what is that reason ? this is something new in the discussion.

'used forever' perhaps, but also a closely-guarded secret apparently, as noted it took me twenty years to find Johnny and that secret. None of the several doctors I consulted, in several countries, mentioned it. So, just trying to pass on useful information..

So, how many different types of surgery are there here? Pardon my ignorance, but from what I understand, I have these options - 1. cut the ligament which in turn will relieve the pressure. 2. cut the nerve down to a "stump" which will eliminate the nerve pain. 3. Cryosurgery - how does that work? 4. Others?

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_______________________________________________________
John Kenny, Pro Triathlete, USAT Certified Coach - http://www.frenchcreekracing.com
Philly Masters and Open Water
Swim and Multisport Events

To summarize my thoughts:
1. Try met pad, or insert/soft arch support w/built in met pad (i.e. lynco 425, NB ultra arch)
2. Wider running/cycling shoes

***IMO...1&2 should be exhausted before contemplating surgery

3. NSAID's, possibly medrol dose pak
4. Consider another corticosteroid injection, however, there is risk involved including intrinsic muscle atrophy, progressive development of hammertoes...leading to more traction on the nerve
5. Surgical options....endoscopic release of overlying DTIM ligament
6. Lastly...complete excision of the neuroma, and hope you're not one to develop a stump neuroma as it isn't as easy by any means to treat (both nonoperatively, and especially surgically)

Cryo..imo and amongst majority of colleagues, remains very experimental...

Good luck

I had a painful neuroma for about a year. I tried everything until surgery we my only option. However, this was 12 years ago and there are more options now. Surgery worked great for me. BUT the best advice I ever got from the Internet was to not take medical advice from the Internet! Thanks, Tom D.

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Team Zoot So Cal

I had surgery. My podiatrist removed a 1.5 centimeter neuroma. Up and running within 4 weeks. Issue free for last 3 years since the surgery, including very little to no numbness. I'll probably need to get my other foot done soon too, since it is starting to bother me.

Prior to the surgery, I did cortisone, alcohol injections, pads, cut holes in my insoles, etc. Nothing worked long term. That stuff may work for the average Joe not pounding his foot on asphalt, but the active folk.

I was very reluctant to do the surgery, because I was a competitive distance runner, before getting into tri's. Best decision I made, no regrets. Just make sure the physician you choose has does a lot of these surgeries with a high degree of success.

I had neuromas for 10 years and deciding to get rid of them changed my life! I was so sick of aching feet and having to manage the discomfort all the time.
If you can't wear shoes with heels and feel like you have a marble taped to the bottom of your foot, a morton's neuroma is your likely culprit. It won't show up on X-rays but a podiatrist will find it in no time flat by palpating the area. My Dr seemed delighted and amazed with mine, describing both of them as "Ginormous!"

• After a certain point when the neuromas get very large the best orthotics in the world will not bring relief.
• When you do get orthotics, go and see a certified pedorthist. It's their field. I wear a soft-molded type which allows for natural foot flexion.
• Cortisone shots don't always work - I had 2 or 3 in each foot with no relief.
• I was fortunate that my podiatrist (in Vancouver BC) was able to do the surgery in this office. I sat in a chair with a numbed foot and watched TV for a couple of hours.
• After surgery I was ordered to stay off the foot for 3 weeks, no exceptions. Crutches suck but I made it through.
• It took 4 more months before I felt like I wanted to try running again. (Rushing the recovery means possibly another surgery to fix the damage)
• A year later, repeat the process for the other foot.

Results (5 years later):

• I still wear orthotics (made for me by a highly skilled pedorthist who is also a runner)
• I bring my birkenstocks with me when visiting friends with non-carpeted homes to keep my feet happy
• I can't wear heels of any height
• I still have numbness at the site, which is weird but I've become accustomed to it
• BUT I've been running ever since with no further problems, and most importantly, NO PAIN!!

Good luck!

~Carol~

Here's the explanation of cryosurgery from my podiatrist's website:

http://www.healingfeet.com/...ents.php#cryosurgery

I went through pretty much every treatment before surgery. The met pads, vitamin B injection (I think), cortisone, expensive orthotics which I think I've trashed at this point, 2 rounds of alcohol injections in both feet (8 shots in each round with increasing levels of alcohol) which hurt but you unfortunately get used to, and finally surgery.

