Treatment of Mortons Neuroma - intense burning pain in ball of foot

Read all the threads here, but have not seen much on treatment options other than Haydukelives that got one cortisone injection and was cured.

For those that dont know, I describe it as having a red hot scrwdriver jammed between the 3rd and 4th toes in the ball of the foot area. At first it flared up on the endless sidestepping days in Granite. then it would flare up just from a long day of skiing hard. Have had custom ski orthotics (some with met pad moldings) for 25 years.

More recently, have shifted to wider ski boots, metatarsal pads, custom orthotics, wider street shoes, icing, etc etc.
Those things have made it better, but now its the point where it hurts most days, even when not skiing.

So, its seems there is:
1) cortisone injections
2) alcohol injections
3) surgery

Anyone tried any of the above and had good or bad results?

Tried any focused stretches yet?

Did all of the above and then had surgery. It was easy. Wished I had the surgery sooner than I did. My only lasting side effect is numbness between my 3rd and 4th toe on the actual inside surface of the toes. Never notice unless I happen to stub that particular toe which is kinda tough. Used crutches two days then limped around in a sugerical show for about two more weeks. Easy!

Good to hear. Did they cut from the bottom or the top?

I'm not worried about numbness, already have that on 3rd and 4th toe.

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Originally Posted by Core Shot

So, its seems there is:
1) cortisone injections
2) alcohol injections
3) surgery

Anyone tried any of the above and had good or bad results?

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You can read my saga here
http://www.tetongravity.com/forums/s...any-experience

IMO, if you are at the "red hot screwdriver" stage and have already lost sensation between your toes the cortisone injections are a waste of time and money. My surgeon's opinion of the alcohol injections was that they were a scam. I am glad I had the surgery (dorsal incision) but

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Originally Posted by Queenie

Easy!

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is not how I would describe the recovery. Granted, I had complications (stitch abscesses), but the time leading up to the abscesses starting was no cake walk. I needed to be on the couch with the foot elevated >90% of the time for the first 3-4 days or it would throb horribly, and I had to keep it elevated the majority of the time for another week or so. After I got out of the ortho shoe and got the stitches out (2 wks) I had to take it very easy for a couple more weeks still. You really need to be off the foot as much as possible for 1-2 months, which isn't too bad if you have a desk job but could be tough if your jobs requires you to be on your feet. Full recovery expect 3-4 months depending on how seriously you take the recovery and whether or not you have any complications.

If you get surgery I highly recommend finding a well regarded foot/ankle specific ortho who works with athletes. The biggest factor in whether or not the surgery "works" is what the surgeon does with the end of the nerve. According to my guy, lots of podiatrists just snip it right above the neuroma and call it good. This can be OK in sedentary people, but if you are active it can often lead to a stump neuroma (google this) that can be as bad as the original neuroma. My surgeon removes the nerve well above the MTP joint and inserts the end into on the intermetatarsal muscles. The nerve end has more space there and being inserted into the muscle reduces stump growth, supposedly.

Dan, that sucks. I'm dealing with Morton's right now. It was really bad at the end of ski season. Pretty sure it is a result of the boots I got 2 seasons ago. I've been on high doses of prednisone for the past 2 years (unrelated) that was probably masking the problem until I tapered low enough this year to uncover it.

So far it has been numbness and no pain. It's getting better the further away I get from ski season. Still feel it after a day on my feet but I'm careful about foot wear choices. I've found that icing/massaging the neuroma with a frozen water bottle has been helping greatly. I may follow up with a podiatrist to see other options but I've been delaying and hoping it continues to get better. interested in seeing how others progress with this. Looks like we have each end of the spectrum so far with queenie and Dan.

DanTheMan is right on with his info.

I too had the traditional surgery for MN, after exhausting every other procedure which failed me completely. All four of my neurectomies grew back into stumps. I then went to a peripheral nerve surgeon, considered a pioneer in the field, and had corrective surgery, as explained by DanTheMan. I am rid of three of them, but one of the nerve branches fell. If you decide on surgery, plead with the surgeon to stitch the nerve ending into your muscle, normally the arches.

