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

[funkendrenchman]

Any recommendations for a doctor in the Aspen/Vail area that does the surgery DTM describes? Also curious how they deal with it if it's both feet. Surgery at the same time? I've been dealing with it in both feet for about 8 years and I think I'm ready to throw in the towel and get surgery, now that I've hit my out of pocket max for the year.

[zion zig zag]

Any recommendations for a doctor in the Aspen/Vail area that does the surgery DTM describes? Also curious how they deal with it if it's both feet. Surgery at the same time? I've been dealing with it in both feet for about 8 years and I think I'm ready to throw in the towel and get surgery, now that I've hit my out of pocket max for the year.

Is your insurance on the calendar year? Guessing at this point having both feet done in the next week is out. As far as doing both feet, I think I would space them apart to the point that you can walk "normally" but not far enough apart that total return to activity is prolonged. Maybe 2-3 weeks apart? I'm sure the surgeon will have better advice.

[zion zig zag]

Question for those that have had the surgery some time ago. I'm almost six months out now, and still get sore with certain footwear and with a lot of walking. I have done 3 moderate (3-4k foot) tours this year and the one yesterday left me super sore, to the point that I cut a dog walk short last night. Does this continue to improve with time? Can I solve this with orthotics? New normal?

[Core Shot]

Haven’t had the surgery but definitely feel better in ski boots once I had a metatarsal arch put in my insoles.
Have you tried that?

Also a wide boot or a super heavy punch.
My ace boot fitter didn’t want to punch it as much as I wanted. Then he turned me into the Lange 130 flex high volume boot.

Also everyday shoes in wide. Wide shoes do suck for more active sports like tennis.

Is the pain post surgery different? Still intense stabbing? Or milder?

[zion zig zag]

Is the pain post surgery different? Still intense stabbing? Or milder?

Definitely a different pain. No stabbing or popping or burning. Just sore. Once it's sore different shoes don't seem to make much difference.

[funkendrenchman]

Haven’t had the surgery but definitely feel better in ski boots once I had a metatarsal arch put in my insoles.
Have you tried that?

Also a wide boot or a super heavy punch.
My ace boot fitter didn’t want to punch it as much as I wanted. Then he turned me into the Lange 130 flex high volume boot.

Also everyday shoes in wide. Wide shoes do suck for more active sports like tennis.

Is the pain post surgery different? Still intense stabbing? Or milder?

Where do you punch the boot wide? 6th toe or a little further toward the arch? I’ve had the 6th toe punched for years and it stills bothers me. Maybe even further?

I might try a metatarsal arch again. Tried it before and it didn’t do much. Maybe I need to mess around the the placement more.

[MTT]

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?

Did you try GABAPENTIN designed for nerve pain.

[rod9301]

Where do you punch the boot wide? 6th toe or a little further toward the arch? I’ve had the 6th toe punched for years and it stills bothers me. Maybe even further?

I might try a metatarsal arch again. Tried it before and it didn’t do much. Maybe I need to mess around the the placement more.

punch about an inch behind the base of the little toe, widest part of the foot(at least for my foot).

Then a metatarsal pad almost in the middle of the foot, farther back than you would think.



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[rod9301]

Did you try GABAPENTIN designed for nerve pain.

I have Morton's for about 3 years, then i punched my boots, wider shoes, and it went away in a couple of months.

It is caused by mechanical problems, tight shoes and it can only be solved by mechanical means, plenty of room in your shoes

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[old goat]

Did you try GABAPENTIN designed for nerve pain.

I found it worthless--at 1800mg/d--for nerve pain from lumbar stenosis. OTOH the lumbar stenosis cured the pain from my plantar neuroma because that part of my foot is now numb. C'est la vie. I've had patients who said it worked for them but I think in general it is overhyped--people are desperate for an effective non-narcotic pain medicine. In the past various anti-seizure drugs and older anti-depressants have been tried for chronic pain. Gabapentin is just the latest.

[MTT]

I found it worthless--at 1800mg/d--for nerve pain from lumbar stenosis. OTOH the lumbar stenosis cured the pain from my plantar neuroma because that part of my foot is now numb. C'est la vie. I've had patients who said it worked for them but I think in general it is overhyped--people are desperate for an effective non-narcotic pain medicine. In the past various anti-seizure drugs and older anti-depressants have been tried for chronic pain. Gabapentin is just the latest.

