Morton's neuroma (pinched nerve)

[Meo]

Anyone has/had a Morton's neuroma in his foot? Morton's neuroma is a pinched nerve just under (between) the toes which, with time, produce a bulge on the nerve itself. When this permanent bulge is inflammated, it can become very painful. I'm stuck with it, it's painful right now, my winter season (my favorite one!) is compromised . I got an appointement with my podiatrist next week, but before any surgery, I'd like to know if somebody had to deal with it here, and how you managed to continue hiking.

Meo the Sad

 

[Peakbagr]

Meo:

Look for a PM. I have personal experience dealing with this.

PB

 

[shadowcat]

I feel your pain

i have that in both feet! and let me tell ya well i guess i don't have to --- it really frellin hurts. i have inserts for my boots that have a raised section for just this and also use some metatarsal pads. both are used to raise up that section of your foot to eleviate the pressure on the ball of your foot. the pads def help a lot. i know this for sure bec yesterday i did not wear them snowshoeing. i didn't think i would need them. well i hurt all the way up but it was bareable. but then about 45 min from the car i stepped just right and set the left foot off into shocking pain. every step was a tear jerker. i didn't (couldn't actually speak)all the way to the car it hurt so bad. i was actually exhausted just from the pain. i will NEVER go w/o those pads again. i have tried the steroid injections in both feet & got some brief relief but after yesterday i am again convinced i will need the surgery to cut the nerve. i don't mind that at all but i do dread the not being able to hike for at least a month while my foot is in a caste of sorts. but in the end i know it will be much better. here are my 2 recommendations for inserts and pain relief that have really helped me. . if you have to pick one over the other i'd get the met.pads i wear them everyday w/ work shoes, gym shoes, heels, hiking boots you name it and they def keep the pressure off the nerve.
1. here's the gel inserts i use:
http://www.footsmart.com/Product.aspx?productId=57

2. i would higly recc these - i never leave home w/ o them: there's other types of gel pads etc which i have also tried but i find they often take up too much room in my shoes and then the shoe is too tight fitting.
http://www.footsmart.com/Product.aspx?productId=67

if you have any questions feel free to pm me. i've had this since last year so i know what you are going thru

 

[John H Swanson]

I have a neuroma in my right foot. Several visits to the foot dr. and the treatment was always a metatarsal pad taped to the foot. His input was the correct placement, which is very important. This was great for the initial case that was the most painful.

Then, after getting tired of the co-pay for reoccurances, I started using the spenco metatarsal pad. (I've been very impressed by many of their products such as their ace bandage and, of course, second skin) I have the metatarsal pad sewn with dental floss onto the normal shoe/boot insole of several of my footwear and this has controled the problem effectively. Proper placement is important and on more than one occasion I had the pad in the wrong place. This is why I went to sewing vs. taping the pad in position. I noticed that all of my shoes did not need the pad, just some of them.

You may also want to know that it is important to have shoes wide enough to not pinch your toes. The foot dr. said that most of the neuroma cases are women with cramped toe shoes. I make sure I get wide shoes and these in turn don't need the pads (for me.)

One more point: My dr said that if the pads do not work, then the final option is cutting the nerve. This would result in loss of feeling to the toe. I'm glad that I have found a livable solution as a numb toe would not be good for monitoring cold toes to avoid frostbite during winter outings.

good luck.

JHS

 

[Waumbek]

Wow, perfect timing, thanks very much. I've got one of these little suckers too, feels like I'm walking on a pebble in my foot. Some shoes and boots it doesn't hurt in, some it does. My 2005 resolution was to go to a pod and deal with it, but I'll try some spenco pads first. A bad pair of boots on a weeklong backpack brought it on.

 

[John H Swanson]

pad position follow-up

I have been told that the metatarsal pad should be positioned suffiently far back towards the heel to be behind the ball of the foot but not under it. This way it raises the foot and reduces the pressure on the bone joints in the ball of the foot. So the pad position I used was not under the ball of the foot, but 1/4" to 1/2" behind it. This is an unnatural position and it gave me some discomfort. Of course a little extra pressure on a part of the sole of the foot not used to it was nothing compared to pinched nerve pain. As I walked with the pad in this position it tended to slide backward into the arch area where it was ineffective. I think this is why the dr taped it to the foot. The only way I could ensure that my pad did not move in my shoe was to sew it in place. Getting the position correct (+ - 1/8") was trial and error. It worked for me.

JHS

 

[Danielle]

I feel your pain! I first experienced my Morton Neuroma in my right foot 2 years ago. Ouch did it hurt! After doing a 50km xc ski race in boots that were too small, I could barely walk. That led me to a podiatrist, who I've been able to purchase shoe inserts from. He sticks a raised, round pad on the insert, which as John said, is below the ball of my foot. I have the inserts in all my running and hiking shoes, and they are great. They definitely relieve the pressure.