Please join us at MN Talk. MN Talk is the only forum dedicated to just this condition. We talk about the various procedures out there and share our experiences with this dreadful condition. www.MortonsNeuromaTalk.com. Hope to see you all there.

BTW, studies show the types of shoes we wear are the number one cause of MN.

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Originally Posted by MN_TJ

BTW, studies show the types of shoes we wear are the number one cause of MN.

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I know but 3" heels really show off my legs!

Seriously though, I have found Keen's to help a lot. They have a wide toe box so no pinching. Hearing your story and Dan's is furthering my resolve to get this treated without surgery. I will check out the site you mentioned. Thanks.

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Originally Posted by Flounder

Hearing your story and Dan's is furthering my resolve to get this treated without surgery.

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To be clear, at this point (6 months post-OP) my surgery appears to be 100% successful and I would do it again. Just don't think it's as simple as getting a mole removed.

As far as treating without surgery, managing is probably a better word. Any nerve damage bad enough to be symptomatic is probably irreversible. You can do your best to keep it from getting worse, but shoes and pads won't make it better.

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Originally Posted by Core Shot

Good to hear. Did they cut from the bottom or the top?

I'm not worried about numbness, already have that on 3rd and 4th toe.

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Top first, around between those toes to the base of the foot. Total incision was about 1 inch long.

This is the most recent thread I could find on Morton's Neuroma. I think mine started 10 + years ago. I would feel it after looong days in approach shoes/climbing shoes, it felt like I was standing on a pebble when I walked barefoot and would subside several days after the activity. I pretty much quit climbing due to job change and started wearing wider approach shoes on big days, and although I would feel it occasionally, it wasn't a big concern.

Fast forward to last spring when I cramponed 5000 vertical feet up Buck Mountain with it absolutely screaming at me. The pain was so bad at times on that day that I thought I'd fall off the mountain with certain foot movements. This was after a big winter of ski touring, and I don't really have memory of it bothering me on normal winter tours.

I got over that episode, had a pretty normal summer. I felt it a few times, but not what I'd call pain, just an annoyance. Yesterday was my first time in ski boots since Buck Mountain and I had one or two times when I was edging on hard snow when it "popped" and was excruciating. Quick instances of stabbing pain followed by long periods of dull throbbing. Pretty calm today wearing altras.

Anyway, long story...do I need to make my ski boots wider, get a custom footbed? I haven't seen a doc, maybe that's the next step?

Custom footbed. (I dont know all the tech terms) Build up a protruding bulge to lift the ball of foot before the metatarsalsAttachment 259304

Doesn’t fix everything but it helps a lot. I do a lot of rolling out my foot too... golf ball, foot massaging ball etc
I’ve got a couple versions of these footbeds but the concept is the same.
The flex of forefoot when ski touring sometimes brings all the pain.
Apparently if the nerves get all bound up in scar tissue you just don’t feel it (numb) and then occasionally it can become knife to foot feeling type pain. Mine varies but I generally have been ok lately.

Oh... and a wider boot helps too. I’m in Vulcans and sx130 and they both work well for me

Morton's neuroma is caused by tight shoes, laterally.

Mechanical cause, so the solution is mechanical too.
Wide shoes at the forefoot, and the bump on your orthotics, which causes the forefoot to spread out, less pressure on the nerve.

Don't look for chemical solutions, ie drugs, or surgery.

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Wider boots are not necessarily the answer. If the fit is sloppy you compensate by cranking the bindings and that makes it worse. A boot that holds your foot securely with the lower buckles just tight enough to not fly open is important, with the width appropriate for the width of the foot--at least that works for me. (Actually, my second from the bottom buckles do fly open from time to time)

As a 10 yr sufferer I’ve had good luck with wider toebox/thin socks for running and bike shoes. Maybe up a half size too. Less running more biking also. For skiing, intuitions in my kryptons do the trick with toe buckle barely buckled. The toecaps seem to create just the right amount of space during the molding process.

