Mortons Neuroma

A snowHead

Prompted by a 'my feet hurt' thread over on Equipment going slightly off topic on to Mortons Neuroma, I have started this thread so fellow sufferers can share their experiences and ask questions.

The thread is here http://snowheads.com/ski-forum/viewtopic.php?t=96519

Maybe we can talk further about Mortons over here?

A snowHead

Any information would be gratefully received. I've got one on my left foot and suspect another beginning to develop on my right. As the current treatment here in my neck of the woods involves needles, I've not sought any specialist treatment yet. I have had my podiatrist make me lots of special insoles (I'm entitled to 2pairs per year on my German health insurance). He also told me that is some kind of relationship or pre-disposition of you have Depuyten's Contracture which I do have in both hands. Again not sought treatment for that as it also involves a lot of needles if you do not want surgery.

I have a total phobia of needles (irrational I know but there you go), but things are getting a wee bit critical with my left foot and right hand, so any suggestion for non-drastic help NOT involving needles would be gratefully received.

Well, the person's real but it's just a made up name, see?

Samerberg Sue, I think you are going to be struggling with the 'no needles' brief Sad

Maybe the kind of orthotics that Zero-G is describing on the other thread, I need to investigate those as I haven't got anything to separate my 3/4 metatarsals, although I have got a 'bar' on my ski boot footbeds.

If it's any consolation, I had the steroid injections in both feet. I was really not looking forward to it but was desperate. I used EMLA cream on my skin and I didn't look. I was expecting it to be excruciating, it actually was really a non-event Embarassed

The only slight discomfort was the pressure of the volume of fluid being injected displacing the tissues. And then later on that day and for a couple of days my feet ached a lot. I think it helped one foot but much less so the other.

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I've also had steroid injections which seemed to involve chuffing great big needles in to the middle of my feet. The aching afterwards, from the steroids, was a big grim.

Anyway, snowHeads is much more fun if you do.

sarah, I'm using them as well when it gets really bad! Mine are made of a soft silicon pad which goes up between the toes with a pad under the foot.

You have no idea of how much fear I have of needles! My dentist has nightmares when she sees I have to have an injection! Embarassed

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Am copying my post over from the other thread for ease of use. Will add that the cortisone injection was painless because I was first injected with local anaesthetic. But the volume of cortisone they injected caused me a good deal of pain for about two days afterwards. It also permanently made the skin on my foot at the injection site paler and completely disappeared a freckle I had there!

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Samerberg Sue, my orthotics are very firm and don't spread the toes, they spread the metatarsals close to the arch of my foot. However, I am extremely hypermobile, so my needs are different.

After all it is free

Zero-G, thanks for the info, that's very helpful.

Zero-G, I was the same, the procedure was not bad at all, but my feet ached a lot for a good 2-3 days. I also have some change to the skin colour around the site of the injections. I am also very hypermobile, probably a contributory factor in the development of the Mortons Sad

. I don't suppose you could post a picture of your insoles or give more of a description of how the metatarsals are spread by them could you? I have just normal 1/2 orthotics to correct over pronation but nothing for the forefoot, now I feel I really need it. As well as the chap you mention in London for the cryotherapy I have also found someone in Sheffield which is closer for me. I think I will investigate both of them.

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sarah, I'll attempt some pics tomorrow if the light is good.

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I have the neuroma in my left foot, and as above will not have the needle due to out and out fear (yet I'll throw myself down blacks all day, go figure)
My doc has suggested that the injection is not a guaranteed solution and does not push me.
He has however suggested the pads for under the toe joint, and these worked when the pain was there, as they spread thee foot over the pad. However I did get pressure sore if I left them in.
I have learnt to got for much wider shoes / boots than I need and this keeps the neuroma at bay. Obviously this wont happen overnight, but when you do buy any shoes, make sure they are not snug at all, and have room to let the toes move. I walk and cycle miles and suffer little now.
My ski boots were widened at the toe box to suit and had custom moulded insoles, and are almost a pleasure to wear.

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The pads I was using were Scholl Ball of Foot pads, and I'd loop them over the toe next to the little, keeping the pad under my neuroma.

njmidd, Thanks for that. Your doc is right about the injection, not a great sample size but 3 of us here on Snowheads so far have had the injections and are still looking for a solution Sad

Glad you are managing to live with it. Mine left one is very bad at the moment, I don't think I can walk for one mile on it at present. Though fortunately it doesn't seem to bother me skiing now (touching wood Confused

).

You know it makes sense.

Very interesting thread. I have had a hurty foot for a few months now. No bruising or physical signs of any damage. No recollection of an incident where I may have damaged it, just slight pain on the ball of the foot between second and third toes, especially when walking. Doctor didn't have any suggestions. It's never bad enough for pain killers (I have very little sensation in my feet/legs anyway) but noticeably uncomfortable at times. I wonder if this is the explanation?

