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

[JRainey]

I've probably said this before but re: wider ski boots--they make the problem worse if you have a sloppy fit and compensate by cranking down the lower buckles. A snug hind foot fit that lets you keep the lower buckles just snug enough so that they don't pop open is best. I have longstanding plantar neuromas; a medium width forefoot; and skinny heels, ankles, and calves, and a low instep and I'm comfortable in a 98mm last boot with multiple insole shims with no slop in the hind foot.

Agreed. I'm punching the forefoot of snug boots, not getting buckets. My issue arose from a way too "race" fit, and stupidly not molding the liners. Those boots have since been punched to near death, but I now only use them for skiing and not touring.

"Wide enough" is what should be said.

[JRainey]

Your insole needs to have a “button” behind the metatarsal heads to keep the bones spread off the nerve. Wider won’t make any difference without that.

I have them in ski boots, biking shoes and for regular shoes. 4th toe numbness is likely permanent for me but no pain since.


Sent from my iPhone using TGR Forums

It's not necessary, but it's a great aid. If for example, you have the "button", but not enough space it still won't work.

I also have no issues barefoot, without any aid spreading my toes. When it was really bad I had issues barefoot, but then I started letting my feet relax in wider shoes and now it's fine.

I've also had luck in shoes that I really want to wear, but are a little too tight, with using a half insole. That way I get arch support, my foot is stabilized and then I get the most forefoot room possible.

I feel like everyone has to go through options and see what works for them. The key is to stop doing what hurts slowly back up from the edge because at least in my experience it was a slow process to get better.

[rod9301]

It's not necessary, but it's a great aid. If for example, you have the "button", but not enough space it still won't work.

I also have no issues barefoot, without any aid spreading my toes. When it was really bad I had issues barefoot, but then I started letting my feet relax in wider shoes and now it's fine.

I've also had luck in shoes that I really want to wear, but are a little too tight, with using a half insole. That way I get arch support, my foot is stabilized and then I get the most forefoot room possible.

I feel like everyone has to go through options and see what works for them. The key is to stop doing what hurts slowly back up from the edge because at least in my experience it was a slow process to get better.

Very similar to my experience

Neuroma is caused by a mechanical problem, shoes too tight, and it's solved mechanically too.

Sent from my Armor_3 using Tapatalk

[bodywhomper]

FWIW, I have found joe nimble shoes to have a very wide toe boxes. Same for mini mil (tactical) boots. Both are minimalist designs, though.

[zion zig zag]

This spring has left me thinking that surgery may be the only option left for me. In general, spring skiing is way worse for pain than winter skiing. I think it's #1 hard snow makes me rotate my foot in the boot more than skinning on soft snow, #2 cramponing on hard snow and kicking in steps, and #3 the snow more often makes me get in the backseat, this is the worst of all. A couple of weekends ago I hit a small stretch of water ice around some rocks and when I kicked in the pain was so intense that I thought I may fall.

The past few weekends I've gone out to ski peaks and by the time I'm done I'm in almost unbearable pain. Switching back to altras for the hike out brings almost instant relief. Have any of you ever tried icing your foot in the snow mid tour? Does that help? Any luck with any anti inflammatories? Four advil seem like little help at this point.

Heading out for another long tour this afternoon and looking for strategies.

[old goat]

This spring has left me thinking that surgery may be the only option left for me. In general, spring skiing is way worse for pain than winter skiing. I think it's #1 hard snow makes me rotate my foot in the boot more than skinning on soft snow, #2 cramponing on hard snow and kicking in steps, and #3 the snow more often makes me get in the backseat, this is the worst of all. A couple of weekends ago I hit a small stretch of water ice around some rocks and when I kicked in the pain was so intense that I thought I may fall.

The past few weekends I've gone out to ski peaks and by the time I'm done I'm in almost unbearable pain. Switching back to altras for the hike out brings almost instant relief. Have any of you ever tried icing your foot in the snow mid tour? Does that help? Any luck with any anti inflammatories? Four advil seem like little help at this point.

Heading out for another long tour this afternoon and looking for strategies.

I've probably said this before too, but when the pain gets excruciating--for me only hiking in heavy boots which I don't do any more--banging my head with an ice axe or trekking pole seems to help for a bit. Seriously--I've done that, although I'm not recommending.

As the years have gone by my hiking boots have gotten flimsier and flimsier. I was about the only person of hundreds I saw on the Tour du Mont Blanc wearing low cuts. Unless you have to kick steps or wear crampons I think the "experts" recommend boots heavier than most people need. I am skeptical that high heavy boots give any protection against against ankle sprain, or maybe I've sprained my ankles so many times that they have lots of room to roll before anything tears, and I'm so sensitive to rolling them that I instinctively unweight them before any damage is done.

[rod9301]

I've probably said this before too, but when the pain gets excruciating--for me only hiking in heavy boots which I don't do any more--banging my head with an ice axe or trekking pole seems to help for a bit. Seriously--I've done that, although I'm not recommending.

As the years have gone by my hiking boots have gotten flimsier and flimsier. I was about the only person of hundreds I saw on the Tour du Mont Blanc wearing low cuts. Unless you have to kick steps or wear crampons I think the "experts" recommend boots heavier than most people need. I am skeptical that high heavy boots give any protection against against ankle sprain, or maybe I've sprained my ankles so many times that they have lots of room to roll before anything tears, and I'm so sensitive to rolling them that I instinctively unweight them before any damage is done.

I think light boots are fine, but i still like the full shank one for kicking steps and for not feeling every little pebble as i walk.

Sent from my Armor_3 using Tapatalk

[old goat]

I think light boots are fine, but i still like the full shank one for kicking steps and for not feeling every little pebble as i walk.

Sent from my Armor_3 using Tapatalk

Yeah, I like the stiff sole. The first thing I do when I buy a pair of hiking shoes is flex them all. It's hard to find a pair of light weight low cuts with a stiff sole. It's not as painful as a neuroma but stepping on a pebble with the 5th metatarsal head in a pair of sole soled shoes is close.

[zion zig zag]

This weekend found me cramponing up perfect neve for 2500 feet. Front pointing was out of the question, I had to french technique with my left foot (neuroma foot) heel down the whole way for some relief. By the time I got to the top I was in excruciating pain. My boots were loose in the forefoot and I had in custom insoles, it just doesn't seem to matter. I did ice my foot at the top and that seemed to help but I think it's time for me to consult with a podiatrist.

[Dantheman]

but I think it's time for me to consult with an orthopedic foot/ankle surgeon

FIFY

[old goat]

This weekend found me cramponing up perfect neve for 2500 feet. Front pointing was out of the question, I had to french technique with my left foot (neuroma foot) heel down the whole way for some relief. By the time I got to the top I was in excruciating pain. My boots were loose in the forefoot and I had in custom insoles, it just doesn't seem to matter. I did ice my foot at the top and that seemed to help but I think it's time for me to consult with a podiatrist.

FIFY

It depends. At my hospital (Kaiser) the podiatrists did all the foot surgery and did it well. That might not be the case elsewhere. Whoever does it needs to be well-trained in foot surgery and doing a lot of surgery. Good luck as Joe Public figuring that out.

[zion zig zag]

It depends. At my hospital (Kaiser) the podiatrists did all the foot surgery and did it well. That might not be the case elsewhere. Whoever does it needs to be well-trained in foot surgery and doing a lot of surgery. Good luck as Joe Public figuring that out.

Well, unfortunately I've had four surgeries on that foot, three all by one doc. Good experiences with him so maybe that's where I start? He's not a podiatrist, just a foot/ankle orthropod. I guess I can call the office and ask him about it?

[Dantheman]

The surgeon who did my resection (Van Boerum at TOSH) claimed he fixes a lot of stump neuromas from procedures that were done by podiatrists. He said that most podiatrists just cut out the neuroma, which is often fine for your average sedentary person but not for active people. He goes further and relocates the end of the nerve into the intermetatarsal muscles. The logic is that being surrounded by muscle reduces stump growth. Some stump growth is also inevitable, so that stump is less likely to cause problems if it is placed in the relatively roomy intermetatarsal space.

[zion zig zag]

The surgeon who did my resection (Van Boerum at TOSH) claimed he fixes a lot of stump neuromas from procedures that were done by podiatrists. He said that most podiatrists just cut out the neuroma, which is often fine for your average sedentary person but not for active people. He goes further and relocates the end of the nerve into the intermetatarsal muscles. The logic is that being surrounded by muscle reduces stump growth. Some stump growth is also inevitable, so that stump is less likely to cause problems if it is placed in the relatively roomy intermetatarsal space.

Good info to know, thanks.

[zion zig zag]

So, I met with the Doc yesterday and scheduled surgery for July 2nd. He said almost everything that DTM has said in this thread. Alcohol injections are a scam and they don't help, cortizone does more harm than good after a couple of injections and once it gets to the level that I describe nothing but surgery will take care of it.

The only type of surgery that he does is also what DTM described. He relocates the nerve into the muscle tissue further back in the foot, towards the arch. He said that the only stump neuromas that he sees are when he is fixing someone else's work and he can tell from a consult what problem they are having because the original surgery scar isnt long enough to have moved the nerve. He also said that in his experience that the bigger the neuroma, the easier the surgery and healing time? Apparently mine is pretty big.

So that all made me feel good enough about the procedure to go ahead and schedule. He told me I would be weight bearing day of surgery and could most likely go back to office work the next day. But reading on the internet it seems like most people need a few days? If I go into the office for 4-5 hours and elevate while I'm there, would that be doable? How long till I can be back on easy MTB rides? Easy hikes?

[Dantheman]

He also said that in his experience that the bigger the neuroma, the easier the surgery and healing time? Apparently mine is pretty big.

Never heard of that. Mine was the size of a raisin, which is pretty big, supposedly. I don't see why that would be the case, the incision is the same size regardless of the size of the neuroma.

He told me I would be weight bearing day of surgery and could most likely go back to office work the next day. But reading on the internet it seems like most people need a few days? If I go into the office for 4-5 hours and elevate while I'm there, would that be doable? How long till I can be back on easy MTB rides? Easy hikes?

Don't push it. A half day at the office with it elevated won't do much harm, but the time you spend driving to/from, walking to and from your car, etc. will add up. With surgery on the 2nd and the 4th being Thursday I'd just try to take the rest of that week off if you can. Elevate, elevate, elevate. Your lymphatic system doesn't work for shit below the knee.

Looking back through my old posts I hit the spin bike pretty hard 3 weeks out and regretted it. 8 weeks out I skied the Bird hard for 5 hours and was fine. Trail running 10+ miles/2k+ vert 5 months out. I also had stitch abscesses that complicated my recovery a bit. I'd say 4-6 weeks for easy MTB, 6-8 weeks for strenuous MTB and easy hiking, 12+ weeks for strenuous hiking.

[zion zig zag]

Never heard of that. Mine was the size of a raisin, which is pretty big, supposedly. I don't see why that would be the case, the incision is the same size regardless of the size of the neuroma.

He's probably just making me feel better, trying to impart on me that this is an easy surgery. I told him I was hesitant.

Don't push it. A half day at the office with it elevated won't do much harm, but the time you spend driving to/from, walking to and from your car, etc. will add up. With surgery on the 2nd and the 4th being Thursday I'd just try to take the rest of that week off if you can. Elevate, elevate, elevate. Your lymphatic system doesn't work for shit below the knee.

Looking back through my old posts I hit the spin bike pretty hard 3 weeks out and regretted it. 8 weeks out I skied the Bird hard for 5 hours and was fine. Trail running 10+ miles/2k+ vert 5 months out. I also had stitch abscesses that complicated my recovery a bit. I'd say 4-6 weeks for easy MTB, 6-8 weeks for strenuous MTB and easy hiking, 12+ weeks for strenuous hiking.

My office is only about a 2 mile drive and parking is close. It's not absolutely imperative that I show up, and I can work from home if need be.

Not the recovery timeline that I wanted to hear obviously. I was hoping for some MTB trail time at 3 weeks out (maybe not too far off?). And I had planned to climb the Grand in a day early September with my kid, but 12 weeks puts me into October.

I guess it doesn't matter, as much as I hate to do it, living with it has started to become untenable to the things I want to do. Thanks for the timelines/experiences.

[Dantheman]

The Grand in a day in early September definitely seems ambitious and probably not advisable. Maybe if everything has gone really well and the surgeon gives you a thumbs up to go for it. Of course, even if your foot is fine your lungs and legs may be another story. 7k of descending after mostly taking the previous 8 weeks off sounds like a good way to get rhabdo in your quads.

MTB at 3 weeks, eh, maybe. I'd test it out on a stationary bike first. Surgical incisions take 6-8 weeks to fully heal. I split my shin open last summer 3" long to the bone (6 internal stitches, 8 external) and that took 9 weeks to fully heal.

Not sure how strict your guy is, by my surgeon wouldn't let me get the incision wet until 24 hours after the stitches came out, which was two weeks after surgery. Two weeks of taking baths with one leg hanging out of the tub. Yeah, that sucked.

