Morton's Neuroma Solutions

[tomahawkins]

I just wanted to post my success with morton's neuroma in hopes that others find it useful. Morton's neuroma is the thickening of the tissue around nerves leading to the toes. It is caused by wearing shoes and boots with narrow, pointed toes, i.e. practically every piece of footwear on the planet -- thanks a lot, stupid fashion industry. I developed a neuroma in my left foot at the end of the '19 season due to lots of days in my boots. Thankfully it happend at the end of the season, but it did kill any hopes for backcountry skiing that spring.

Neuromas are debilitating. When I first experienced mine, the sensation was like someone was cutting off a toe with a pair of scissors. I was walking in my yard in a pair of flip-flops. At the time I fully expected to look down to see a rattlesnake attached to my foot. It progressively got worse over a series of weeks to the point where walking was difficult and hiking, jumping, or any sporting activity was out of the question. I tried skiing once afterward, but the pain was excruciating anytime I got near the backseat.

I know some have success with surgery. Fortunately mine tempered down after several months of wearing metatarsal pads all the time. The placement of the pad is critical. It has to sit just behind the ball of the foot. It is not an arch support. In fact arch supports like inserts, footbeds, Birkenstocks sandals, Chaco sandals, etc. were of no help, and if anything, made symptoms worse. Metatarsal pads feel a little weird at first, but you get used to them. I've tried lots of footbeds; the ones I've had far and away the best success with are these made by a company in Poland, which I now use in all my shoes and boots:

https://www.amazon.com/Emsold-Ultra-Thin-Orthotic-Metatarsal/dp/B076MRF5KM/

To give my toes maximum freedom, I minimize time in shoes and wear these Sandals by Spenco:

Men's Sandals

www.spencofootwear.com

I find that the metatarsal support is needed nearly all the time. I even avoid walking barefoot for extended periods as that will bring back symptoms. But thankfully, that is all I've needed. Since I developed the neuroma, I've had two rocking ski seasons with no issues.

Perhaps metatarsal support is good prevention of neuromas? I only have the neuroma in my left foot, but I equally wear the pads on my right, which has remained perfectly happy. It might be something to consider...

Some shoe companies are moving away from pointed toes and are starting to sell natural foot shape shoes: Altra and others. Ski boot manufactures have been slow on the pickup, but it is encouraging that most are now talking about more room for toes and that narrow toe boxes doesn't lead to better performance. I had good luck this past season in a pair of K2 Recon 130 MVs and am looking forward to trying on new 2022 boots that are explicitly calling out redesigned toe boxes, Head Formula being one. (Others?)

 

[Rod9301]

It's not do much how wide the boots are in the toe area, they should be wide back of the little toe, which at least for me, it's the widest part of the foot.

 

[4ster]

Glad you found a solution!
I have been dealing with neuroma’s for more than 40 years. Most of the damage was done when I was young & dumb from a combination of tight waterski bindings & narrow ski boots. Better & better fitting boots over the decades keep the symptoms at bey for the most part but warm spring days can be brutal.

I tried skiing once afterward, but the pain was excruciating anytime I got near the backseat.

LOL, nothing like some negative reinforcement to keep us from leaning back

 

[Posaune]

I had never heard of Morton's neuroma before this, but I've been experiencing some discomfort in the area affected and some stabbing pain when I get in the back seat while skiing. I looked it up online and I'll bet that's what I have. I have a Dr.'s appointment scheduled and I'll bring it up. The interesting thing about my case is that it bothers me most when I don't have weight on my feet. After walking around in the morning for a while it seems to go away, but it bothers me at night and when I sit for a while.

Thanks for the heads up!

 

[geepers]

Yep. Started getting that pain (left foot only) about 5 years back. At 1st only happened after skiing when wearing Sorels so put it down to an incorrect fit. Got progressively worse until this year it's been there regardless of shoes, bare feet and often worst at night laying down with no weight on feet at all. Ranges from moderate discomfort like it's a crease in the sock through to an intense burning pain and numbness affecting toes and metatarsals 2 and 3.

Podiatrist installed a pad as described by the OP and began to get relief within a day or two wearing it 80-90% of time on feet. Been about 4-5 weeks now and overall it has cut this back to a minor nuisance. Toes/mets sometimes get numb whilst sleeping but a few minutes walking around with the pad typically solves it.