Otherwise you'll just go on seeing the one name:

queen bodecia, Could be and that you have been another one to have some problems with ski boots. It's usually between the third and fourth toe but to be honest mine can sometimes feel like all the middle ones. It can feel as if you're standing on something and it can be tender if pressed on top. Classic though is if you squeeze your foot sideways it hurts!! It's usually very easily picked up on a simple ultrasound scan, maybe get the doc to send you for one.

A snowHead

sarah, I definitely can't bend my foot without some sort of pain and yes it often feels like there is something in my boot under my foot! It also hurts if I press the area under and between my toes. But no loss of movement. I don't think it's a ski boot-related problem as it's almost a year since I last wore ski boots and I've only noticed this in the last few months. I'm hoping to buy new ski boots in resort next week, I sold my old ones on Fleabay. This sounds like another reason why I need bigger ski boots!

A snowHead

queen bodecia, No it's not a ski boot problem but for some people that can be how it first manifests itself, like with me I had horiffic pain in my ski boots and it seemed impossible to alleviate even with the very best efforts (I thought I was going mad as there was nothing obviously wrong and had tried everything). Only when I started trying to run and had the same pain was I then taken seriously by the consultant and diagnosed with Mortons. Honestly though no point second guessing if this is what you have, get a quick scan done and then you know what you're dealing with or not hopefully Smile

Well, the person's real but it's just a made up name, see?

sarah, I dread to think what the wait for a non-urgent scan is. I waited 10 months for a scan and biopsy to diagnose cancer!

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Anyway, snowHeads is much more fun if you do.

Right, I have some pics of my orthotics. Have lightened the pics artificially to reveal more detail.

These orthortics are constructed of three parts and materials:
1. The main part (you can clearly see the outline from the heel to just in front of the arch) is made from a rigid polymer that was laser cut from a solid block to match plaster casts made of my feet. This section provides the arch support and aligns my hypermobile knees (the original purpose of the orthotics)
2. The leather upper that covers the rigid polymer material and extends down to the toes to keep the orthotics in place in my shoes
3. Sandwiched between the two is a very firm but ever so slightly compressible material that provides the higher areas you see just in front of and to the left and right of the arch supports. These nubbins separate the metatarsals, creating space for the neuroma. As you can see from the pics, the left nubbin is much larger in area and has greater depth than the right because the neuroma in that foot is about the size of a 20p piece. The neuroma in the right foot is still very small.

With these babies, I am pain free.

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Zero-G, That is fantastic, very helpful. Alas for me my fab podiatrist has gone off to live in France, I will have to engineer a trip to the 3V sometime soon Toofy Grin

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sarah, definitele a good reason for a trip to 3V during the winter wink

After all it is free

Zero-G, how do you know how big and exactly where the neuroma is? Is this something that would show up on a scan?

Yes, I had an ultrasound and it was at that point I had the cortisone injection. It was quite fascinating watching the needle enter the neuroma on the US scan.

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Jellemr's miss here, I have mn on my right foot between 3&4 mt, had all sorts of fancy expensive insole moulds made and various ski boots fitted. In the end my mn has been alleviated by full tilt Mary Jane boots initially purchased for easy on easy off in case of pain but to my amazement I experienced no pain except slight niggle if I left my boots tight on a lift after a steep run. As full tilts don't have footbeds I purchased some inexpensive super feet insoles that work by correctly alligning the rear of the foot. No pain to report after a week skiing. It might not work for you but it did for me. I've also taken part in a 10 week Pilates course to work on core strength and flexibility. I'm certain this also helped reduce the pain as I was previously putting 60% through my right leg with 70% to the forefoot.

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jellemr, I do pilates too, was sent there by my physio to help with trying to get me all in line and tighten me up a bit as I'm hypermobile. I have heard that about Full Tilt boots before, glad you have a solution. I am now in Atomic Hawx boots with custom footbeds and I feel that the flex zone in the forefoot helps me with my neuromas. Also it's a more upright boot as for me less forward lean in the boot is a good thing for keeping pressure off the forefoot.

sarah, I'm at the hospital now waiting for my next consultation with the foot guy. Will let you know what he says. Scans I had a couple if weeks ago weren't conclusive, so not too sure where I stand (if you excuse the pun).

You know it makes sense.

I've made an appointment with my GP first week in March to see if I can get a referral for a scan. Thanks all for the advice.

Otherwise you'll just go on seeing the one name:

I've been doing pilates since 2005 (started off three times a week, increased to five times a week for the past two years). It did nothing to prevent the neuromas, nor did all that über core strength prevent a spinal injury 20 months ago. Pilates is great but it's still just pilates.

A snowHead

Had another consultation with my local foot surgeon, and yet more x-rays, load-bearing and unweighted. His initial diagnosis last summer (from a manipulation test) was Morton's, but at a further consultation and after some steroid injections he was unsure so I was sent for US scans and x-rays. There was no evidence of Morton's Neuroma in either feet, but some small adventitious bursae around the joints between metatarsals and toes. He said they weren't big enough to be responsible for the acute pain I sometimes get when skiing. He then showed me the x-rays and said the geometry of my foot bones was very unusual and resulted in most of the forefoot pressure being focused on the 3rd metatarsal at the joint with the toe. This is exactly the point that I get pain radiating from when I'm skiing hard, and sometimes it gets to the point where it is impossible to put any weight or pressure through the foot.

