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

[rod9301]

Still fighting this, but have been moving the right direction. Currently good until about the 3 hour tour mark, then things start to go downhill managbly, but i shudder to think of a 5 hour tour.

Trying to decide my next move, wondering if I should do another small punch, or try and get custom orthotics made. The SOLE inserts did help, but my main question is this:
For those who have tried both will a pedortho make something better, or will it just be a $250 version of the SOLE product?
The boots aren't exactly a tight fit, so hesitant to keep punching, unless that's what I have to do.

I found that there shouldn't be ANY lateral pressure at the widest part of the foot from the boot

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[MagnificentUnicorn]

Still fighting this, but have been moving the right direction. Currently good until about the 3 hour tour mark, then things start to go downhill managbly, but i shudder to think of a 5 hour tour.

Trying to decide my next move, wondering if I should do another small punch, or try and get custom orthotics made. The SOLE inserts did help, but my main question is this:
For those who have tried both will a pedortho make something better, or will it just be a $250 version of the SOLE product?
The boots aren't exactly a tight fit, so hesitant to keep punching, unless that's what I have to do.

You need a metatarsal arch pad or an orthotic with one built in. It’ll keep your metatarsals spread and take pressure off the neuroma. Most(none?) off the shelf insoles have much if any metatarsal pad. Try putting a pad under or on top of your insoles in that little pocket behind the metatarsal heads. You’ll probably find relief.

You can get punches or a wider boot but the metatarsal arch will still collapse without a pad and that’s what puts pressure on the neuroma.

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[yeahman]

I would do both the metatarsal pad and another punch. An all of the above approach is best. I assume you are using toe sock liners. If not you should be.

The pads can be uncomfortable at first but you'll get used to them. Once the pain goes away completely I think you can stop with the pads, unless you start feeling twinges of pain again.

I've never used any sort of custom ortho, just those blue footbeds sold OTC.

[Yukonrider]

I assume you are using toe sock liners. If not you should be.

Toe sock liners?

I decided today I should get another punch. Seems as my feet swell my feet get squeezed. They feel really roomy to start the day, then slowly get tighter.

[yeahman]

Toe sock liners?

They really help keep your toes and metatarsals spread out rather than scrunched. I don't need them skiing anymore but if I go for a long hike or to bag a peak I always wear them and they help a lot.

Injinji Liner Crew Toesocks https://a.co/d/dQQxNa7

I wear a thin regular wool sock over them.

[old goat]

It might be worth a visit to a podiatrist to see if the SOLE's metpad is adequate and in the right place for your foot--bring your boots. Looking at the online photo of the met pad version it does look like the met pad is pretty thin, although hard to be sure from a picture. If it's not adequate you can stick on a pad to beef it up. I wouldn't think a full custom-made insole would be any better for plantar neuromas unless the SOLE met pad isn't in the right place for your foot.

[Core Shot]

Another thought. Sometimes it’s the liner.

Went for another punch after it still hurt with one punch and top skill level ski footbeds with a met bump.
He refused the punch.

Took the liner out and made vertical gull slits ( only through the outer liner skin - not all the way through) on the knuckle of my little toe ( or whatever the fuck you call it - distal metatarsal??)

That provided more relief.
If your liner is tight punching the shell won’t help.

[rod9301]

On a tight liner you could make a slit in the sole

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[old goat]

Another thought. Sometimes it’s the liner.

Went for another punch after it still hurt with one punch and top skill level ski footbeds with a met bump.
He refused the punch.

Took the liner out and made vertical gull slits ( only through the outer liner skin - not all the way through) on the knuckle of my little toe ( or whatever the fuck you call it - distal metatarsal??)

That provided more relief.
If your liner is tight punching the shell won’t help.

Proximal interphalangeal joint (PIP)

[Core Shot]

Proximal interphalangeal joint (PIP)

Thx Doc!

[zion zig zag]

I've got new ski touring boots this year. I'm hoping I can get them to where spring steeps skiing is fun and pain free for me again.

Bump and back again. I think I’m ready to throw in the towel and just get the surgery on my right foot. I’ve been in 5 different ski boots in 3 years, gotten custom insoles and visited two different highly recommended boot fitters. None of it seems to help if I spend more than 4-5 hours in boots or if I am on hard snow.

