post is that you had a nuclear bone scan and MRI for a VERY common pathology.

This sends off an alarm bell that whoever ordered that (assuming somewhat competent) they thought you had something else. The good news is that they (bone scan that is) are negative I assume and rules out some of the bad possibilities. A Morton's neuroma should be more of a clinical diagnosis, sometimes seen on MRI, but not always depending on how the MRI cuts fell.

I don't do many neuroma surgeries any longer since they usually respond to some type of conservative treatment, but some don't. The surgery has been done since the turn of the century, so plenty of follow-up ;-) You will be able to run/resume activities as before and most do not notice any numbness at all. There are 4 nerves that innervate each toe and you will only be "missing" one of them (on the adjacent sides of the 3rd and 4th toes). The biggest complication of surgery would be a "stump neuroma" (recurrence) which is not that unusual. Of course, this takes years to form and then you are no worse then before anyway.

ETOH (alcohol) injections can accomplish the same thing by sclerosing the nerve and I find them effective in about 70% of patients. I generally recommend this for type-A athletes over surgery since you can "train through" treatment. They do hurt to get, but only for a few secs - not much worse than your previous steroid injection. Drawback here is the lower success rate (vs. surgery) but no real side effects at all other than some more lost time dealing with your neuroma.

Cryo or radiofrequency ablation accomplishes the same thing as ETOH or surgery. I don't do because if it "gets that far", I prefer the resection surgery since it is more predictable (we don't have good long term data on Cryo/radio/etc.) and minimal dissection/trauma (assuming surgery from the top, not the old fashioned plantar incision).

Hope this helps some!

Rod,

I have had quite a few patients request crysurgery after doing the internet research. I assume the cryosurgery guys are doing a good job in scaring them off from the chemical sclerosing and surgical options. I do not know personally any surgeons doing the cryosurgical ablation. . Is this a common option for treatment in your area?
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Re: People who have had surgery for Morton's Neuroma [nickwisconsin] [ In reply to ]
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I don't do cryosurgery. Not entirely against it, but there just isn't enough data to support its use yet in my mind. Also, IMHO, most of the guys doing cyro for this do so in their office which may imply a couple of things: #1 They bought the cryo machine/probes (not cheap at 25K+) so they tend to do more and certainly "think" it works or worse yet #2 do only office based surgery (not hospital privileged).


I used to do the EDIN procedure as well (Endoscopic Decompression of an Intermetatarsal Neuroma), but didn't find it terribly effective and many went on to traditional neuroma resection surgery anyway (although it certainly makes sense since it is similar to a carpal tunnel procedure, but the recurrence rate/forces on the forefoot are much greater than the wrist).

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: People who have had surgery for Morton's Neuroma [teamheadwind] [ In reply to ]
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Are the alcohol injections more painful than the cortisone injections?
I would think that killing a nerve or removing it would cause a different sensation that you'd be accustomed to (numbness, pressure, lack of feeling, etc.). I guess not for you?

_______________________________________________________
John Kenny, Pro Triathlete, USAT Certified Coach - http://www.frenchcreekracing.com
Philly Masters and Open Water
Swim and Multisport Events
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Re: People who have had surgery for Morton's Neuroma [endorphin] [ In reply to ]
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Interesting. Wouldn't this be effectively the same thing as using "yoga toes" or similar products? I've had at least 2 of my podiatrists specifically warn me NOT to use yoga toes as they do the opposite of what I want.

_______________________________________________________
John Kenny, Pro Triathlete, USAT Certified Coach - http://www.frenchcreekracing.com
Philly Masters and Open Water
Swim and Multisport Events
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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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suffered for 6 years with a Morton's Neuroma - 5 cortisone shots with varied results (at best one gave me 5 months pain free) and then finally had surgery. Stayed off running for one month afterwards - no numbness - no more pain - life is great. Should have done the surgery much, much sooner.
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Re: People who have had surgery for Morton's Neuroma [marathoner31] [ In reply to ]
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Did you get this on both feet even though you only had syptoms in one foot? Ironically, my symptons (inflammation, etc.) are present between the 2nd and 3rd metatarsal in addition to between the 3rd and 4th. So, I'm thinking I need to have 2 of them removed.