So while I'm pleased that a surgical procedure is not required for Morton's, there's not an obvious solution for the pain in the metatarsal head region. I'm due more steroid injections when I get back from my next ski trip (for the bursa I think) and he wants to do some work with my footbeds to creat a space underneath the 3rd metatarsal head to reduce the pressure. I'm also going to change my balance point so I'm putting more pressure through the arch of the foot than the forefoot, but that's not an immediate change I can make to my skiing.

Feet. Pah!

A snowHead

rob@rar, wow, that sounds like a fundamental change to your skiing!

Well, the person's real but it's just a made up name, see?

rob@rar, Good news for you really then Smile

Have a good think about more steroid injections as they can cause the fat pad in the foot to atrophy and can exacerbate the problem Sad

I would think CEM can do some stuff with your footbeds.

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sarah,

Actually that's exactly what I was doing last week. I try to get a week or two of coaching each season and last week one of the key things I was working on was keeping my balance point a bit more precisely above the middle of my foot. Not to avoid the pain, but if it helps with that its a very welcome bonus.

I'll ask him about the steroid injections, especially side effects of repeated injections. I'm waiting for his written diagnosis so I can speak with a bit more precision to CEM next time I'm at his place.

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rob@rar, sounds like a good plan Smile

Do you use those Skia balance block things?

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Interesting thread... I'm now in month 7 post diagnosis (2 neuromas, small one in the classic 3-4 joint, but a bigger one in 2-3). My MN (right foot) was probably exacerbated by a change in running style (from marathon to 10k's), with a resulting increase in fore-foot impact as was running faster. Wish I'd never made that choice. Had 2 sets of injections, both under US, 2 different radiologists, 2nd one, against my judgement, talked me out of having the 'strong' steroid that I'd agreed with the surgeon (Sam Singh, knows his stuff, and wrote some of the standard procedures on treating MN).... hard to tell, but think the injections made no appreciable difference. but, fun to watch the injections on the US screen.
(the 2nd radiologist was more concerned that the injection 'might' cause residual pain.... but as I already _had_ residual pain, I didn't see why that was an issue.)

Now have some fancy footbeds from hfs-clinics in london, who really do seem to know what they are doing. only downside to that bit was that orthotics not covered under health insurance.... I only use them for running at the moment, as have 'happy-feet' liquid insoles in my office shoes. Those were an absolute bargain from the ski show - £33 a pair, and they feel blissful, and, more importantly, no pain from the MN.

I still get a small amount of pain when running, although it's terrain dependent - worse on hard ground and hills, not so bad on the flat (or when I run slower).

fortunately, no pain when skiing - which in my case seems to be 'cos the ski boots stop my foot bending front to back, and for me, it's that bit that causes the pain. (although a week's touring in downhill boots nearly gave me MN in the other foot)

Received wisdom, as others say, is avoid anything that squeezes the toes.... the other thing is to not get this 'not well understood' and 'not easily treatable' problem in the first place.... those of us not in the first flush of youth are reminded to not 'suddenly' change their exercise regime.

If the problem isn't fixed by October, I'll probably go for surgery, assuming insurance will cover it,

@rob - the feet are complex... not sure a bursa is _much _ different to a neuroma, but if it's _just_ liquid, might go on its own / with antibiotics (have had those for other bursas)... good luck either way.

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An update:

By the end of my season in Cham, I was experiencing pain again while skiing. Although it didn't stop me from skiing, it did reduce the number of hours I could ski each day in my final weeks.

The situation has grown progressively worse: I can't put any weight on the left foot when I first wake up in the mornings and whatever is in my foot has grown decidedly larger and is pushing two toes apart ever so slightly. The danged foot throbs constantly, even at night while I'm trying to sleep.

Saw the podiatrist when I returned to London and he referred me back to the surgeon. Have been scheduled for surgery to remove both the neuroma and what is an enlarged bursa in the same area. Looking at the recovery info the surgeon gave me, I won't be able to start my next work contract until mid-June, so I get to continue slothing for a while longer.

I was concerned about the whole stump neuroma thing but the surgeon said he'll cut the nerve high up enough in the foot where it won't be rubbed by moving bones. Whatever, as long as I can ski again wink

After all it is free

sarah, I'm not particularly bummed about it, it's relatively minor surgery – at least it looks that way from the surgery vids I've just watched on YouTube). But I am wondering how to stop my brain from shrivelling up due to disuse for another month (bear in mind that I spent all winter skiing and have yet to do a lick of work this year).

The surgery is next week. It's a 20-minute procedure done under general on a day patient basis.

Glad to hear yours isn't giving you too much trouble!

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Zero-G, Just re-read the other thread, did you decide against the cryosurgery then in favour of the conventional chop it out?

Help!!

Mortons Neuroma

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