This spring looks like I’ll miss out on climbing and skiing mountains because my feet hurt too much to do it, or I’ll be recovering from the surgery. At least one of those tracks puts me in a position to return to spring season next year.

[rod9301]

Are you sure that your boots or shoes are wide enough?

And you have a pad on the orthotics to spread your toes?

Surgery success is not great.

Since the neuroma is caused by mechanical issues, mostly narrow shoes, it can only be fixed by mechanical means.

I had it for many years and finally cured it 7 years ago by making sure my bc boots were wide enough

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[zion zig zag]

Are you sure that your boots or shoes are wide enough?

And you have a pad on the orthotics to spread your toes?

Surgery success is not great.

Since the neuroma is caused by mechanical issues, mostly narrow shoes, it can only be fixed by mechanical means.

I had it for many years and finally cured it 7 years ago by making sure my bc boots were wide enough

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I went wider and wider till the bootfitter said you have too much foot movement and that irritates the neuroma. So I went back to gentle support, custom footbeds, and yes pad on the footbed to spread. None of it does much. I can manage the pain in any other type of footwear than ski boots.

My surgery on my left foot seems successful, I'm 5 years out this summer and no more pain. I have seen some websites that claim 70% of surgeries are unsuccessful, but they all seem to be selling some other solution. Do you have any real studies that show stats of outcomes?

[Lee Murian]

I've been dealing with this forever, I have a super high volume foot and every shoe except birks and rainbows Altra wides makes my foot 12/10 on pain scale after an hour or 2. Compression socks even hurt like hell. I have mercilessly punched and met padded, toe spacers, inji socks, everything. Finally yesterday went to a local pain specialist who also has personally managed this himself and has tried every other procedure on himself.

We did a steroid and glucose injection which hopefully puts out the fire and makes more space in the joint. I'm curious to see if this helps and for how long, next step would be nerve ablation and he didn't recommend multiple injections. Anyone have experience with injections?

I kind of feel with my history and the amount of pain I'll need a more aggressive treatment, but hoping this helps for now.

zzz, did you get the surgery on the other foot? How's it going? How long is the recovery?

[rod9301]

Surgery is a Last resort.

You say that every shoe other than hoka wide hurts. Than why not just wear the hoka?

The neuroma will go away if you religiously only wear wide shoes AND ski boots.

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[PeaHead96]

I’ve suffered from MN on and off for probably 5 years now.

Most articles and doctors say that you can’t heal it once it forms, and maybe that’s true, but I’ve made considerable progress by restrengthening my feet. I actually rarely feel it anymore. It only flairs up when I get very sedentary for some days and become lazy about stretching and exercising.

Don’t listen to people that say you should be wearing insoles or orthotics in all your shoes (ski boots sure, skiing is not a natural activity for humans). You’re just making your feet weak.

I have a lot more I can add, but just know there’s a lot you can do to treat it. Everyone is different of course, but yeah I would avoid surgery.


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[zion zig zag]

<p>

I&#39;ve been dealing with this forever, I have a super high volume foot and every shoe except birks and rainbows Altra wides makes my foot 12/10 on pain scale after an hour or 2. Compression socks even hurt like hell. I have mercilessly punched and met padded, toe spacers, inji socks, everything. Finally yesterday went to a local pain specialist who also has personally managed this himself and has tried every other procedure on himself. We did a steroid and glucose injection which hopefully puts out the fire and makes more space in the joint. I&#39;m curious to see if this helps and for how long, next step would be nerve ablation and he didn&#39;t recommend multiple injections. Anyone have experience with injections? I kind of feel with my history and the amount of pain I&#39;ll need a more aggressive treatment, but hoping this helps for now. zzz, did you get the surgery on the other foot? How&#39;s it going? How long is the recovery?