The pain was alleviated for a year, maybe two, but has returned to some extent in the right foot. My hunch is that a stump neuroma has developed. The left foot comes and goes and seems to be manageable.

Moral of the story is that every body and every case is different. And that the internet can be a very scary place. Rroof once told me that nothing is absolute and it's not like wrenching on a bike. I struggled with the level of risk of the surgery and wound up with moderately positive results. Others have had very good results. See multiple doctors and weigh what the risks mean to you and your family. If any of the doctors tells you that any of the more aggressive treatments are 100% effective or without risk run away. Or I guess in this case limp away.

Carol,

I am considering surgery for my MN but what has been bothering me is the fact that studies show that post-surgery 70% of people still need modified footwear even though the pain is gone. I wonder why but could not for the life of me find any explanations. I mean, if the neuroma pain is gone then why not unrestricted footwear? Is it new post-surgical discomfort that requires shoe modification? And I'm not talking about the initial 6-12 months post-surgery because that's understood.

Then I read your post where you say that you can't wear heels of any kind and still use birckenstocks and orthotics. I would really appreciate it if you could expand on that. I think it would really help me make my decision about surgery. My question is basically what is it about your feet now (neuroma-free) that is still making you wear orthotics and putting restrictions on your footwear?

Thank you very much in advance.

Steve

I have never required modified footwear, but I have had to be more prudent in my footwear choices. My shoes need to accommodate my orthotics so I tend to look for more "sensible" footwear. Sadly, sexy footwear will never grace my feet again! (Good thing I've always preferred runners to stilettos, so no great loss). I also have fallen arches, so it's not just for the neuromas that the orthotics are required. Many people never need orthotics after having their neuromas removed.

Although my recovery has been excellent, I was warned that there would not be a complete return to my pre-neuroma foot. I am pain-free (that "marble taped to the ball of my foot" feeling is gone), and I no longer have to manage my foot pain in general, but I do have some residual discomfort. There is still numbness betweend the toes, and some scar tissue build-up although my physio has recently been helping me with that by massaging the area to break it up - probably should have addressed that years ago. It feels a bit lumpy at the site, and in the morning and at the beginning of a run it needs to warm up a bit before the weird discomfort goes away. After that, bring on the (pain-free) miles! I can't explain exactly why I can't wear heels (or stand on my toes to search a high shelf) - it just hurts. Strangely, it hurts more if I am just standing as opposed to walking or dancing in heels. However, with the nice padding in a pair of runners, standing on my toes doesn't bother me at all. (No barefoot running in my future...)

My Mom had neuromas removed 30 years before I did (she just hobbled around without crutches), and she was able to wear heels again and has never complained about foot discomfort since. So it goes to show that every case is different. My podiatrist did tell me about a patient of his who did a triathlon 3 weeks post-surgery, and she was back within a year getting the surgery done again, so post-operative care is very important.

All I know is that the neuromas were literally crippling me, and running was becoming impossible, as was hiking or walking anywhere barefoot. The surgery, while not resulting in a "perfect" result, was still worth it in the long run for me. I couldn't stand the constant, aching pain any more, and literally bounced into my Dr's office, eager to have the little buggers gone!

It's a daunting decision - good luck with your search for answers! You can PM me for more info if you want.

cheers

Carol

Carol,

Thanks very much for your detailed reply. For some reason I'm not able to send a PM - maybe it's because I'm still new to the forum.

I've had the neuroma for a year and a half now. Tried many different things to avoid surgery, none of which worked. Finally made the decision, found a reputable surgeon, scheduled the procedure for end of October, arranged time off from work, and now starting to get cold feet (no pun intended). Partly it's because I almost feel like I'm not in as much pain as I used to be - that could be because I've religiously worn orthotics for the last 9 months so maybe the nerve just calmed down a bit but could probably flare up again. The other reason is that all of the sudden I started coming across articles and studies that suggest that 70% of post-surgery patients still cannot wear regular showear as well as other restrictions. Maybe this is all mental as I'm nearing the surgery date.

I'm in my early 40s, have 3 young kids and would love to nip this thing and move on. Hopefully will make my final decision in the next few days.

Thanks again for the reply and for the offer of more info.

