Morton's Neuroma? (1)

Triathlon Forum
1

I rode 40 hilly miles 10 days ago with my shoes cinched too tight. Idiot me tightened down the two velcro straps that I usually never touch.

I had terrible hot foot on the ball in the last 5 miles of my ride.

Since then the ball of my left foot has had a spot about the size of a quarter that is numb.

I know lots of you have had this MN issue. Could one ride have done this? I have always used good shoes and SOLE insoles.

Am I f*%ked?

Yes, i will probably see a doc - but won’t get in for a month or two.

2

I had MN earlier this year after logging too many miles in my NB Trail Minimus’. The pain got pretty bad where I wasn’t able to run as much as I wanted. Took two weeks of easy running, sans speed work, and iced the hell out of it. Two months later the pain is completely gone. I’ve been told it just take time for the swelling in and around the nerve to subside.

3

My MN was between the 3rd and 4th toes. I don’t think a MN manifests itself near the ball of the foot. It is easy to misdiagnose foot pain. Good luck with it.

4

I think I had a case of MN as aresult of a new pair of running shoes. Icing, rest and a change back to my older running shoes seems to be helping. Last week the pain was pretty bad, but I was also on vacation with the family and walking around water parks barefoot all day.

Wear shoes as much as possible, ice the hell out of it and let the pain be your guide re: running. Since it appears to be linked to an isolated incident, you have a decent chance of bouncing back quickly.

5

Might not be a Morton’s but there are plenty of nerves down there to piss off. I agree with others. Rest and ice for a while and see if it goes away by itself. It really takes you a month or two to see you GP?

6

That’s to see a specialist. I could go to urgent care or make a family doc appt (and get in in a week or two). But, I can go to in-plan specialist without referral too.

7

Hello everyone,

I have dealt with MN for more than 3-1/2 years, with the last three years being the worse. I have had nearly every procedure and type of surgery you can possibly have, save few.

Yes, your shoes can cause this, and they can cause this after just one wear. Studies show the number one cause of Morton’s Neuroma is the types of shoes we wear.

Yes, you can develop MN in the ball of the foot (the fore pad) between the metatarsals, which is the most typical place for them, since as the metties move about and become compressed, so does the nerves that run between them, therefore causing a neuroma to develop, with the most common locations being between the 3rd & 4th and the 2nd & 3rd metatarsals. Lucky me, I had four neuromas develop in all of those areas on both feet.

If you catch it early, and I mean early, you can self treat it successfully with ice and rest, just as Pindurski did. Do this until you don’t feel it anymore, and if it comes on again, do it again, and keep on top of it.

I have communicated with many, many people about MN, and some find relief wearing shoes while others (like me) suffer with anything on their feet, yet I can get away with some flip-flops for 20 minutes or so. See what works for you, but if you do opt for shoes try to make sure they are as comfortable as possible and will allow your metatarsals to splay, and if you can, stay away from any shoes that have an elevated heel, as the heel with force you to place your weight over the ball of the foot, making the neuroma enlarge.

With that being said, I’d like to introduce you all to a brand new discussion bulletin board for those of us who suffer with Morton’s Neuroma.

This bulletin board/forum is completely dedicated to Morton’s Neuroma and is named Morton’s Neuroma Talk!!! MN Talk is a **FREE **discussion support group for those of us who are dealing with Morton’s Neuroma where we can talk about this condition, how it is treated, and how it has effected our lives.

After some research I found that there truly isn’t a dedicated bulletin board for MN out there. There are sites here and there that talk about health and medical conditions, etc., that may or may not talk about MN from time-to-time, hit or miss, but none dedicated solely to this condition.

I fully expect this brand new forum group to soon be jam packed with lots of information and advice from many experienced MN sufferers and become a go-to resource, but we need your help to grow it. If you have a story, if you have experience, if you can shed some light on any of the many topics that surround MN, please join us.