I also found that I had to buy new hiking shoes that were wider in the toe box, as I think part of my problem was that my toes were getting smooshed too. I currently wear the Merrell Chameleon Ventilator Lows, and they work wonderfully for me. Also, I ended up getting rid of most of my shoes with bigger heels, as those just exacerbated the problem... I realize most men don't wear heels though

I don't know if the Neuroma ever really goes away, but I have found (luckily!) that I'm able to manage mine with the inserts and my new hiking shoes and that is definitely a good thing!

Meo, good luck and hope some of this advice from us helps you out!
Happy Hiking!
Danielle

 

[Meo]

Oh yes, it helps a lot! I'm reading and rereading all the posts several times, thanks! Anyway I'm stuck with this problem since at least 2001. I had an orthotic made in 2003 (with a padding right where John wrote, plus another padded line between the 4th and 5th toe to help "unsqueeze" the toes), and my problem seemed to disappear for almost 2 years. Two weeks ago, a 4 day backpack carrying an insane 60lbs pack up the Bond range brought back the pain. A full week rest was obviously not enough: last Saturday, a short 5h hike on the Willey range brought intense pain.

Yesterday I saw my family doctor. I'm taking pills to diminish the swelling, I plan a good 3-4 week rest, I got an appointement with my podiatrist next week (I'll ask for a new orthotic), another one with a sport oriented doctor tomorrow. It's not a good year for my right foot (a sprain in November, the neuroma in January ), but a least it's comforting, reading your posts, to realize that it's not an uncommon situation in the hiking community. Another good side of VFTT

 

[John H Swanson]

Even when my neuroma is in "remis", I can still wake it up is I inflict too much stress. Surprizingly the type of shoe makes a big difference in whether or not it wakes up.

b

 

[moose_mckenzie]

Hi, All,

I have had Morton's Neuroma -- thickening of the nerve sheath -- in my right foot since 1992. It is sited between the first and second toes, about a centimeter from the web. My podiatrist made up matching orthotics for each foot; each one had the toe stretcher. I have worn them ever since. when the orthotics were being repaired, I would take two- 2 inch gauze pads, center them on the bottom of the foot, under the nerve. I would then take two strips of adhesive and wrap the gauze in place. that often worked as a good substitute.

I have never had the resection operation. It was described to me in great detail, with some research on my own. Essentially there are two ways of approaching the MN. The first is from the bottom of the foot. Often the resulting scar causes more pain and discomfort than the neuroma itself had. The other approach is through the top of the foot. Problem there is that often the surgeon will cut the tendons to the toes, as the nerve is below the tendon. Cutting the tendon means that the patient will not have the ability to wiggle ones toes. Some surgeons and podiatrists feel that toe wiggling is a useless and unnecessary.

Non-invasive technologies -- some people say that ultrasound works wonders. If you have access to an ultrashound machine on a daily basis, then go for it -- it cannot hurt. Magnets -- they will work on muscle inflamation and stone bruises, but will not affect the MN. i have used magnetic inserts for year, without avail. Maybe i placed the magnets in the wrong places, so they didn't work for me.

Pain killers -- I take several Advil or Orudis (ketoprofin) or Aleve (Naproxin Sodium) when I do a backpack or a long day hike. This recommendation has come from various physicians associated with the outdoor community, including Dr. Stu. Lately I have been taking a strong anti-inflammatory for tendonitis; that drug seems to have alleviated my pain. I hope to not take anti-inflammatories for the rest of my life.

Made to order boots -- Gary Barlow is a bootmaker in NY State whose specialty is making boots with orthotics. In September, after wearing boots that left my feet in utter pain, I went to vist him. I spent three hours doing a fitting. He took my old pair of boots and showed me -- by looking at the sole -- that when I walk on the my right side of my foot, not heel-toe like the rest of the world. End result -- I have a new pair of boots, which will quite probably last me for the rest of my life. The orthotic is part of a removeable insole; Gary supplies supplemental pads for when I use my podiatrist's orthotic.

Gary works with each customer one at a time. His turn around time for boots is -- this is not a misprint -- 3 to 5 weeks. His boots are all leather, which require proper care and feeding. He does not use Gore-tex. His boots aren't cheap -- mine cost about $800; considering that I buy a pair of $100 boots every two years, then they will pay for themselves within 10 years. Plus, I can use them in the winter, with the addition of an overboot.

His website is: www.hamiltonny.com/barlowboots

Moose

 

[Meo]

Given the high level of interest in this neuroma thread, Peakbagr accepted to let me post his emails concerning his own struggle with this burden. Could be particuliary interesting for whoever thinks about a surgery. And BTW, I'm recovering right now, but I can feel it's not over yet, I still feel my toes "buzzing" when I walk (not painful though). I keep my orthotics all day long, including home.