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I did not get surgery. Primary reason: after a few long back to back ski touring days, I realized that the foot I had surgery on had more issues with the neuroma than the foot I was getting ready to have surgery for. So even after surgery it was back, which is supposedly very common. I went to another doctor for a second opinion and he advised me not to get surgery. Instead, he made me a very expensive pair of custom orthotic footbeds for my day to day shoes. If they are much better than off the shelf footbeds, I can&#39;t really tell. I was using SOLE footbeds with the metatarsal bump in them but I&#39;ve since discovered ones from Tread Labs that are better and allow custom placement of the metatarsal bump.&nbsp;</p>
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I have custom insoles in my ski boots and the metatarsal bump in those is crazy, big and hard. They are mildly uncomfortable to wear all day, like my feet are on the edge of cramping while using them, but....they seem to prevent the neuroma pain. Spring ski touring will be the real test as that&#39;s what usually causes me the most issues. Front pointing in crampons and skinning hard off camber snow really seems to flare it up. Which brings me to my next point: ignore the advice to just go wider and wider until there is no pain. I think that works fine for walking around the mall, but it absolutely does not work in any type of athletic pursuit. If your shoes are too wide and you give the forefoot room to slide around, then things like front pointing, walking downhill, and sidehilling end up causing your foot to bang into the side of the shoe repeatedly all day.&nbsp;</p>
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So, just wide enough to be comfortable without extra room for movement and a really locked in foot behind the arch seems to be key for me. And something else that I&#39;ve semi-recently discovered; the pain is much worse with cold feet, which I notoriously have. So I&#39;m starting to experiment with heated socks, we&#39;ll see how that goes. Good luck, and I&#39;d be happy to have a convo with you if you have specific questions, I&#39;m not the expert but I&#39;ve been dealing with it for a long time and tried lots of things, including years of ignoring it and toughing it out which I don&#39;t recommend.&nbsp;</p>

[Harry]

I was scheduled for surgery in Spring of Twenty Twenty, but the world shut down and my surgery got canceled because the hospital was overrun with patients on ventilators.

Fast forward five years and I seem to have cured myself. Not just wide shoes but extra-wide. Always use prescription orthotics. I found the “metatarsal bump” makes mine worse. Ice when inflamed. Ibuprofen as needed.

Slowly it just went away. I don’t even think about it anymore.





Edit, ski boots = Lange LX One Thirty (one oh two wide)


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[skuff]

Metatarsal pad on custom orthotics was the solution to my Morton&#39;s neuroma. It was uncomfortable at first, but the person making the orthotics kept sanding the pad down, little by little, until it was comfortable and working well Haven&#39;t had any MN issues since then and the footbeds are still going strong after ~twenty years. Only wear them in my shoes, currently using Instaprint custom footbeds (no metatarsal pad) in my ski boots

[24Dave]

I completely agree that just too wide of a boot will not necessarily help. I spent decades torquing too-wide snowboard boots up skin tracks splitboarding and developed mortons as a result. Boot width should be wide but also just right and the rest of your foot, instep, ankle area heel need all to be just-right snug so your foot is held well.

In my case, my pain spilled over into everything. I travelled to have a surgical release of the ligament on top of my Neuroma, and cryo applied directly through a small top of the foot incision because I didnt want to fly back to a specialist for the ultrasound applied cryo or other nerve killing treatments wihci sometimes take a few tries to get thorough relief. I think the best modern adive is to avoid cutting the nerve. read everything linked to the Center for Mortons Neuroma in MA, my MD Dr. Horwitz at Feet for Life in St. Louis. I travelled from out west and am so glad I did.

I have custom insoles in my ski boots and the metatarsal bump in those is crazy, big and hard. They are mildly uncomfortable to wear all day, like my feet are on the edge of cramping while using them, but....they seem to prevent the neuroma pain. Spring ski touring will be the real test as that&#39;s what usually causes me the most issues. Front pointing in crampons and skinning hard off camber snow really seems to flare it up. Which brings me to my next point: ignore the advice to just go wider and wider until there is no pain. I think that works fine for walking around the mall, but it absolutely does not work in any type of athletic pursuit. If your shoes are too wide and you give the forefoot room to slide around, then things like front pointing, walking downhill, and sidehilling end up causing your foot to bang into the side of the shoe repeatedly all day.
So, just wide enough to be comfortable without extra room for movement and a really locked in foot behind the arch seems to be key for me. And something else that I&#39;ve semi-recently discovered; the pain is much worse with cold feet, which I notoriously have. So I&#39;m starting to experiment with heated socks, we&#39;ll see how that goes. Good luck, and I&#39;d be happy to have a convo with you if you have specific questions, I&#39;m not the expert but I&#39;ve been dealing with it for a long time and tried lots of things, including years of ignoring it and toughing it out which I don&#39;t recommend.