Steve

I would suggest that people can still wear regular footwear post-surgery, but perhaps it will take a bit more care to find the right brand of shoe in which your feet will feel comfortable. I need a softer, more cushioned footbed for comfort but I can also wear less supportive footwear if I grin and bear it. The biggest thing is that the pain is gone and I can remain active. I bet that in a few months you will have happier feet, too.

But, I understand the "cold feet" - surgery isn't exactly fun at any time.

Hi Carol, my neuroma is getting worse ad worse. Did alcohol injections a few years ago. Now, I have to turn down walks on the Stanley park sea wall because of the pain. Who was the dr who did your surgery? I am currently looking into my next steps. Thanks, kristy.

Dr. Gregory Laakmann. His office is downtown across from the Art Gallery. Great guy.
Tel.604.681.2837

Good luck!

PRINCESS - I have been dealing with pain from Morton's Neuroma for years and I only recently found information on the cryo-surgery you mentioned. I live in Wisconsin and so far, have no clue why only a handful of podiatrists would offer this option. Could you fill me in a little more extensively on what you dealt with having they cryo-surgery, your recovery time, and why you would not hesitate to do it again? Thanks!

Hi - the recovery time was almost non-existent. I walked out of the office and took the bus home. The podiatrist just said not to swim for a few days and I don't remember if there were any other restrictions. It was a simple office procedure in which she numbed my foot and inserted the device (sorry - don't remember all the details) and froze the nerve. It's been quite a while - at least three or four years and it's still good. It flared up a bit a while back and she didn't think I needed more cryo surgery and just gave me a cortisone shot which has been ok. Hope this helped

Finally after dealing with this for over 15 years , I am ready to take the next step
I had stopped running for 13 yrs
Now after cortisone injections for the past 2 years I am tired of dealing with the pain.
Surgery scheduled for mid November after IMFL
Here's hoping it works and IMLP will be pain free this time

I've got a real doozy and would love everyone's combined expertise and experience to help me figure it out.

About 6 years ago I started wearing Newtons to help me transition from heel to mid-foot running. It felt great. I'm also a part-time fitness instructor, so I wore my Newtons to teach classes too.

Then about 2 years ago, I started training for the NYC marathon and knew I wanted to do most of my training on a trail by my new house. I didn't think my Newtons (with the metatarsal bar) would fare well on the trail so I got a pair of Hookas and a pair of New Balance.

About the time I started getting into the 16 and 17 mile training range, I started feeling sharp pain between my 2nd and 3rd metatarsals. I would wiggle my toes, the pain would go away, and then I'd keep running. I was also walking around barefoot in my new house with wonderful hard wood floors. Needless to say, it didn't take long before I could barely walk, had to drop out of the marathon and was diagnosed with Morton's Neuroma in both feet.

The doctors surmised the Hookas were too soft for me, leaving my metatarsals unstable. The hardwood floors didn't help either.

For a year, I tried all the less-invasive approaches. Accupuncture (did nothing), cortisone shots (nothing), expensive, custom orthotics (horrible!). I went back to my Newtons and wore store-bought metatarsal pads which pulled weight off the neuroma. Also the best thing were from restoremyfoot.com. I sleep with them every night to keep any pressure off the neuroma.

In January, I bit the bullet and paid out of pocket for radio-frequency ablation. I didn't exercise but I was still wearing my Newton sneakers from time to time...unknowingly aggravating the injection site. I explained to my doctor the pain, not once thinking it was from my Newtons. He said he'd never heard anyone describe their pain that way. I wore the Newton's to my procedure and to subsequent doctor visits. I even told him about my shoes in my initial consult. It was another doctor who was with him in a follow up visit who suggested my Newtons were hyperextending my toes with every step and doing more damage. He even suggested my Newtons were to blame for the Morton Neuromas in the first place.

So now, I'm in even more crippling pain and considering surgery. I wear silicone pads on the balls of my feet and I'm on prescription strength anti-inflammatories because the nerves in my feet twitch endlessly.

I would love any thoughts, comments, suggestions. I'm also looking for names of good doctors in the NYC area. Needless to say, I'm not too happy with mine now.

The underlying problem is the nerve between your metatarsals gets inflamed as a result of the biomechanics / way you naturally probate. My recommendation is get the surgery, you've exhausted other options. I've have zero issues and no regrets post surgery many years s later, and I still run a lot. Just ensure your podiatrist is experienced doing this surgery. Good luck!!

smarty, where do you live and who was your doctor? Up and running in 4 weeks? I've heard so many times that you're in a boot for like 3 months!

