Morton's Nueroma

jabell9

Ok, so I was diagnosed having a morton's neuroma Aug 2009. I got a cortisone shot, quit using bungie laces (except on race day) and haven't had a problem until a week ago. It came back from a stupid decison I made. I ran 11 miles in a new pair of shoes, way more minimal that what I was used to.  It does't hurt when I run (yet), but throbs later in the day. I am taking NSAID's and icing it.

I have a podiatrist appt for next week, but my questions is should I go for another cortizone shot? I have heard that too many weaken the tendon, and also injecting things in general is not good. My thought is if it were more often I would opt out, but since it's been a year (and I won't run that far in those shoes again) I think it's ok. Any other opinoins definaltey welcome.

Thanks

Jessica

wileyfish1

 Jessica, I feel your pain.. I dealt with this for many years, went through surgery, injections, and custom inserts....  Finally found a good orthotist in Portland ME, that did the trick....  Basically what is happening is the bones of the foot (metatarsals) compress on the nerve bundle that runs between them, either from shoes being too tight or because of a mechanical issue that occurs during foot strike.  ( I apologize if you know all this...)  I think using newer shoes (not broken in pos tighter) probably aggravated this, So what i would do at this point is some elevation, non-steroidal anti-inflammatories (advil, alleve) and well cushioned shoes for a few days and see if this quiets it down.  If you find you are still having a problem it may make sense to have another cortisone injection, especially now since you acutely have some inflammation there.  As far as the cortisone shots being bad, you can run into trouble with them if you get several stacked back to back over a short period of time, I don't suspect you will have any problems getting them a year apart....  Another option would be to try an oral steroid taper, but not as effective as the shots

hope this helps

Brian

Michael Nardone

I had the same problem but it was very sudden and thought i had broke a bone in my foot. (got caught late on the handoff at a relay and had to hammer a 4 mile leg, I launched out way way to fast. I believe this is what triggered it) I had one cortisone shot but it lasted about 4 minutes and made things worse. My result was I had it surgically removed, while i was getting bunion surgery and some cartilage looked at in my big toe. There is no more pain in that area but there is no feeling between my 2nd and third toe on the inside surfaces. a small price to pay. I had to get used to it. I guess you should hold out on all surgery and it may heal. I dont know this as i didnt wait long myself. A couple of friends had this problem and are still sticking things under their feet in their shoes after 4-7 months and their pain has gone away. good luck......they are surely a pain the buttt.

jabell9

Thanks guys, I think another part of the problem is I have had to reteach myself to run more on my forfeet to keep my legs aligned (this was to fix ITBS). I think running my forefeet on the less cusioned shoes for so long is what did it. It was throbbing last night after swimming, I think from pushing off the wall. I will try and hang back on running for a bit and take NSAID's. If it still bothers my I may just get the injection and increase miles back slowely. Man, if it's not one thing it's another. I guess it's the price we pay as athletes. Glad you guys got fixed up.

Hasanbaydoun

Jessica - morton's neuroma can indeed by pretty frustrating, and agree with you that multiple steroid injections will definitely weaken the ligaments in that area.
the other option available to you is icing (10 minutes on-off) during the day; and a specific morton's neuroma orthoses (which has a cutout to decrease the pressure in that area)
hope u get better - keep us posted ;-)

Michael Johnson

I would stay with the intermittent cortisone injection despite it's downsides. Also the other nonoperative treatments are fine. Because, if cortisone doesn't work, you looking at surgery (not a small deal). Cortisone downsides are still less than surgery.

Paul Hough

Try icing it. And then ice it some more. And later on ice it again. Buy and wear toe spreaders at night. I have ones to wear in bed, and others that are gel packs that you refrigerator so you can ice between the toes. Did I mention you might try icing it? Good luck.

jabell9

Thanks again, you're funny, Paul. I will let you know how it goes. I am going to get an ice pack now

Leigh Boyle

lots and lots of variables can contribute to mortons- shoes, your stride, the bike, muscle mobility and flexibility, etc etc. especially if it keeps coming back.

make sure you're stretching your calves (upper and lower parts) like it's your job! frozen water bottle rolls for the foot are also a life safer. the whole nerve has to be kept loose, not just the end part that's getting squished in the ball of your foot. that's the key to really kicking it. shots will do most of the heavy lifting, but you've gotta work at the rest since our calves usually hate us as triathletes.

jabell9

Thanks Leigh. I do want to clarify that it doesn't really keep coming back. It has been a year and happened after one specfic run. I do agree that I should maintain the steching and icing routine, but if it's been a year is a shot that bad. Do tendons repair themselves over time? Yes I am looking for the fast and easy way out but it worked like a charm last time. I'll avoid the new shoes too. I'll even eat more veggies!!