_______________________________________________________
John Kenny, Pro Triathlete, USAT Certified Coach - http://www.frenchcreekracing.com
Philly Masters and Open Water
Swim and Multisport Events
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Re: People who have had surgery for Morton's Neuroma [rroof] [ In reply to ]
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Well, I had the X-ray first thinking it was my typical metatarsal stress fracture that I've had more than twice. That was negative. MRI showed some "ganglion cysts" but it did not correspond clinically to what/where (it) was actually bothering me. Then, I got a cortisone injection. Then, I got a diagnostic ultrasound which showed what they called bursitis. Ironically, the treatment recommendation was the same, another ultrasound guided cortisone injection. After none of this stuff worked, two of my doctors suspected that I may in fact still have a stress fracture that didn't show up on anything. So, I got the bone scan, and it showed nothing that corresponded with my symptoms clinically.

I've been out of running for 6 months and the 2 months before that, I was in severe pain. I'm not the type A in the sense that if my doctor says taking off another month will help, I can trust him and take off that month. That being said, it sounds like the surgery is a better option than alcohol, radio frequency, and the like. In fact, if it's as much of a sure thing as everyone says, why not just have all of those nerves removed in one shot? I'm kind of tired of messing around with treatments and getting no relief.

_______________________________________________________
John Kenny, Pro Triathlete, USAT Certified Coach - http://www.frenchcreekracing.com
Philly Masters and Open Water
Swim and Multisport Events
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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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The basic idea is like "yoga toes", except this technique only creates a separation between the critical toes and it enables precise control over the spacing. Also, I suspect that an underlying cause of my Morton's may be that my 3rd toe is a pretty bad hammer toe. Tightly binding it to the 2nd toe allowed me to straighten it out some.

I would be surprised if a podiatrist advised against this technique. The benefit seems pretty clear: it splays the 3rd/4th metatarsals apart taking pressure off the neuroma. I'm no expert, but that seems pretty straightforward.

CodyBeals.com | Instagram | TikTok
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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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I had inflammation and pain between my 3rd and 4th that lasted for 6 months, despite no running (still biked and swam). Walking on the hardwood floor in the morning- felt like a had half a golf ball underneath my foot. Had X-rays, MRI, and physical examination. The orthopod ultimately didn't know what the problem was. Who knows how relevant and/or similar to your situation this is. However, I will say what ended up helping me was a wedge in my cycling shoe. I was able to transfer/balance out the stress on my forefoot. The wedge propped up the ball of my foot, reducing stress on the outside of my foot and felt much more comfortable. The doctor was convinced the problem was impact related, but I think the bike was the cause. Again, may or may not have relevance to you, just would suggest thinking critically about the bike as possible source of or contributor to the problem. N=1
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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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I ran for over 15 years on my neuroma. Many techniques were used to avoid surgery.

After finally having the neuroma removed surgically last July, I only wish that I hadn't waited so long.

DFL > DNF > DNS
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Re: People who have had surgery for Morton's Neuroma [SallyShortyPnts] [ In reply to ]
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It's funny you say that. I'm getting two opinions, generally. 1. The opinion you've given me where surgery was great and worked 100%, highly recommended. 2. Do whatever you can to avoid surgery because it could have other complications - later developing a stump neuroma, etc.

_______________________________________________________
John Kenny, Pro Triathlete, USAT Certified Coach - http://www.frenchcreekracing.com
Philly Masters and Open Water
Swim and Multisport Events
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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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I've had both regular surgery and cryosurgery. I had regular surgery because I had a bunion removed and the Dr. just did the neuroma at the same time - no problems at all with either. Then the neuroma flared up in the other foot - I had bunion surgery on that foot also, but the neuroma didn't bother me at that point. When it did, the Dr. suggested the cryo over regular surgery because it's less invasive and I could just walk out of the office after it and only wait a week or so before running, etc. That was about 2 years ago and only lately I've had minor flare-ups. If it gets worse, I wouldn't hesitate to go back for cryo-surgery again.
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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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jkenny5150 wrote:
It's funny you say that. I'm getting two opinions, generally. 1. The opinion you've given me where surgery was great and worked 100%, highly recommended. 2. Do whatever you can to avoid surgery because it could have other complications - later developing a stump neuroma, etc.