Also made some changes to walking gait. Keeping the toes raised with the TA at heel strike, utilising the lateral arch side of the foot 1st, then metatarsals down successively across the transverse arch to the medial arch side and finally toes down as the foot pronates. This was related to better functioning feet for skiing with improved control of edging and establishment of a foot platform for balance but it is helping with the Mortons (or whatever it is that's causing the problem in that foot).

Not so sure it's simply a problem of shoe fashion. Dr google seems to indicate other causes are likely - such as collapsing of transverse arch resulting in less space between metatarsals for the relevant nerves and various gait issues that have caused the body to attempt to 'protect' the nerve with a neuroma. Maybe one of the actual medical people can comment...

 

[cem]

the pain from neuroma can be as described debilitating, however the solution is different from patient to patient, a ski boot/shoe too wide is as much of a problem as one too narrow, and a metatarsal pad works for some but not others

firstly assessment is key, neuroma pain can be very similar to several other conditions plantar plate tears, joint capsulitis to name just 2, but after it has been diagnosed correctly there are a couple of manual tests but this should really be backed up with an ultrasound (not that we offer then in our boot room) the boot/shoe should then be checked for width, it certainly should be compressing he metatarsals but equally too much space and the foot will be able to migrate and then the lateral side crushed into the shell exaggerating the pain, all too often i see boots where an inexperienced fitter has blown out the side of the shell thinking it will solve a neuroma and all it does is make the pain worse
neuroma pain in each individual can depend on the spread and declination angle of the metatarsal shafts, some people are predisposed to this and others can have fairly large neuromas ands little or no pain

our insole treatment consists of firstly a custom insole appropriate to the individuals foot in terms of make up and material flexibility we then usually use one of two methods
the metatarsal pad as talked about ... this is the "wonderbra effect" (lift and separate) by creating space between the metatarsal heads the nerve doesn't get compressed and the pain is much reduced, but for some people this doesn't work or it increases pain
the alternative method i often use is to support ALL the metatarsal shafts but to excavate (in the case of a true Mortons neuroma) under the third metatarsal shaft and head, this allows the neuroma to displace under the metatarsal which is often where it wants to go. this is our preferred method as normally it gives better relief but you have to get the channel in just the right place, that said the placement of a metatarsal pad is equally important and easy to get wrong.


these are of course treatment options for early stage or "smaller" neuromas, if the pain doesn't subside be it in ski boots or day to day shoes, then the next phase is a series of cortisone shots ( the DPM i used to work with normally gave 3 shots 3 weeks apart ) and if that isn't enough there are surgical or destructive methods out there (alcohol injection, cryotherapy) One note on surgery, if any surgeon suggests that they will make the incision in the sole of your foot get the hell out of their office sharpish and find another surgeon, the surgery from a dorsal incision is slightly more complex as they have to work around other structures in the foot but your healing time is about 3 weeks compared to around 3 months form a plantar incision


final thing.... its only a "Mortons" Neuroma if it is between the 2nd and 3rd metatarsal, named after Thomas Morton, not to be confused with Dudley Morton who the "mortons toe" is named after

 

[LiquidFeet]

....
Also made some changes to walking gait. Keeping the toes raised with the TA at heel strike, utilising the lateral arch side of the foot 1st, then metatarsals down successively across the transverse arch to the medial arch side and finally toes down as the foot pronates. This was related to better functioning feet for skiing with improved control of edging and establishment of a foot platform for balance but it is helping with the Mortons (or whatever it is that's causing the problem in that foot).
....

@geepers, paying attention to details of repetitive movement as you describe is quite difficult, or it has been for me. I've found distraction to be the major impediment. How have you dealt with keeping your focus on those things you list above when your mind wanders away? Or are you gifted with the ability to keep the focus strong for long periods of time, so embedding new patterns into muscle memory is not so difficult?

I've done lots of work on changing my gait and posture while running/walking over the last 10 years. I have been working on changing my foot, hip, shoulder, arm, and head/neck mechanics. Some things are, after a few seasons of repeated focus, finally getting embedded into muscle memory. My advanced age may have been a factor in how long it has taken me to redesign my gait mechanics; not sure.