Leigh Boyle

the shot isn't bad. it just doesn't cure the cause of the problem so if you've got stuff on the calendar go for it. just don't be surprised when it comes back.

tendons and muscles can heal, they just take time if they've been a problem for a long time.

jabell9

Thanks Leigh, good point. The podiatrist said wait on the shot too, so I did. Good news is I don't feel it as much now. I ran twice this week (after 3 weeks off) and no pain. Gonna still ease back into it (in the right shoes). Nothing on the calander expect the off season so I'll try to be patient. Thanks again everybody

harrast

Hey Paul (and anyone else who would be willing to respond), I'm hoping that you can help your old Muncie pal with a possible Morton's Neuroma issue.  Here's my history:  Spring 2012 I did the marathon hack along with the OS and started having shooting pains and burning in the ball of my right foot.  I kept up the workouts, though very painful, and got through my marathon in April. 

As I continued to train into the summer, the pain increased and spread to my left foot.  By July I was skipping runs because I couldn't stand the pain.  Even the bike hurt, but I gutted it out.  I went to the podiatrist in July and had orthodics made.  The orthodics make workouts about 20-30% more tolerable, but the pain can still be debilitating.  I can do maybe 3-4 miles before I'm limping. 

I quit running for the entire month of August.  In September I finished my race schedule experiencing severe pain during the run.  After my race I took a week off the running workouts then started some short workouts.  This week I started the get faster program and am right back where I was with the pain.

This morning during my run, I felt like I had a fold in the sock in both of my shoes.  I pulled off my shoe and found nothing.  I put it back on and still felt like I had a fold in my sock. 

I have iced the feet, but I haven't kept this up as a regular therapy.  I wear orthodics at work and during workouts.  I have taken a month break and the pain returns immediately.  I don't want to rely on NSAIDs as a long term therapy.  I have an appointment with my podiatrist on Monday. 

Thoughts?

Scott Alexander

Here's a whole other thread I started about "hot foot". You might find some good info in there, I hope...

members.endurancenation.us/Training...fault.aspx

kyliejean

Hi all,

I don't know if it's relevant to what has been asked, but in case it helps anyone to read a good news story on a nueroma diagnosis...

Two years ago, I developed pain in my right foot during the latter part of a half-marathon. Didn't think much of it, as you get all sorts of niggles during a race. But then it started to come on at about 8km into any run, then 5km, then it got to the point where it hurt whenever I ran at all, and finally so bad that it hurt just to walk about the house, and would keep me awake at night.

The podiatrist I was seeing then was convinced it was a nueroma (and the symptoms did match all the reading I did about it). He created pads to put under my orthotics, which helped a little bit, but not a lot. I also found running on one side of the road helped (put a different angle on my foot), but not a lot. He basically told me I could only run if it didn't hurt, as hurting would just be making it worse and the treatment options aren't great (injections or surgery, as you have all mentioned). Aside from one abortive 20-minute run where I tried to convince myself it didn't really hurt, and a couple of 3-minute runs off the bike, I basically stopped running while I waited to get in to get scans/x-rays etc. This meant no running until three weeks before a half-ironman...

Anyway, the time off - about six weeks, I think - did the trick, eventually. When I finally had the scans, I was told there was no sign of a neuroma, no stress fractures or broken bones... basically nothing. The podiatrist's verdict after getting the results was that if there was still some pain, it was up to me whether to run because if it wasn't a neuroma then I wasn't actually doing damage. So at least I was able to do my race. Very slowly, given lack of training.

Interestingly, the massage therapist I was seeing at the time had been quite adament that he didn't think it was a neuroma. (Unfortunately, massage didn''t help but I wasn't seeing him just for the foot, so it wasn't wasted money. Regular massage is a good thing!)

So in the end, I don't know if it was or not. However, the layoff seemed to fix the pain actually inside my foot. I was left with an odd stinging pain along the outside of my foot, which had come on at the same time. It''s never completely gone away. The only thing that helps with that is seeing a chiropracter regularly.

Like I said, not sure if this helps anyone, but I find other people's stories help me with all sorts of stuff, so I'm paying it back...

Hope both of you find some ease,

Kylie

 

 

 

 

 

 

 

harrast

@Kylie, that's good to hear. I took a month off, but I came right back to an HIM and pain in the same place and intensity. I went to the Ped this PM and he continues to assert that I have a biomechanical issue in my foot--which I can believe, but it seems to me that the nerve may be a secondary issue. Anyway, after our "discussion" he decided that I needed a cortisone injection. I wasn't really feeling like I wanted to go there, but the next thing I knew it was done and I was heading out the door. I'm supposed to take a couple of days off before I run again.

Jess Withrow

Piggybacking on what Kylie added - I don't have a Morton's Neuroma-specific story to relate, but I can definitely attest to the benefit of having a chiropractic adjustment of the foot! It was HUGELY helpful when I had a case of sesamoiditis that flared up before IMNYC and I was left walking on the outside of my foot to spare the pain in the ball of my foot... all of that wonky walking left everything out of balance in my foot and having it adjusted a few times did me a world of good. I'm pretty sure Brenda Ross has had some luck with having her foot adjusted, too.