Flareups suck. Agree w Goat its important to find happy medium on snugness as flopping around creates issues too. My foot did not like the built up footbed bump. Subscribing to find other best practices.


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FWIW, I had one footbed buildup that didn’t work (more pain) and then another that was way better. I think the first was too big a bump.
Definitely agree on intuitions and cross training.

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Originally Posted by Cabinfever

As a 10 yr sufferer I’ve had good luck with wider toebox/thin socks for running and bike shoes. Maybe up a half size too. Less running more biking also. For skiing, intuitions in my kryptons do the trick with toe buckle barely buckled. The toecaps seem to create just the right amount of space during the molding process.

Flareups suck. Agree w Goat its important to find happy medium on snugness as flopping around creates issues too. My foot did not like the built up footbed bump. Subscribing to find other best practices.


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Originally Posted by cdubski

FWIW, I had one footbed buildup that didn’t work (more pain) and then another that was way better. I think the first was too big a bump.
Definitely agree on intuitions and cross training.

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Please don't get started on posted vs non posted footbeds, or this thread could go on for 100 pages. Actually, it's probably too late.

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Originally Posted by old goat

Please don't get started on posted vs non posted footbeds, or this thread could go on for 100 pages. Actually, it's probably too late.

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What if the footbeds were on a treadmill?

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Originally Posted by mcski

What if the footbeds were on a treadmill?

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Schrodinger's treadmill?

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Originally Posted by rod9301

Don't look for chemical solutions, ie drugs, or surgery.

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Done right, the surgery absolutely works. It may not be necessary depending on the severity of your neuroma, but there is a point beyond which it's the only thing that's realistically going to work.

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Originally Posted by Dantheman

Done right, the surgery absolutely works. It may not be necessary depending on the severity of your neuroma, but there is a point beyond which it's the only thing that's realistically going to work.

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I read that the success rate it's not that high

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Originally Posted by rod9301

I read that the success rate it's not that high

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Source?

IIRC stump neuromas are common, but that's why I said "done right." The biggest factor in whether or not the surgery "works" is what the surgeon does with the end of the nerve. According to my guy, lots of podiatrists just snip it right above the neuroma and call it good. This can be OK in sedentary people, but if you are active it can often lead to a stump neuroma that can be as bad as the original neuroma. The nerve needs to be resected well above the MTP joint and the free end inserted into the intermetatarsal muscles. The nerve end has more space there and being inserted into the muscle reduces stump growth. Mine is all good six years out.

I’ve got a decent foot surgeon that I’ll probably consult soon. If I can control with footbeds and boot work I’ll do that. But I’ve been limping for three days since skiing Saturday. It’s not really painful anymore but it’s uncomfortable feeling that thing roll around inside my foot.


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Well, I think this started up for me for the first time yesterday after a 45 min uphill run (interval training) in too-narrow racing flats the day before. I have been wearing wide toed shoes (Xero shoes) as a "daily driver" for the past few months, except those racing flats which I just loved for short, fast runs. Pain is there, but mostly some tingling and feeling like my sock is bunched up.

Since it just started, I'm really hoping it goes away soon if I baby it but I guess we'll see.

Mine flared up again this fall, after a long hike. I went back to only wearing shoes with really good arch support. Dansko Clogs out on the town and Spenco slides around the house. All my footwear has some type of semi custom footbed.

I've found that at least arch supports (Superfeet) sometimes make my neuromas worse, maybe by not letting the metatarsals spread. They work for plantar fasciitis though.

Been resting it (no running/hiking/skiing) and using toe spreaders. Seems to be getting better so far -- pain is pretty much gone but still have a touch of numbness/tingling -- but the real test will be when I start moving on my feet again. Had been up to 10+ hrs a week of running/touring so it's been really hard to take two days off. Might try to bike today.

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Originally Posted by old goat

I've found that at least arch supports (Superfeet) sometimes make my neuromas worse, maybe by not letting the metatarsals spread. They work for plantar fasciitis though.