I've worked on these things in the green season while running and hiking on woodland trails. Much of this work translates directly to skiing, and I'm sure the neural network construction supporting the new muscle memory is useful on snow as well.

But the major benefit of doing this work during the summers, when I get back on snow, has been developing tactics to keep my focus on target when distractions are so omnipresent. Keeping my focus on my hip mechanics, for instance, for a whole run, has seen much improvement.

Does any of this synch with your experience? Just curious.

 

[geepers]

@geepers, paying attention to details of repetitive movement as you describe is quite difficult, or it has been for me. I've found distraction to be the major impediment. How have you dealt with keeping your focus on those things you list above when your mind wanders away? Or are you gifted with the ability to keep the focus strong for long periods of time, so embedding new patterns into muscle memory is not so difficult?

I've done lots of work on changing my gait and posture while running/walking over the last 10 years. I have been working on changing my foot, hip, shoulder, arm, and head/neck mechanics. Some things are, after a few seasons of repeated focus, finally getting embedded into muscle memory. My advanced age may have been a factor in how long it has taken me to redesign my gait mechanics; not sure.

I've worked on these things in the green season while running and hiking on woodland trails. Much of this work translates directly to skiing, and I'm sure the neural network construction supporting the new muscle memory is useful on snow as well.

But the major benefit of doing this work during the summers, when I get back on snow, has been developing tactics to keep my focus on target when distractions are so omnipresent. Keeping my focus on my hip mechanics, for instance, for a whole run, has seen much improvement.

Does any of this synch with your experience? Just curious.

It sure is a challenge to adjust movement patterns. Particularly the ones we've used practically every step of our lives. Or at least for decades, maybe since an injury resulted in us adopting an inefficient/ineffective pattern.

It's surprising the amount of things we do on auto-pilot once we become unconsciously competent. Even high level stuff like driving a car. Ever finished a regular drive and then been unable to recall a single detail of it? We're pretty sure we didn't run over anybody but no real idea of what else may have happened as our mind was busy elsewhere.

My approach seems to be the same as yours. Attempt to maintain focus until it becomes the new movement.

Something that certainly helped in business (and driving cars) is the mantra:

What time is it? NOW. Where are we? HERE.

Staying in the present is a necessary condition for maintaining focus. (And at least it's cut those zombie car trips to basically zero.) It's very early days for this set of gait changes so I'm still very aware of it. Practicing the movements in slomo wherever there's a few spare seconds - like waiting for the coffee machine or in a queue. And keep bringing it back to top of mind whenever it slips away.

On skis have found that it seems to work best to concentrate on a new movement for a whole run (or two), ignoring other issues that may result, and then do a couple of runs of 'normal' skiing with attention to previous work. Rinse, repeat. Have in past done days n days focused on just one thing. But that's hard to do if skiing socially and runs the risk that other aspects suffer. Although overall I try to ski to standard whenever the skis are on the feet.

No special gifts for adaption and, although I'd like to say any slowness is due to the calendar, that's not really the case. Long term clutz here.

 

[Pat AKA mustski]

Glad you found a solution!
I have been dealing with neuroma’s for more than 40 years. Most of the damage was done when I was young & dumb from a combination of tight waterski bindings & narrow ski boots. Better & better fitting boots over the decades keep the symptoms at bey for the most part but warm spring days can be brutal.

LOL, nothing like some negative reinforcement to keep us from leaning back

Same dealeo here. I have them in both feet but they only act up in ski boots. What is it about warm spring days to create additional havoc? If do find that skiing with my toes lifted helps to prolong my ski day during those spring days. It has the additional bonus of helping with my absolutely abysmal dorsiflexion! Spike heels were a hell of a great fashion but they created a multitude of permanent feet problems!

 

[tomahawkins]

I just wanted to plug Emsold Footcare USA, the US rep and distributor for the orthotics I listed in the original post. I recently put in a order for a family member and since the size was different than my previous orders, Eric, the owner, personally reached out to make sure there wasn't a mixup and was kind enough to answer a few questions at the same time.

N.E. Distributors Co. – Orthotics, Arch Supports and Comfort Insoles

nedistributors.com

 

[Eric Edelstein]

I can relate to everyone with this affliction. The pain in between the 3d and 4th toe joints in the ball of the foot is excruciating in ill-shaped footwear or walking barefoot on hard floors. Undoubtedly too many years in footwear (yes...my ski boots especially) with too-narrow a space for the ball of the foot to expand under pressure has jammed the bones and nerves together and created the irritation and thickening of the nerve which can feel crippling.

It affects not just my foot, but the act of avoiding the pain causes odd foot-ankle-knee-hip-torso coping responses throwing my alignment and movement out of whack... compounding the malady throughout the entire body after short time. My podiatrist told me years ago an operation "might" help...but many people do not get permanent relief from release or removal of the affected nerve area, so he said try using footwear with a natural toebox (Keene and Altra boots/shoes are my favorites so far) to not scrunch your the joints of the ball of the foot together horizontally, and put a metatarsal pad ("met pad") in all my shoe/boot inserts to help spread the metatarsals apart slightly under pressure so the nerve does not get crushed into a painful response. He said if it gets worse or does not help... cortisone injection is an option with mixed results for different people....with surgery as the last resort.

These home remedies of different shoes and metpad inserts have worked pretty well for several years...but as my foot changes shape with age, the Morton's Neuroma seems like it's rearing its ugly head again more aggressively. Thanks to my favorite bootfitter and the newest tools to expand precise areas of my ski boots, it's possible to keep things managed fairly well for skiing. If anyone has experiences with surgery to relieve this condition, I'd be all ears!

Cem's comments about every person needing different evaluation and treatment is spot-on. My condition and responses with my footwear and met-pads may not be the same for others. See a specialist...maybe 2!

 

[geepers]

Quick update on the impact to foot pain from the changes to walking gait posted above.

Several weeks now and it's not a cure but it sure helps to relieve symptoms in the same way as a metatarsal pad. Not always convenient to put on shoes with the pad when numb toes occur - like the middle of the night - however a few steps with that gait does the job.

Also there's been an unanticipated benefit of this and the other BPS foot strengthening exercises. Left ankle had been getting more problematic for some years. Affected both the archilles area and deeper into the ankle. Not entirely sure main cause but it was aggravated by unconscious dorsiflexion, especially sleeping - elsewhere some-one posted an image of a foot device to wear at night to keep the ankle flexed and that seemed a good option. However those pains started diminishing with the foot exercises and have now basically gone.

 

[tomahawkins]

A plug for another product I like. I'm finding that the Spenco sandals don't have enough of a pad so I'm now putting these are ordinary flip-flops.

Drop - Metatarsal Arch Support Pad Teardrop Shape (1 Pair)

Alleviate burning and aching feet with pedag Drop, medium sized metatarsal pads made from vegetable tanned leather in Germany. Learn more about the DROP here.

pedagusa.com

 

[SkiMore]

I've also got Morton's Neuromas between the 2nd and 3rd toes on both feet. They get pretty agitated by the end of the season and quiet down at the end of the season after not wearing boots. These met pads do help a bit but they tend to fall off frequently inside the ski boot due to the moisture. My podiatrist recently added the pad under my Sidas custom footbed. Hoping that will help. The podiatrist suggested at the first sign of pain at the beginning of the season to come in for cortisone shots. If that doesn't work, I'll consider the surgical option at the end of next season.

 

[Rod9301]

I've also got Morton's Neuromas between the 2nd and 3rd toes on both feet. They get pretty agitated by the end of the season and quiet down at the end of the season after not wearing boots. These met pads do help a bit but they tend to fall off frequently inside the ski boot due to the moisture. My podiatrist recently added the pad under my Sidas custom footbed. Hoping that will help. The podiatrist suggested at the first sign of pain at the beginning of the season to come in for cortisone shots. If that doesn't work, I'll consider the surgical option at the end of next season.

View attachment 142103

Don't do cortisone shots. You have a lifetime limit of 3, otherwise they will when the tendons.

The neuroma is caused by a mechanical problem, boots too tight laterally. So the solution is mechanical as well.

Pads plus make sure the shoes or boots don't put ANY pressure laterally, behind the little toe and shit 3 inches back.

 

[SkiMore]

@Rod9301 , thank you for the information. The sides of the boots have been punched out and I feel no discomfort or pressure there anymore, but maybe there is some slight pressure remaining that could be contributing. And thank you for the alert on the steroid shots. I'll discuss that with my podiatrist.

 

[Greg Whitehouse]

the pain from neuroma can be as described debilitating, however the solution is different from patient to patient, a ski boot/shoe too wide is as much of a problem as one too narrow, and a metatarsal pad works for some but not others

firstly assessment is key, neuroma pain can be very similar to several other conditions plantar plate tears, joint capsulitis to name just 2, but after it has been diagnosed correctly there are a couple of manual tests but this should really be backed up with an ultrasound (not that we offer then in our boot room) the boot/shoe should then be checked for width, it certainly should be compressing he metatarsals but equally too much space and the foot will be able to migrate and then the lateral side crushed into the shell exaggerating the pain, all too often i see boots where an inexperienced fitter has blown out the side of the shell thinking it will solve a neuroma and all it does is make the pain worse
neuroma pain in each individual can depend on the spread and declination angle of the metatarsal shafts, some people are predisposed to this and others can have fairly large neuromas ands little or no pain

our insole treatment consists of firstly a custom insole appropriate to the individuals foot in terms of make up and material flexibility we then usually use one of two methods
the metatarsal pad as talked about ... this is the "wonderbra effect" (lift and separate) by creating space between the metatarsal heads the nerve doesn't get compressed and the pain is much reduced, but for some people this doesn't work or it increases pain
the alternative method i often use is to support ALL the metatarsal shafts but to excavate (in the case of a true Mortons neuroma) under the third metatarsal shaft and head, this allows the neuroma to displace under the metatarsal which is often where it wants to go. this is our preferred method as normally it gives better relief but you have to get the channel in just the right place, that said the placement of a metatarsal pad is equally important and easy to get wrong.


these are of course treatment options for early stage or "smaller" neuromas, if the pain doesn't subside be it in ski boots or day to day shoes, then the next phase is a series of cortisone shots ( the DPM i used to work with normally gave 3 shots 3 weeks apart ) and if that isn't enough there are surgical or destructive methods out there (alcohol injection, cryotherapy) One note on surgery, if any surgeon suggests that they will make the incision in the sole of your foot get the hell out of their office sharpish and find another surgeon, the surgery from a dorsal incision is slightly more complex as they have to work around other structures in the foot but your healing time is about 3 weeks compared to around 3 months form a plantar incision


final thing.... its only a "Mortons" Neuroma if it is between the 2nd and 3rd metatarsal, named after Thomas Morton, not to be confused with Dudley Morton who the "mortons toe" is named after

I believe a Morton’s Neuroma is found between the second or third intermetatarsal spaces. So it can be between the 2nd and 3rd, or 3rd and 4th toes.
Fascinating that the Morton’s toe and Morton’s Neuroma are named after two people? Good knowledge!

 

[tomahawkins]

A plug for another product I like. I'm finding that the Spenco sandals don't have enough of a pad so I'm now putting these are ordinary flip-flops.

Drop - Metatarsal Arch Support Pad Teardrop Shape (1 Pair)

Alleviate burning and aching feet with pedag Drop, medium sized metatarsal pads made from vegetable tanned leather in Germany. Learn more about the DROP here.

pedagusa.com

And I like these better still:

T-FORM - Leather Metatarsal Arch Pad with Latex Cushion (1 Pair)

Take care of forefoot burning and stinging with the pedag T-FORM, a large metatarsal pad made with vegetable tanned leather in Germany. Learn more here.

pedagusa.com

 

[ted]

If you have limited ankle dorsiflexion it makes things worse, causing excessive ball of foot pressure and forefoot abduction. Manual therapy mobilizations can also help reduce the stresses that produce neuromas.

 

[cem]

I believe a Morton’s Neuroma is found between the second or third intermetatarsal spaces. So it can be between the 2nd and 3rd, or 3rd and 4th toes.
Fascinating that the Morton’s toe and Morton’s Neuroma are named after two people? Good knowledge!

3rd interspace for "mortons" neuroma, nerve neuroma for anywhere else

the reason they are most common in the 3rd interspace was what Morton investigated , the 3rd interspace is the juncture between the medial and lateral columns of the foot, (if there wasn't all the soft tissue structures in there you could literally fold the foot in half along this juncture) there is a lot of longitudinal shearing in that area which increases the nerve irritation