@ Jessica - my foot issues were also due to wearing more minimalist shoes. Out of curiosity, what shoes are you running in now? Oh yeah, I also had a cortisone injection... really hope I don't have to repeat THAT!

cyberspin

I had this a few years ago and looked it up on Mayo Clinic's website. They recommended a certain pair of running shoes that are made for this problem. I think it was New Balance that made them but there might be more companies now. They make the shoe so the heel drops lower that your toes and takes the pressure off your toe area. It worked for me. I wore them for a year and now I can wear whatever shoe I want. A good running store should carry the shoe.

harrast

Looking for thoughts--here's my foot history:

Severe burning and shooting pain in ball off foot during runs (milder during walking) becomes intolerable spring 2012.
Podiatrist July 2012 prescribed orthodics.
Pain continues.
Two cortisone shots summer 2012.
Pain continues.
Appointment with orthopedic doctor February 2013.
Third cortisone shot.
Foot MRI--no visible fractures.
Pain continues.
Referred to foot and ankle specialist.
Prescribes orthodics with metatarsel pad.
Use new orthodics.
Pain continues.

The foot and ankle Doc says the next treatment is to clip a tendon to release the pressure on the nerve. I am always a little leery of doing something that can't be reversed. I asked about RF ablation or cryosurgery, but the Doc did not entertain this as an option. Among the normal population clipping the tendon appears to have a high success rate. My concern is that the tendon holds my foot together, and I would like to run another 25 years, so it scares me a little. Any thoughts?

Scott Alexander

Welcome to this (unfortunate) club! Take a look at this thread of my progression:

http://members.endurancenation.us/F...fault.aspx

Also, just posted this to another forum only hours ago:

I suffered from "hot foot" for the last 7+ years. It first appeared when I started hitting real long distances on the bike (100+ miles), then kept showing up when the distances were getting shorter and shorter, until just about every ride was excruciatingly painful.

Then, being triathletes like we are, having to get off the bike and run - it just felt like the bottom of my feet were forming huge blisters (obviously, making it difficult and comfortable to run). No blisters were ever created!



Over the last 7 years, I've tried everything I could to fix it 'mechanically', including: powders, socks/no socks/different socks, footpads/inserts, additional "bumps" on the footbed, new shoes, new cleats, cleat positions.

I then went the medical route, with cortisone shots, "podiatherm" to electrically kill the nerves between the toes, and finally bilateral

nerve/neuroma excision earlier this year (cutting those dam nerves out completely).



You see, "hot foot" is what's actually called Morton's Neuroma. In between each of your toes, there's a Y-shaped nerve. When you push your feet into shoes (in this case cycling shoes), add heat (which the body produces) and push thousands of times (RPMs), the bones in your feet push against each other - and inflame this Y-shaped nerve between your toes.



The bilateral nerve/neuroma excision surgery I had in March this year was the final solution. If removing the nerve didn't solve the problem, there's nothing else to do!

Under general anesthesia (the anesthesia takes longer to wear off than the procedure itself), the surgeon cuts a 1" incision in the top of your foot, between toes 2-3 (count from your big toe inwards). Then they go in and physically cut out the affected nerve, cauterize the remaining end points, then stitch you up. Easy.



I had both feet done at the same time, although my right foot was significantly worse.



Post-surgery, each foot was wrapped in surgical gauze and wrapped in ace bandages. Then I got this neat-o pair of hard-soled "space shoes" to wear around for 12 days, until the stitches were removed. NO activity is allowed for that 12 days.

For that 12 days, I was supposed to stay off my feet as much as possible (right, who does that!). I was allowed to shower, although I had to encase each foot/leg in towels and plastic bags with tape and bungee cords, to prevent the dressing from getting wet.

As soon as the stitches were removed, I was allowed to bike and swim as much as I wanted to. The doc encouraged no running for another month (who does that? I've got an Ironman to train for!), but if pain allowed you to run, he didn't prevent you! Swelling will exist for at least another two months.



My right foot was FAR worse than my left (I've got pics of the excised nerves if anyone wants to see them).

The left "Y" nerve was just starting to form a knot at the middle, while my right nerve looked like a recently-defrosted raw chicken breast (nasty), not at all shaped like the "Y" it's supposed to!

Given that my right foot was worse, it healed and the swelling decreased surprisingly fast.

My left was still swollen a few months later, but not entirely uncomfortable. A little self-massage and ultrasound to get the scar tissue under control was the prescription to help assist with that process.



I would suggest finding an ortho to discuss these options, NOT a normal podiatrist (they seem to want to address the symptoms and not fix the problem, in my experience).

Being that this is, technically, surgery, with general anesthetic, it can get a little pricey (thankful for having decent insurance). But for me, it was totally worth it to finally resolve this 7+ year issue!

Do NOT let anyone cut through the BOTTOM of the foot, if you do get it. That significantly impacts recovery and pain is severely worse, from what I understand.



Well, this all happened for me in March.

It's now June, and I'm 100% pain free and able to ride and run as much as I want without issue! I've got to train!

There is a little bit of numbness on the ball of my foot, but not enough that I won't feel it if I cut myself on something; just feels like a toe is asleep.



Let me know if you have any questions!



Scott