The address is http://www.mortonsneuromatalk.com. Please check it out, and definitely, if you know someone who has this condition, please share the web address with them.

Thanks!

TJ

8

TJ, Bookmarked your site and will look at it later.

I have been dealing with MN for many years now in my right foot.

The first round of treatment was alcohol injections (6 total spaced every other week). That worked great for about 5 years and then it started flaring up again.
Last year I got another round of alcohol injections (same spacing). The doc said that if it flares up again he suggests surgery. So far I get a some discomfort on routes 70 miles or longer. There are times when just the slight compression of socks can irritate the nerve. I rarely run anymore and stick to cycling. Even taking long walks with my wife will start irritating the nerve.

I have had friends that had no luck with alcohol injections and some that did surgery with success and some not so much. Treatment and success seem to vary per person that I know and why I have delayed surgery until I have no other choice.

Hopefully to the OP you can take care of this with some rest and wear shoes with a wide toe box.

For cycling shoes I have to be careful. (all my shoes actually from this point forward) Specialized seem to work for me as the box on this particular pair are more open and yet the heel is tight enough. I tried things like metatarsal pads and other things that were supposed to open up the toes, but none of those things worked.

Best wishes

9

Hi Felt, I too had the alcohol sclerosing injections (16 needles there) four sessions, four neuromas. They did nothing for me but develop more scar tissue. That’s what most people don’t understand about these treatments, even surgery, all of it will cause more and more scar tissue to develop. It’s the scar tissue that is taking up the space inside our feet causing the nerves to have less and less room to move around and causing the neuromas to worsen. Anytime an agent or cutting is involved, more scar tissue is created causing to nerve to thicken with more scar tissue. All of this scar tissue will have to be dealt with at some point in order to alleviate the pain and compression of the nerves (or what’s left of them after treatments or surgeries). If it is not dealt with, then it can be a painful road ahead. It’s also possible people may still complain that the original problem still exists or exists in a different way, when perhaps it is just the scar tissue that needs to be resolved.

After having the alcohol injections, a cortisone shot (where the well-meaning doc stuck the needle all the way through my foot AFTER he hit the nerve), 5 sessions of anlagesic shockwave therapy with 8 more needles (given every other session), cryosurgery with 12 more needles (you would think freezing the nerves would have killed them, but no), then finally traditional surgery (and who cares about the needles at that point, I was finally put to sleep), then of course, there were ankle nerve blocks after that…

As you can see, all of these treatments added to the scar tissue that was already set in motion by the original condition. I am now seeing a deep tissue massage therapist to break up all the scar tissue. Although it is taking some time, I am seeing results. Perhaps due to both the traditional surgery (six months ago) and/or the deep tissue therapy (began three months ago), my toes (although the nerve branches have been removed) don’t go numb as often as they used to pre or post surgery (yes, I still have lots of nerve sensations that boggle the mind although I supposedly have no nerves there), my toes are starting to realign (the ginormous neuromas caused the metatarsal bones to misalign spreading my toes apart abnormally), I can walk across soft surfaces like carpet, grass, and sand now, whereas before the nerves would “fire,” I can have sheets and even blankets touch my toes without setting the nerves off, etc. These all sounds like small successes, but added up, I think they are huge.

Looking forward to talking to you more and hopefully will see you at MN Talk.