Thought I would throw it out there. It did nothing for me. It did not help my leg pain. Because it's not nerve related.v My issue is blood flow . And thats a pretty big deal. I had a sonogram and the tech looked very concerned but did not share. And the Cardiologist never got back to me. Now I am unemployed with no medical insurance. And a leg that goes out with severe pain after about 1 min of use - Like walking

[Flounder]

I have Morton's for about 3 years, then i punched my boots, wider shoes, and it went away in a couple of months.

It is caused by mechanical problems, tight shoes and it can only be solved by mechanical means, plenty of room in your shoes

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Doc said my mechanical issue is related to my freakishly long middle toes. I've gotten relief once I went to 100+ last on my ski boots, cushioned insoles, and stiffer sole/ wider shoes. Right foot cleared up completely. Left foot I have to use metatarsal pads with a notch cut out of them and that keeps the pain at bay.

As for gabapentin, I was on that for about a year for a seperate issue that was nerve related. It did help with nerve pain but it scrambled my brain as well. I'd have to think long and hard before going back on it.

[funkendrenchman]

Anyone have luck with calf stretching?

[old goat]

I probably said this before but don't go overboard on the loose shoes thing. What worked for me in ski boots was excellent heel and ankle hold so that the lower buckles are loose enough to barely stay closed (most of the time). My boots are 98 mm last, my foot width is D.(Tecnica Mach 1 130LV). In hiking boots, lacing so that the lower laces are loose while the uppers are tight (twist the laces around each other halfway up or reverse through the lacing holes or hooks to that the upper and lower lacing are independent).

[rod9301]

I probably said this before but don't go overboard on the loose shoes thing. What worked for me in ski boots was excellent heel and ankle hold so that the lower buckles are loose enough to barely stay closed (most of the time). My boots are 98 mm last, my foot width is D.(Tecnica Mach 1 130LV). In hiking boots, lacing so that the lower laces are loose while the uppers are tight (twist the laces around each other halfway up or reverse through the lacing holes or hooks to that the upper and lower lacing are independent).

I the same with hiking shoes. I lace them lose low, then i use zip ties to hold them together, then lace tight higher up.

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[funkendrenchman]

I probably said this before but don't go overboard on the loose shoes thing. What worked for me in ski boots was excellent heel and ankle hold so that the lower buckles are loose enough to barely stay closed (most of the time). My boots are 98 mm last, my foot width is D.(Tecnica Mach 1 130LV). In hiking boots, lacing so that the lower laces are loose while the uppers are tight (twist the laces around each other halfway up or reverse through the lacing holes or hooks to that the upper and lower lacing are independent).

I can agree with this. I just had some Nordicas blown out to make the forefoot nice and wide and then I compared them to my Salomons that fit like a vice grip and have a pretty narrow forefoot ( lower buckle is barely buckled). My neuroma feels best in the Salomons

[Core Shot]

Makes sense for a ski boot. Without good heel hold your weight shifts forward onto the ball of your foot.

[zion zig zag]

Time to bump this up. I had surgery on my left foot, and although I still feel the bump in there, it never really causes me pain.

My right foot on the other hand nearly brought me to tears yesterday multiple times. Why is cramponing and skiing in hard snow so much worse than any other activity? I'd link two turns on steep hard snow and almost double over in pain. Skiing down the apron where I could ski by primarily using the downhill inside edge caused almost no pain.

[yeahman]

I had this really bad a couple years ago. Could barely walk. I followed Rod's advice and fixed the problem mechanically.

1. Had all my ski boot shells punched out so my forefoot was not being squeezed. Then punched them again. (Yes you sacrifice a bit of performance.)

2. Threw away $500 in hiking shoes, work boots, etc., and bought all 4E wide shoes. Tough to find and I mostly ended up with dorky Sketchers. They make a couple ok hiking boots though. And 4E Asics from Famous Footwear are good and cheap too.

3. Started wearing toe separators every evening while watching tv or reading. Soft rubber kind. See photo.

4. Bought toe socks/liners and wore them when skiing and hiking. This (along with xtra wide shoes) does a great job of keeping your toes from squishing together, which of course is what irritates the nerves in the ball of your foot and causes the pain.