These are our messages:

Peakbagr 1:

Meo,I was diagnosed with this a number of years ago. I tried the route of cortisone which worked for me for about 60 days.

What happens is that in your feet, your metatarsal bones are a tiny bit too close together. There are nerves that run thru those spaces and and the combination of the close spacing and perhaps overuse(running, hiking, tight shoes) cause the metatarsals to rub and squeeze the nerve sheaths, swelling and inflaming them. Now what you have are the nerves getting pinched and no where for them to go. The result is a sharp pain in that spot that doesn't go away without rest. If I remember my discussion with the doctor, the more those nerves and sheaths are rubbed and pinched, the more susceptible they become for further abuse of them.

In my case I was hiking 40 weekends a year and running 25 to 37 miles a week. On top of that, the toe next to the large toe is longer than the large toe, which is a genetic thing that makes Morton's neuroma more common.

What did I do? Cortisone. The shot hurt like hell and burned, and then the foot felt great for 60 days. After 2 months, the neuroma was back with a vengeance because the cortisone masked the pain and damage that I was continuing to put the foot thru. I decided to go for surgery. Its outpatient and they basically sever the small nerves that go thru the pinched area. It results in a lack of some sensitivity to those toes(no big deal), but with rest, the pain went away. Some interim things you can do is get fitted with orthotics which will improve your foot geometery and will help in general. And, you can be sure that your shoes, boots, slippers and sneakers all have a nice wide toebox. My doctor also told me to never use loafer shoes again and the looseness promotes your foot sliding around in the shoe and that laceup shoes hold you foot in the proper place inside a shoe or sneaker. This is not going to be a fun process for you the next few months, but there is light at the end of the tunnel. You can start helping the process by resting the foot for a few weeks and reassessing the kind of shoes and boots you were. Take a real good look at your hiking and climbing boots. I find that I sometimes try and put a little too thick a combination of socks in my boot, and I can dull-ly feel it pressing up in the spot where the neuroma used to be. Given the winter hiking season, lots of socks and a tight boot with your body and pack weight pressing down on the neuroma may have kicked this off for you. Let me know how everything works out.

Meo's answer:

Peakbagr, thanks a lot, you're cheering me up just to know I'm not alone! Actually, I must deal with this problem since at least 4 years. 2 years ago, I hade an orthotic made and the problem "hushed" for a long time. In the past 12 months, I hiked for a total of 50 days, including several loooong dayhikes (like the Presidential in one day) without any problem related to that. But last week, we did a 4 day trek on the Bond range, carrying an insane 60lbs pack. I had my orthotics in my boots, but it wasn't enough, my sworn ennemy returned... I took a full week rest, but obviously it wasn't enough. Saturday I did the Willey range (a short 5h hike), and the pain came back. Now I intend to take a full month break, and I'll see what the doctor will think. Maybe a new orthotic, along with a new pair of boots. Maybe cortisone. I want the surgery to be the last option (how long have you been on crutches? Did the incision was over or under the foot? How long did you have to wait after the surgery to get back hiking?).


Peakbagr 2:

Meo,I feel for you. They did the surgery in the doctor's office with a local anesthetic. LOTS of needle stick. I had my foot in a bandage and used crutches for 2-3 days, and then a cane for a few days. Surgery was not a big deal for me. There are negatives associated with cortisone. It can only be used a couple of times without doing tissue damage, the cortisone masks pain, and it keeps you feeling the pain for on-going damage. Take a look at your everyday shoes and sneakers. Also, getting new orthotics may help. If you've been on long treks this time of year, you probably had a boot filled with socks taking lots of space, and your neuroma was pushed down from all the weight you were carrying. The incision was on the top of the foot, otherwise the scar tissue, healing and stitches would be what you'd be walking on. Good luck and let me know how things work out.

 

[shadowcat]

surgery for neuroma

pkbggr: i am at the point where i will have to consider surgery. this pain is just too debilitating and i've done the steriod injections and even w/ the inserts, neuroma pads etc. the pain is there and it is interferring w/ my quality of life. i was curious tho to see you only had your foot wrapped for 2-3 days???? both surgeons i saw: one was an orhto and the other a podiatrist mentioned some hard boot like caste i would have to wear for 3-4wks (podiatrist) 4-6 wks (ortho). that's a lot of time! esp since i have problems in both feet and i would want to get both done at the same time. where are you from? if anywhere around the albany area can you pm me the drs name you saw? both my drs were doing the top foot surgery but that's a huge difference: wrapped & a few days vs cast and 4-6 wks.
also: there are drs out there doing trials w/ cryogenic surgery where they freeze the nerve vs having to actually cut it. my drs were a bit skeptical but i would be a lot less invasive then cutting. i am surprised at the number of guys who have this problem - they say women get it from all the high heels we wear - usually the toes are narrow which results in pinching the nerves and it progressess from there. (do you guys have some secret fetish w / heels???? thnx for all the info - misery doth love company!