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I wouldn’t expect on OTC orthotic to provide any relief from a neuroma as they are a corrective only in the rear foot. A metatarsal arch pad would be more specific biomechanically for the neuroma pain and can be had cheaply online

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Originally Posted by bourbonisgood

I wouldn’t expect on OTC orthotic to provide any relief from a neuroma as they are a corrective only in the rear foot. A metatarsal arch pad would be more specific biomechanically for the neuroma pain and can be had cheaply online

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Good advice.

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I add the metatarsal pads to the footbeds.

I have had pain from my Morton's neuroma for over 20 years. The wider shoe/boot worked for a long time and then stopped working. For skiing, I had my boot fitter add the metatarsal bump to the custom foot bed (sport loft in SLC). I had the pain while hiking, so I had sport loft create a custom bed with the metatarsal bump. I also have gym shoes (new balance) with an insole insert that has the metatarsal bump.

In summary, the metatarsal bump is the solution.

Do I maybe have this? The third/fourth toes are experiencing twinging pain when I am doing certain hard turns and has been getting worse every time I ski. No burning or constant pain, just when I do certain movements in ski boots on left foot only. Like the sensation of sticking your tongue on a 9-volt battery, but more intense and in the toes. It has been going away when not skiing or in ski boots, but when I get back in ski boots I can feel it when I make certain movements. fuuuhk

Yup, that’s the beginning.

Think about not letting your bones grind when doing activities. There’s a nerve in there that is getting pinched.

Don’t wear narrow shoes.
If you have custom foot beds, have them push a met arch into it.
Also, race plug boots with narrow toe boxes are evil.

Thanks for the response.

Boots for last few seasons are 100 mm boots nordica speed machines that are even punched on outside of foot. I also use blue super feet.

Don’t feel too narrow at this point but boots my whole life have. There’s a chance I need more room.

I will look into met arch pad mod.

Sounds like a death sentence

Not a death sentence
You caught it early.
Boots sound fine.

Instead of a stock superfeet, get a comformable custom footbed with a met arch. It helps spread the bones apart

Thanks again.

I get most often get the sensation along with a click when I roll my ankle from the outside ski edge to inside ski edge on harder turns. like a nerve between toes is rolling over something sharp/clicking then the painful sensation. Also I have quite a bit of vertical room in the toe box.

Also, nothing hurts or feels different when I message my foot in the general areal, but I am starting to get the twinge (feeling of a nerve sliding over/under something) more often when not in a ski boot.

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Another thought I had is that boot fitting the front of a ski boot at the mid height of the ski boot to add width may cause a bit of a concave shape at the front of the foot cause the foot to squeeze in middle. Anyways the metatarsal pad makes a lot of sense.

Conformable footbeds is in order

Any recommendations for a met arch or pad? Are these added to a footbed or are there footbeds that include a met pad?

I have been having issues with narrow-fitting shoes/boots. It is largely controlled with wide shoes, but it can flare up on long hikes. Since getting Scarpa Maestrales (101mm last) it hasn't been an issue with skiing or skinning.

I've had success with these arch pads added to stock insoles in many shoes to spread metatarsels and take pressure off the nerve. Placement seems critical - to far forward makes problem worse, too far back didn't do anything

Pedag T-form Anatomically Correct Metatarsal Arch Pads https://www.amazon.com/dp/B00EV5AKBE..._9QQHCb224YMZR

Also Aline insoles work well for me because they have a metatarsel pad built in. I use these in my touring boots where I don't have a full custom footbed.
www.aline.com

FWIW I get by without a met pad in my alpine boots with a custom footbed.





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Will something like a toe separator help in between the 3rd and 4th toe?

The clicking and associated sensation I get when I roll my foot from outside to inside weighting (like a back foot in a baseball swing or rolling the foot for a ski turn on groomer) goes away when I physically separate my 3rd and 4th toes and do the same motion.

This product is not marketed as such and maybe this will cause other problems..

Attachment 273752