If something else happens, such as a stump neuroma, then I'll deal with it as it comes. Having no pain is its own reward! As I age, other body parts hurt more than before. Repair and maintenance is more time-consuming than it used to be, so if I have to have bunion surgery next, then so be it.

DFL > DNF > DNS
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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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I've never had cortisone injections only the alcohol. They just really hurt while getting them, not after. Looks like you have a big decision, but for me I'm very happy going with the alcohol shots.
Good luck with whatever you decide!
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Re: People who have had surgery for Morton's Neuroma [jkenny5150] [ In reply to ]
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I've had neuromas in both feet since 1974..

What's worked well is a trick Johnny Halberstadt at the Boulder Running Co. showed me: cut a small circle of orthopaedic felt and stick it to the bottom of the inner of the shoe, just behind the metatarsals. It usually takes a few tries with each new pair of shoes to get the pad situated just right, but once it's there, it lifts and separates the metatarsals and relieves the pressure on the neuroma. This helps with the pain and helps prevent further damage. Placement of the pads is critical - this is why a consumer product probably won't work. A custom orthotic might, but the ones I got were worthless. Doing it yourself allows for cheap trial-and-error until the pads are exactly right. Pain-free running (well, no neuroma pain, other pains in plenty ;-) since 1998..

I use these inserts in all my work and casual shoes:
http://www.footsmart.com/...oductId=96&cmx=Y

As you've found, it's critical to have plenty of room in the toe box of ALL your shoes, running, bike, and work/casual. Compression of the metatarsals is a factor in this injury. Also make sure to get running shoes with excellent forefoot cushion, that's the primary characteristic I look for; and replace them often.

Instead of upside-down lacing, just relace to leave out the bottom 3-4 eyelets altogether. I have also at times resorted to a utility knife and cut a couple of 1" slits in the upper, above the metatarsals, to relieve pressure.

For the surgery,
http://www.ncbi.nlm.nih.gov/...p;list_uids=11568193
65% pain-free after 5 years, but the same percentage have mild or major shoe-wear restrictions.
Those odds aren't good enough for me.
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Re: People who have had surgery for Morton's Neuroma [doug in co] [ In reply to ]
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You might want to read that study yourself since 85% of those that followed up after almost 6 years report excellent to good results. Also just one study. Others even higher still (and others lower of course). Also, most long term follow ups have LESS good than bad results patients actually following up. And, this was a VERY small study of 66 patients.

Your met pad solution has been around forever and works for many and I highly recommend. I'll assume the OP has tried? Besides, why on earth would even consider surgery if a simple met pad solution has worked?

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
Last edited by: rroof: May 7, 12 10:00
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Re: People who have had surgery for Morton's Neuroma [rroof] [ In reply to ]
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rroof wrote:
You might want to read that study yourself since 85% of those that followed up after almost 6 years report excellent to good results. Also just one study. Others even higher still (and others lower of course). Also, most long term follow ups have LESS good than bad results patients actually following up. And, this was a VERY small study of 66 patients.

Your met pad solution has been around forever and works for many and I highly recommend. I'll assume the OP has tried? Besides, why on earth would even consider surgery if a simple met pad solution has worked?

I'm quoting from the pubmed summary of the study for the 65% number - did they get it wrong ?
Numbers of other studies do get up to 80% satisfaction, but those I've seen also all report shoe-wear restrictions for 60-70%. My judgement only - OP can research for hours happily in pubmed ;-) that study is just a place to start.

I assumed the OP had not tried this specific solution since I've never seen it described anywhere else, in the 38 years since I started to pay attention to neuromas.. mostly 'metatarsal pad' means one of these which are generally not much use.
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Re: People who have had surgery for Morton's Neuroma [doug in co] [ In reply to ]
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I guess this is the reason people shouldn't play "internet doc". Nothing wrong with anecdotes though I suppose (much like those that had the surgery in this thread ...). Or, you can simply live with the pathology - nothing wrong with that either.

BTW, your post:
"cut a small circle of orthopaedic felt and stick it to the bottom of the inner of the shoe, just behind the metatarsals. It usually takes a few tries with each new pair of shoes to get the pad situated just right, but once it's there, it lifts and separates the metatarsals and relieves the pressure on the neuroma."

is precisely what a met pad is and they have been used forever.

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