10

I developed a MN a year ago almost to the date. Running in Newton’s on rocky terrain and increasing my run volume did it for me. To begin with I thought I had a pebble in my shoe between the 3 & 4 metatarsal, but I couldn’t find anything so I kept running. It wasn’t until the pain came a few weeks later that I realized what it was. Got a Cortisone shot which got me through Vineman 70.3, but then the pain came back. After A LOT of research and discussions (and being told by two podiatrists that it was chronic), I began getting acupuncture and ART with Graston technique mixed in. The ART/Graston breaks down the scar tissue that has formed around the nerve, and the acupuncture speeds up the healing and building of healthy tissue. I have been going religiously for 6 months on a weekly basis, and the neuroma is close to being gone. It has gone from being the size of a small pea to being the size of a pinhead. The treatments are painful, but they help greatly. To assit the healing my awesome coach recommended I put small gel inserts in all my shoes right under the neuroma. This has meant that I have been able to continue training at very high volumes without any interruptions or pain, and continuing the healing process. After MUCH experimentation, I found that Powerstep Metatarsal Relief Pads are the perfect option for me. I wear them in my bike shoes, my running shoes, my dress shoes and I NEVER walk around barefoot. Needless to say, I stopped running in Newton’s right away, and have switched to Brooks as they have a lot of room in the toe box allowing my metatarsals to spread out. I am on a really good path and very happy that I haven’t had surgery or more cortisone shots and my feeling is that the issues should be resolved within the next 6 months or so.

11

Can you go see an in-plan podiatrist? I’ve had MN 2x in my life at very different times from running. One time I went to a podiatrist, the other time an orthopedic surgeon. No injections, they just made some quick, “cheap” insoles with a metatarsal relief pad. They had me walk in them a few days to break them in, and then I could gradually increase my running mileage. MN went away both times. It was sure painful when I had it though, however, I didn’t need any cortisone or nerve blocks (aka, phenol/alcohol injections). Good luck!

-Pete

12

Sept 4 is my appt with my in-plan podiatrist. Still hoping it is nothing.

Reduced my mileage on the bike this week and reduced certical climbing.

I still wake up with my foot feeling bizarre. Not painful really, but numb at a spot on the ball of my foot. I am overcorrecting so that is not good. I have been wearing Birkies and Haflingers which both have a significant degree of support. That feels good.

Thanks for all the comments everyone.

13

Unfortunately, orthotics didn’t work for me. I paid $300 out of pocket for custom-casted orthotics, and all they ever did for me was give me knee pain that I would have to ice after every run.

Since you have to wait so long to see a doctor, John, maybe you could try a temp orthotic/metatarsal lift like Allen and Bond are talking about, just to get you through. Try your local pharmacy for some insoles with built-in lifts first, then if you can’t find what you are looking for, do an internet search and have them express mailed to you. At least try it to see if it may help alleviated some of the sensations and reduce the potential damage. I know they have helped some folks, so it’s definitely worth a try. Good luck with your appointment, John.

14

Hey I’m late to this but love the topic.

I’m multi year sufferer. I’ve had the cust orthotics, cort and alchohol shots etc…too many to count. Heres my two cents for all,

I dont think one time can cause. Its more a matter of not addressing it and tolerating it over long periods of time that will bring you trouble. My first flag was after a day of skiing, just didnt realize what it would become.

Wider shoes are the key. This goes for work and play. Great tip i learned is take all your shoes, remove the insoles and stand on each of them. If your foot hangs over, the shoe is not the propper width. I live by this now.

For biking i bought Sidi megas and even then went a size larger. I drilled hole and moved the cleat plate back behind the met heads. Not quite midfoot, but not ball of the foot either.

Felt, I think you’ve done the right thing waiting. I also found most Dr’s want to cut out the nerve. Like you said, there are many complications that come from this. I read there is no other common nerve injury where the treatment is to remove the nerve.

I had surgery last week just a different kind.It was called the KOBY/ISOGARD surgery. Its basically the same thing they do for people with bad carpal tunnel. The nerve is getting trapped and squeezed between the met heads and the DTL(ligament). The whole thing took 30 minutes to clean and scrub and 10 minutes for the actual procedure. I even went back to work the same afternoon. They shoot a local, and cut the ligament to create space between the affected met space. Its been 5 days and I’m getting around. It doesnt tickle but it is maneagable. I was told I can resume whatever I want as I can tolerate it. I think I could ride as of today but I wouldnt be pressing hard. I’m having my other foot done in 2 weeks. The complete official recovery takes 6 months but I will be full training(swi, bike, run) by the beginning of October.