Insoles have helped me dramatically. I am now wearing them in my everyday shoes as well as running shoes.

I live outside of Philadelphia in West Chester, PA. My podiatrist has moved; however, it's not an uncommon surgery for any podiatrist with experience. Just make sure they remove it from the top of you foot (not the bottom). I'm not sure where you heard 3 months, but that's incorrect. Expect to be out 4 weeks +\- a week.

"I got a pair of Hokas"
I am guessing those were Hoka Cliftons ?
Those are notorious for narrow toe boxes - see my post above for reasons why that's a bad idea.

I have found I no longer need to install metatarsal pads in my running shoes, when running in Hokas. My neuromas respond well to the cushioning.

"He even suggested my Newtons were to blame for the Morton Neuromas in the first place."
Agreed, I was able to race in Newtons but could not tolerate them for training as they inflamed the neuromas..

Once inflamed it usually takes me weeks/months to calm them down again. Birkenstocks with the cork insoles can be helpful.

I've had a number of people reach out to me directly about this so, I figured I would do a follow up on here...

As I mentioned above, I had tried everything and gotten just about every solution possible. I was headed out to IMAZ (to spectate, not to race), and I already had an appointment lined up with a highly recommended podiatrist out in the Phoenix area. Coincidentally, I was on a conference call with Matt Dixon around 2 weeks prior to the trip and we discussed this very issue. Matt made the suggestion to see Dr. John Ball of Maximum Mobility Chiropractic. Dr. Ball effectively gave me a thorough evaluation and gave me very specific things to work on from there. He targeted the pain, which happened when I stood on my toes with one foot... the pain shot directly through the nerve. He did soft tissue work... tough to describe, but he effectively did a form of ART which gave me relief from 95% of the pain in a matter of 10 minutes. I'm not sure if all ART folks would be able to do this, but Dr. Ball has a great intuitive feel for this and gave me great relief such that I was able to run for nearly an hour that week, when I hadn't really done ANY running for 12-18 months prior.

The other causes were issues structural in nature or had to do with my gait. I have high arches and wide feet. I switched to Altras (soon after I found out they existed) and their shoes work 100% better than any others. Zero drop and a foot shaped toe box, which doesn't pinch my metatarsals nearly as much as any other. The only thing better would be custom shoes, which I'm not sure I could afford. Side note: I tried 2 different styles of custom orthotics and really saw no benefit at all from them. In fact, they made it worse. The other issue I had was in my ankles and achilles. Basically, when I was running, I would land on my toes and my ankles would stay very rigid and not allow my heels to come down to the ground. So, it put a lot of pressure on the metatarsal heads and also on the ankles and achilles tendons. Aside from the usual eccentric heel drops, we did a variety of ankle mobilization exercises and dynamic movements (hops, jumping rope, etc) designed to land more on the midfoot and also allow my ankle to flex and the heel to come down upon my foot striking the ground. I spent an entire winter (5 months) in Phoenix working on this, and ultimately my form was changed dramatically.

At this point, I'm back to full capacity, although I generally keep my running mileage much lower than most. I supplement a lot by doing things like deep water running, running on softer smoother surfaces, and I still use PowerCranks regularly as well.

In hind sight, this was a much better option than surgery, and I'm glad I went the route I did. I highly recommend Dr. Ball to anyone, even if you're not in the PHX area. His reviews are about as close to unanimous as any doctor I've seen. He has a great intuitive feel for the structure and mechanics of running and has worked many folks through what may seem like complex overuse type injuries.

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_______________________________________________________
John Kenny, Pro Triathlete, USAT Certified Coach - http://www.frenchcreekracing.com
Philly Masters and Open Water
Swim and Multisport Events

Thanks for the update. I had the very same issue and later realized that the shoes and the compression of the toe box was causing most of the issues. Since I switched to another shoe brand that promotes wider toe box and allowing the foot to spread my problems have totally vanished. Funny how I always felt that glove like fit for racing shoes was a good thing and now I realize it's not very good for even those of us with narrow feet. I've tried a number of models of the brand and they al seem to work well for me. Glad you found a less invasive and more effective solution, as often times we go back to the same shoes, and wonder why things come back. Hope you have many more pain free miles ahead......I know how painful that is.