I was surprised all this worked. The pain was so severe at times I thought for sure I would require surgery. But doing all this before you build up a bunch of scar tissue is important. It is an investment and a PITA but all I knew was that crazy shooting pain every time I set my foot down was going to ruin my life if I didn't get it under control. Now I don't even wear the toe socks or separators anymore unless I feel some twinges. Then I do it a few days and it goes away. Bottom line is you need to stop your ski boots and shoes from squeezing your toes and forefoot by getting new gear, shell punches, whatever it takes. Good luck, it sucks to deal with but try this stuff before surgery.

[Lee Murian]

Good timing, I've been dealing with a self diagnosed MN for the last few seasons. After about 2 hours in anything but my flip flops or Altras it feels like a hot screwdriver is being plunged into my foot. Removing the boot is excruciating but brings near instant relief. Combined with snow and stepping on a convex hard object helps too. There's a near constant twinge in my foot, like hitting your funny bone that I can feel even barefoot and exponentially worse depending on footwear. During a skimo race this year it was so bad I almost quit on the last climb and realized it was from the compression socks I was wearing.

I've punched, stretched, custom insoled, neuroma padded, pretty much everything mechanical and nothing works. I do have a EEE+ and my whole life jammed my feet into shoes too tight. It feels like it's time for a professional opinion.

Do you start with a podiatrist? I'm in NorCal if anyone has any recs. Thanks for all the info here, super helpful

[Core Shot]

Ouch. Yeah it sucks.

Like yeahman I switched to all wide footwear.
But if you already have a wide foot you are fucked.

Switched to a wide forefoot ski boot and that helps. No punch.
But some days I take off my right boot at lunch.

Had a met arch pushed into my ski insoles. That also helped.

Haven’t gone custom orthotics in street shoes. Yet.
No surgery. Yet.

The pain is insane when it’s happening.

Good luck.

I self diagnosed as well. But never saw a podiatrist.
Once you read about it you know you have it.

[old goat]

I'm sure I've posted this before: If you have a low instep, over tightening the lower buckles to compensate for the loose forefoot fit it will squeeze the foot side to side and aggravate the MN. Adding some Bontex insoles is the solution. You want your lower buckles just tight enough to stay closed.

I recently replaced the liners in my Tecnica Mach 1 LV's. I got Intuition HD Race. Nice and snug around my skinny ankles, heels and calves, but roomy around my forefoot, despite being in a narrow boot. As advertised.

[bodywhomper]

People looking for very wide forefoot walking boots, Belleville makes one called the “mini-mil.” It’s a minimalist shoe/boot, so that may bring other issues out with your feet. Their wide version is extremely wide. I’ve found them to be pretty durable given the cost and their lightweight nature. Size up by about half size because they run small.

[yeahman]

Good timing, I've been dealing with a self diagnosed MN for the last few seasons. After about 2 hours in anything but my flip flops or Altras it feels like a hot screwdriver is being plunged into my foot. Removing the boot is excruciating but brings near instant relief. Combined with snow and stepping on a convex hard object helps too. There's a near constant twinge in my foot, like hitting your funny bone that I can feel even barefoot and exponentially worse depending on footwear. During a skimo race this year it was so bad I almost quit on the last climb and realized it was from the compression socks I was wearing.

I've punched, stretched, custom insoled, neuroma padded, pretty much everything mechanical and nothing works. I do have a EEE+ and my whole life jammed my feet into shoes too tight. It feels like it's time for a professional opinion.

Do you start with a podiatrist? I'm in NorCal if anyone has any recs. Thanks for all the info here, super helpful

Tried the toe socks and toe separators?

[ColMan]

Curious if any of you have tried cryosurgery or ablative radiofrequency for your MN? I've been doing a bunch of reading and it sound promising. Not necessarily a permanent fix but worst case I may get 1-2 years pain free while I punch the heck out of my boots, get into wider shoes, etc. Quick recovery as well so I wouldn't lose much more than a week of skiing. Heck, I'm already losing a couple weeks while I wait to get into the doctor. Still hoping some of the other things I'm trying will work (some based on recommendations in this thread) but I have a feeling the scar tissue is pretty thick at this point so cryo/RF may not even be an option.