Last thing I offer is a toe pad. I read a book, “why you really hurt”. It recommended placing a pad under your first met head(big toe). The idea being it alters the biomechanics so you bear more weight on the larger met bones(big toe). Prior to using this stupid thing I would get halting pain around mile 5. The kind only MN people know. Well with the pad I finished the IMLP this year. It doesnt stop the pain but it hold its at bay enough to continue.

Good luck all, I hope to report the KOBY surgery is the answer…stay tuned

15

I’m also late, but have experience.

Background - competitve runner turned triathlete who still runs an average of 35-40 miles/week.

Initial treatment - cortisone, just a temporary fix to reduce inflammation and pain.

Next treatment (after cortisone fails) - alcohol shots. Waste of time in my opinion.

Final Solution - surgery (removed a 1.5cm neuroma).

For the average Joe, cortisone or alcohol may work to reduce the inflammation? For active people like runners or triathletes, this is a much more difficult problem to deal with because we’re very active. Wearing wider shoes may help, don’t walk around barefoot, try icing, massage, etc… I did it all for over a year trying to find relief and avoid surgery, nothing worked. In hindsight, the surgery was the best decision I made. I’ve been running pain free and issue free for the last 3 years post surgery. It’s not that I’m advocating surgery, but in my situation I was out of options. It’s also nothing to be fearful about. I was riding my bike in 3 weeks and running in 4 weeks.

17

Smarty,

that is a huge neuroma, mine are 7mm and I was told they’re on the larger side. Thats great you have positive results!!

I still cant believe how maddening the condition is. I hope I report the same results.

I agree about the alcohol. I’ve read they only work if their guided by sonar otherwise its just impossible to be sure you’re hitting the right spot. I’ve also heard and convinced my dr that they should be given proximal, higher on the foot, where the nerve is still healthy. The idea is a healthier nerve is easier to damage with the alcohol.

Continued success

18

I would just like to put it out there that our office regularly treats MN with an extremely high success rate utilizing a multitude of procedures including acupuncture, ART, and chiropractic adjustments. Just had one recent case where the individual could barely bike let alone walk for the last 7 months and felt so great after 7 treatments that he ran the beach 2 beacon 10k without a single symptom. Point is that if you have tried conventional therapy and haven’t gotten the results you need, keep looking!

Best,

Dr. Zev Myerowitz Jr. D.C., L.Ac.
Director of Chiropractic Services
Cape Chiropractic and Acupuncture
2 Davis Point Lane Ste 1B
Cape Elizabeth, ME 04107
207.799.9950
www.CapeChiroAcu.com

19

I agree, most will respond to more conservative treatments if you start soon enough. I was too late.
Surgery is the last option but for some including me, there is nothing left to try.

20

You indeed can get a neuroma after just one incident or wear of the wrong types of shoes. An accident can cause a neuroma, and depending on the accident, it may already be too large to be dealt with by just icing and resting. I have talked to countless people who have told me so. The key is to stop whatever activity you are doing immediately and address it to make it go away. If you don’t, and continue on for any period of time, it will get worse and worse…

Also, I am learning that if a doctor doesn’t embed the nerve ending into a muscle after they have amputated it and removed the neuroma, then you can and most likely will develop a stump neuroma, as what happened to me. Visit http://www.dellon.com/ who developed this procedure, which now other doctors are starting to implement.

That totally makes sense about targeting the healthy portion of the nerve, mtaio. I wonder how many doctors think of this and do this. And Smarty, that also makes sense about the alcohol sclerosing injections having more success on those who are not active. Some things to definitely think about.

21

Who told you its too late? Did you even try? I’m not saying with 100% certainly it will correct the issue, however the words “go home and live with it” and “there’s nothing left to do but surgery” are very common phrases my patients were told before getting relief at our office. Just don’t give up :slight_smile: