Morton's Neuroma

Hello,

Has anyone on here ever had to deal with this? I have been dealing with this for quite a while now and its starting to get worse. Day to day stuff its fine. Some days I can tell that it's there but not really any pain. Hiking is generally OK except for maybe days where I put in some long or difficult miles. Where its really an issue is skinning and is down right excruciating, feels like someone is stabbing my foot. I recently had some boot work done but it didn't do anything. Its got to the point now where I can't even go touring, which sucks of course. I fear I am getting to the point where my only solution is surgery. Anyone here dealt with this? Anyone have any recommendation for a good foot doctor in Seattle? Someone who knows about outdoor recreation. Want to see what some options or other treatments might be. Thanks.

John

I'm not sure if morton's neuroma is the term for the foot pain I used to have, but I use orthodics to relieve the condition.  What I had was foot pain related to having a collapsing arch.  As it was explained to me, the nerve paths travel down your foot inbetween the bones and when your arch collapses, those nerves are compressed and cause pain.  The remedy that worked for me was simple. I got orthodics with a "metatarsal pad" in them which supported my arch so it didn't compress the nerves and the pain went away

My first orthodics were perscription ones and cost hundreds of dollars. Later a chiropractor friend told me that I could get generic ones for about $60 bucks and I've used those ever since and never had the foot pain return.  I use the lynco brand

aetrex.com/lynco-orthotics

You can read the section on "metapads" and you'll see they mention morton's neuroma.  HTH

My wife has trouble with this too. One important touring-specific thing is to not use your bindings heel risers until truly necessary. Lots of people engage them on terrain that is too mellow, positioning the heel slightly higher than the toes, which puts extra pressure on the front of the foot and aggravates the condition. Keeping her weight back on her heels provides some relief.

I have an ultrarunner friend that had this for a while, a long while, before getting surgery I believe. Fixed it and not heard a word since. I can get details if required.

I had this same problem for many years and the first orthopedic doctor did the shots, boot inserts,etc. with zero improvement.  That went on for a year or so.

When I would explain my foot would start really start hurting after about 7-8 miles of hiking or 4 hrs of skiing he would act like it's really nothing because I was not in any pain normally during non skiing or hiking days.  Right before I switched doctors I couldn't hike over 2 miles.  I asked about an MRI and that suggestion was blown off.  

I switched orthopedic doctors and the first thing the new doctor did was have an MRI done on that foot.  Found a 8 mm Neuroma and pretty much said all the shots and inserts in the world won't be able to fix that.  He removed it and it is fine now.  One toe is a little numb now but that is a small price to pay.  I live south of Olympia so I don't know of any good orthopedic doctors around Seattle area.  
If you are interested in who my doctor was pm me.  

Thanks for the replies. Some additional info and replies.

I did have a metatarsal pad added to the foot bed on the problem foot. Yesterday was the first time using and it did nothing, maybe even made it worse as it almost never hurts when riding (only skinning) but yesterday it hurt while riding down as well. It may be in the wrong spot I'll have to have that looked at again.

Jake I hear what you're saying about the touring riser but touring out on the flats yesterday was painful as well. May have been from it already being aggravated. This also isn't just a soreness or dull pain its excruciating.

Haggis and khp1 I'll send you a PM.

Thanks.

Also dealing with foot pain, for a long time: downhill boots, AT boots, hiking boots and bare feet on hard surfaces. Already have an appt with a foot Dr later this month. So appreciate this discussion and any one else's input as well.

Position of the metatarsal pad is really critical when skiing. For me, I can't have it too close to the knuckles. I think if it gets too close it actually helps push the scared nerve up into the construction between the knuckles - owwie!! But I'm going to try the cortisone shot shortly as the pad is no longer quite 100 % for me (edited to add: the shot will apparently help reveal whether I in fact have inflammation which can be knocked down or if the fattening of the nerve is now all or mostly scar tissue), and hope not to have to go to nerve removal, though it doesn't sound too bad. Dr Glen Curda in Bellevue is good. Wants to keep you having your fun. Helped my wife with a simple solution where other docs had told her only surgery would do.

I have been dealing with metatarsalgia, pain in a similar part of the foot as well as some bursitis in the Achilles area.

I've had luck with Superfeet, but make sure to get the right size for your arch. I had to cut mine down to fit in my boots. I cannot tour without arch supports at all, because it feels like my foot gets crushed.

Also really key for has been calf stretching and foot strengthening exercises. Towel scrunches are good, along with heel raises.

Position of the metatarsal pad is really critical when skiing. For me, I can't have it too close to the knuckles. I think if it gets too close it actually helps push the scared nerve up into the construction between the knuckles - owwie!! But I'm going to try the cortisone shot shortly as the pad is no longer quite 100 % for me (edited to add: the shot will apparently help reveal whether I in fact have inflammation which can be knocked down or if the fattening of the nerve is now all or mostly scar tissue), and hope not to have to go to nerve removal, though it doesn't sound too bad. Dr Glen Curda in Bellevue is good. Wants to keep you having your fun. Helped my wife with a simple solution where other docs had told her only surgery would do.

That's good to know. Seems like maybe thats what the metatarsal pad I had put in is doing. I'll have to go back in and have it readjusted and test it out again.

Position of the metatarsal pad is really critical when skiing. For me, I can't have it too close to the knuckles. I think if it gets too close it actually helps push the scared nerve up into the construction between the knuckles - owwie!! But I'm going to try the cortisone shot shortly as the pad is no longer quite 100 % for me (edited to add: the shot will apparently help reveal whether I in fact have inflammation which can be knocked down or if the fattening of the nerve is now all or mostly scar tissue), and hope not to have to go to nerve removal, though it doesn't sound too bad. Dr Glen Curda in Bellevue is good. Wants to keep you having your fun. Helped my wife with a simple solution where other docs had told her only surgery would do.

Thanks for the doctor recommendation.

Position of the metatarsal pad is really critical when skiing. For me, I can't have it too close to the knuckles. I think if it gets too close it actually helps push the scared nerve up into the construction between the knuckles - owwie!!

So I had the metatarsal pad removed yesterday and had new one of softer material and put in a different spot on my foot and WOW what a difference it made. I made 3 test skins up quicksilver and gold hills yesterday basically with no pain. I am still going to see a doctor to discuss other options but yesterday gave me some hope.

You mean you don't miss that feeling of a hot rusty dagger stabbing your foot with each stride and turn!?

Great news and good luck!

I have had this condition for almost 2 years now. Initially, I was prescribed Voltaran topical gel to apply 4 times a day. I was skeptical, but it helped. After almost a year of that, I got tired of using the stuff and went back to my orthopedic doctor who didn't seem very helpful. I switched to a foot and ankle doctor who is also a skier. He started me on a series of cortisone injections which helped, but the biting, stinging pain has always come back after a month or so. I am about at the end of that option because the cortisone can permanently damage and reduce healthy tissue in the area causing other issues. I have custom orthotics in my ski boots and had some made for my street shoes which has helped some, but not eliminated the problem. I live on the lake and spend a lot of time in sandals and flip flops in the summer, which really increase my pain. So, my next step is called sclerosing. The doctor does a series of 3 - 8 injections a week apart of an alcohol solution. This basically deadens and kills the nerve in the offending area, but also results in numbness in that area. It is a very low risk procedure that is over 80% effective. I'm going to have it done after ski season is over. I guess the biggest risk of surgery is after they cut the offending nerve, it can sometimes try to grow back and curl in on itself making the problem worse than before surgery, so I am very hopeful the sclerosing will be successful. My doctor is Dr. Bierman and he has an office in Covington, but I believe he has a couple other offices in the area.

CD, thanks for that info. Very helpful as well. Yeah luckily for me day to day is fine (assuming I haven't aggravated it from skinning). And now that this metatarsal pad seems to be making some progress I am feeling a little better about this. When I get my appt made I will ask about the sclerosing procedure. I really want to do what I can to avoid surgery. Know a couple people who have had and had a hard time afterwards.

I had the surgery done on my right foot several years back where they took the nerve out. Doc said it was supposed to be the size of a spaghetti noodle and it was the size of his pinkie. Not good. It's been great ever since.

I just recently had ankle surgery on the left foot and while they were in there they did a newer version of Morton's surgery where they release a ligament that puts pressure on the nerve. Less tingly issues and supposedly no ill effects for skiing, climbing, biking or ball room dancing.

Metatarsal pad adjustments are great, so is modifying the toe box of your boots and shoes. Before you work with Doctor/surgeon, I recommend getting boot specialist involved, Jim Mates is an excellent resource.

Metatarsal pad adjustments are great, so is modifying the toe box of your boots and shoes.  Before you work with Doctor/surgeon, I recommend getting boot specialist involved, Jim Mates is an excellent resource. 

Thanks. I have been working with Martin up at Crystal and he has been a great help. Its not just skinning that aggravates it (skinning is just what causes the worst pain) so I do need some more "work" done. Met with a doctor yesterday and am going to get some other footbed work done for my other footwear and also going move forward with the steroid injections.

I had this in my left foot for 15 years. Initially running aggravated it after about 5 miles. Low fit alpine race boots were not good for it. Bike cleats and big climbs were hard on it. I started skinning a lot. I had all boots pressed out in the forefoot. It got to the point where the foot came out of the boot and into the snow 2-3 times between Paradise and Muir to relieve pain.

Mine was large, between 3rd and 4th toes counting big toe as #1. I never had an MRI. A trained foot Dr. could locate it immediately with a physical exam.

I did the whole progression....wider shoes, boot work, pads, cortisone, alcohol injections, then surgery. There is a lot of conservative therapy propagation going around by a lot of "foot doctors" who get paid for just that, for example one said "oh yeah, metatarsal pads cure this easily", another suggested foot massage, another the alcohol injections, orthotics, etc. Some of this might work for mild cases, but in severe cases, a good Dr. should tell you that they rarely work for athletes. In my case, none of that did anything. Cortisone got me through a few months of two seasons.

So I had it taken out. It is not a difficult procedure nor in my opinion very painful. But you need to baby that foot for quite a long time. Ex, 4-6 weeks off it. I had mine done on May 15. No skinning all summer. Light hiking moving to moderate hiking by late August. Through the first ski season, it hurt some, and a 18 mile flatish tour caused it to flare up in February. But, it was always better than before surgery, and now in season two, it has been a non-issue. My surgeon (an orthopedic MD foot specialist, not a podiatrist) told me flat out, the foot will never feel exactly like the other one, and that the recovery would take quite a bit of time. That is spot on. Overall I am happy. I'll also try to stay off the risers on long tours. Thanks for that tip Jake. Feel free to PM if you want to discuss more.

Thanks for the inout David. I'll let you know if I need some more information.

Great vibe of community and sharing on this thread!  I'm hoping someone can enlighten me on foot pain I've been experiencing recently.

I'm 70 and do mellow tours on skinnies & leathers, no heel risers (45 days this winter).  The past four times I have gone more than about three miles uphill, I have been stopped by intense pain in my right heel, with fairly rapid onset.  The first few times just felt like a bad blister, tho there was just redness, no broken skin.  Yesterday the pain felt like a hot nail being driven from my heel towards my ankle.  I found a flat dry rock and investigated.  About where the tendons broaden, about an inch above the sole, was a roughly horizontal irregular thin pulsating bulge about an inch across.  It looked a bit like a worm burrowing just beneath the skin, which was red, but unbroken.  The pain gradually subsided with my weight off, but I had to stop a couple times for about a half-hour on the return, which was the first time the pain has continued and worsened on the way down.  I was nearly crying by the time I reached Paradise, but it's not even sensitive to touch this morning.

Great vibe of community and sharing on this thread!  I'm hoping someone can enlighten me on foot pain I've been experiencing recently.

I'm 70 and do mellow tours on skinnies & leathers, no heel risers (45 days this winter).  The past four times I have gone more than about three miles uphill, I have been stopped by intense pain in my right heel, with fairly rapid onset.  The first few times just felt like a bad blister, tho there was just redness, no broken skin.  Yesterday the pain felt like a hot nail being driven from my heel towards my ankle.  I found a flat dry rock and investigated.  About where the tendons broaden, about an inch above the sole, was a roughly horizontal irregular thin pulsating bulge about an inch across.  It looked a bit like a worm burrowing just beneath the skin, which was red, but unbroken.  The pain gradually subsided with my weight off, but I had to stop a couple times for about a half-hour on the return, which was the first time the pain has continued and worsened on the way down.  I was nearly crying by the time I reached Paradise, but it's not even sensitive to touch this morning.

Mohair bug egg.

Great vibe of community and sharing on this thread!  I'm hoping someone can enlighten me on foot pain I've been experiencing recently.

I'm 70 and do mellow tours on skinnies & leathers, no heel risers (45 days this winter).  The past four times I have gone more than about three miles uphill, I have been stopped by intense pain in my right heel, with fairly rapid onset.  The first few times just felt like a bad blister, tho there was just redness, no broken skin.  Yesterday the pain felt like a hot nail being driven from my heel towards my ankle.  I found a flat dry rock and investigated.  About where the tendons broaden, about an inch above the sole, was a roughly horizontal irregular thin pulsating bulge about an inch across.  It looked a bit like a worm burrowing just beneath the skin, which was red, but unbroken.  The pain gradually subsided with my weight off, but I had to stop a couple times for about a half-hour on the return, which was the first time the pain has continued and worsened on the way down.  I was nearly crying by the time I reached Paradise, but it's not even sensitive to touch this morning.

Sounds like an irritated achilles tendon insertion point. For me, this was caused by right calves and hamstrings. Stretching the calf muscles and making sure to warm up helped me.

I have had this condition for almost 2 years now.  Initially, I was prescribed Voltaran topical gel to apply 4 times a day.  I was skeptical, but it helped.  After almost a year of that, I got tired of using the stuff and went back to my orthopedic doctor who didn't seem very helpful.  I switched to a foot and ankle doctor who is also a skier.  He started me on a series of cortisone injections which helped, but the biting, stinging pain has always come back after a month or so.  I am about at the end of that option because the cortisone can permanently damage and reduce healthy tissue in the area causing other issues.  I have custom orthotics in my ski boots and had some made for my street shoes which has helped some, but not eliminated the problem.  I live on the lake and spend a lot of time in sandals and flip flops in the summer, which really increase my pain.  So, my next step is called sclerosing.  The doctor does a series of 3 - 8 injections a week apart of an alcohol solution.  This basically deadens and kills the nerve in the offending area, but also results in numbness in that area.  It is a very low risk procedure that is over 80% effective.  I'm going to have it done after ski season is over.  I guess the biggest risk of surgery is after they cut the offending nerve, it can sometimes try to grow back and curl in on itself making the problem worse than before surgery, so I am very hopeful the sclerosing will be successful.  My doctor is Dr. Bierman and he has an office in Covington, but I believe he has a couple other offices in the area.

So have you gone forward with sclerosing shots? Dod they do anything for you? The cortisone shots I got did;t really do much and now I am starting to feel the neuroma with just walking around, which I did;t feel before. The doctor I am going to recommended we try cortisone first and see how that goes and then the sclerosing shots next. Curious to see what you think. Thanks.

No, haven't gone forward with the alcohol injections, yet. Went back to the doctor and he wanted to try 2 more steroid injections. I don't seem to have as much pain, particularly when wearing good shoes, but after spending a week in Hawaii running around in flip flops, the pain's back with a vengeance. Will be making an appointment soon, after my schedule settles down.

My wife has gone with the alcohol injections and they have worked well. She goes to Issaquah foot and ankle where they use an ultrasound to image the oversized nerve then shoot alcohol into it. She usually takes about three shots to reach the point where the pain is gone but she still has some feeling. The pad under the forefoot helps and never wearing tight(width) shoes is huge.

No, haven't gone forward with the alcohol injections, yet.  Went back to the doctor and he wanted to try 2 more steroid injections.  I don't seem to have as much pain, particularly when wearing good shoes, but after spending a week in Hawaii running around in flip flops, the pain's back with a vengeance.  Will be making an appointment soon, after my schedule settles down.

Speaking of flip flops you should check the Vionic ones. I bought pari on the suggestion of the foot doctor I am going to and I love them.

OK good to know. I have an appt in a week with may doctor to discuss the alcohol injections.

So a follow up to my situation. I ended up having the surgery. 8 weeks ago today. Healing up nicely, but still have some healing to do. Was given the green light to be more active and go snowboarding, just need to careful still. Went for a skin today (just did some laps at Hyak to test things out) and felt great. Had some soreness due to the healing but the sharp pains are now gone. So glad I had the surgery. Doctor said mine was a pretty decent sized one and that I made the right call to have the surgery. Can post a photo of the neuroma looks like if anyone wants to see it. Its pretty gnarly.

Good to hear it is working well so far. Orthotics and several rounds of steroid injections have not been able to resolve this for my wife, so she is having it removed soon.

I can't say I am interested in seeing the photo.