[zion zig zag]

The Grand in a day in early September definitely seems ambitious and probably not advisable. Maybe if everything has gone really well and the surgeon gives you a thumbs up to go for it. Of course, even if your foot is fine your lungs and legs may be another story. 7k of descending after mostly taking the previous 8 weeks off sounds like a good way to get rhabdo in your quads.

MTB at 3 weeks, eh, maybe. I'd test it out on a stationary bike first. Surgical incisions take 6-8 weeks to fully heal. I split my shin open last summer 3" long to the bone (6 internal stitches, 8 external) and that took 9 weeks to fully heal.

Not sure how strict your guy is, by my surgeon wouldn't let me get the incision wet until 24 hours after the stitches came out, which was two weeks after surgery. Two weeks of taking baths with one leg hanging out of the tub. Yeah, that sucked.

Rhabdo is a good point. I tend to make the mistake of categorizing things I've done a few times before as easy, despite me getting older

I hear you on the bath thing. When I broke my calcaneus I had three surgeries basically spaced to where I had to bathe that way for almost 5 months, and was non weight bearing. 2 weeks doesn't seem too bad in comparison.

[old goat]

Well, unfortunately I've had four surgeries on that foot, three all by one doc. Good experiences with him so maybe that's where I start? He's not a podiatrist, just a foot/ankle orthropod. I guess I can call the office and ask him about it?

I'm not suggesting that you leave the orthopedist you're comfortable with and find a podiatrist, especially since he's a foot and ankle specialist, only that orthopedists aren't automatically better at foot surgery than podiatrists. Depends on the orthopedist, depends on the podiatrist.

[zion zig zag]

Surgery is done, happened on the 2nd. I'm getting around by walking on my heel. I have had surprisingly little pain, I think I've taken three ibuprofen and two naproxen total. And I did have 1 hydrocodone, I had to remind myself that I don't like them.

I decided tonight to probe around the bottom of my foot where the neuroma used to be, that was painful when I hit the sweet spot. I tested the waters with normal heel to toe walking today too and it's still a little sore for that.

[md81fe]

Not sure how strict your guy is, by my surgeon wouldn't let me get the incision wet until 24 hours after the stitches came out, which was two weeks after surgery. Two weeks of taking baths with one leg hanging out of the tub. Yeah, that sucked.

[Falcon3]

For all those dealing with foot issues, I'm sorry. I don't have a Morton's but I did develop a neuroma between the big toe and second toe a couple years back. Don't underestimate that PT can really help stabilize certain muscle groups and take pressure off parts of your foot. Even strong, fit people can be overdeveloped or underdeveloped in certain muscle groups, and getting a good PT to balance things out with you and strengthen the stabilization chain can make a big difference in the end pressure being applied to your toes, which directly affects the pain and stress of the neuroma. Just a thought.

[jmills]

I have been dealing with Neuroma type symptoms since skiing 2 days (12/24/17 and 12/26/17) in a boot way too marrow for me.
Since I am experiencing the pain and numbness between the first and second toes and seeing an ortho 18 months ago that called it metatarsalgia on my first visit I’ll call it neuroma symptoms. He sent me away with met pads the first visit and changed it to not being sure on my second visit but gave me a cortisone injection.
I have managed it with footwear changes (Air Jordan 1s shelved) and met pads. I have been able to ski without pain being in a boot with custom footbeds and punches around my 112 wide forefoot.
Barefoot on a cold tile floor isn’t pleasant and when I do make the mistake and wear the wrong shoes I have felt it flare within minutes but have gotten used to the fire in my foot and numbness.
Since it developed I’ve had my first gout attack (internet diagnosis) which hasn’t been treated and much more pain in the neuroma affected area and bunions on both feet. I see my internist today as I am having another flare up.
Thanks to DTM I have an appointment with Van Boerum the end of this month. Since I’ve managed it for a couple years already if he thinks I need to do more than what I’ve been doing I will wait until after the ski season.

[meter-man]

Thanks for the thread and comments. I developed MN last season in both feet, so my armchair diagnosis is that a new pair of boots (Dalbello KR2s) caused it, after 8 years in Lange overlaps. I'm in Maestrale RSs for touring. Wondering if there are any theories on a tongue boot (KR2) being worse for MN than an overlap (Lange)?? I know too tight in width is the killer, but curious if the different mechanics in the boot play a role too. Armchair theories? I think I'll probably ditch the KR2s this year, and get a new alpine boot and test the theory.

I got Sole footbeds for my biking and running shoes with a met bump, and they are awesome. I also got Sole flip-flops with met bump - most comfortable flips I've ever had. Highly recommended.