Morton’s Neuroma-Revised Rewound Rebuffed Revisited
Thank you all so much for your comments and support. I have received a lot of feedback and fantastic questions about Morton’s neuromas (MN) and your problems with diagnosis and treatment of such. This area of the foot can indeed be terrifically confusing and difficult to diagnose. I want to help you all as much as I can with this conundrum, and I would love to answer each and every one of you individually, but I just can’t and shouldn’t in this setting. As always refer to AOFAS for specific help.
If you have been labeled with the diagnosis of a Morton’s neuroma and various treatments are not working so well, maybe you don’t have a Morton’s neuroma.
The MN diagnosis is made way too often. Why? Here are some misconceptions that surround the dreaded Morton’s neuroma and lead us astray:
- MN’s are really common. Actually they are not common, especially a 2nd web space MN (15%). Even 3rd web space MN are not common. If your doc is indicating a 2nd web space MN, question it and consider the much more common 2nd MTP synovitis (inflammation of the central ball joint). If they are thinking 1st or 4th web space, RUN.
- MN diagnosis is SEXY. We docs just got to make that diagnosis. “You have a Morton’s neuroma”. It has teeth. It sounds so definitive and sure. It is like a golf ball set up on a tee just waiting to be shanked.
- MN’s are easy to diagnose. Actually, they are not easy to diagnose. I have done this for 27 years and now more than ever, I am now even more cautious and I respect making this diagnosis ore than ever. It is actually a diagnosis of exclusion. This means that I rule out the other possibilities to the best of my ability before making the call of a MN. Too many good docs jump right to this diagnosis. It has to be the last diagnosis, and even then I am often not as sure as I would like to be normally.
- “You have a Mulder’s click”. This is a physical finding that is rarely helpful, but boy, do we really like it.
- The MRI and more recently, ultrasound have not helped matters either. In fact, those who rely on these tests are trying to increasingly make a claim regarding their diagnostic prowess, which is not true. Stick to old fashion history and exam.
- MN may be all your doctor knows.
Basically, central forefoot (2nd, 3rd, 4th metatarsal head region, not 1st or 5th) pain that starts in an otherwise normal foot can be divvied up into four basic diagnoses the great majority of the time. There are several more diagnoses that are uncommon and frankly, outliers that are not discussed here such as Freiberg’s infraction, inflammatory arthritis (rheumatoid), etc. Here are the names and the diagnostic criteria, according to the AO. Keep in mind that the majority of these can be diagnosed by history alone and an MRI or an ultra sound is generally not needed in any of these. Waste of time and money. If your doc is quick to say they need an MRI to make the diagnosis consider another route. I’m not sayin’, I’m just sayin’.
Exam is important, but only to support and confirm the history. By the way, no matter what you think or hear, none of these ever have a history of actual causative acute trauma. If you have a history of trauma and you have one of these I would say True-True-Unrelated.
Finally I am not discussing treatment. The treatment of each of these is clearcut as long as one is confident in the diagnosis, which what this is about.
Intractable plantar keratosis (IPK) or plantar corn or callus
- Generally older, 50 yo plus, but can be any adult
- Pain is on the bottom
- Insidious slow onset, present for some time
- Visible seed, small tight callus that is exquisitely tender to touch.
- No swelling
- You would have to be brain dead to miss this one.
- Pain only with weight bearing
- Worse on barefoot, better in shoes
- When it comes to trauma, this one could be the exception. If there is bonafide past or remote trauma to your foot/metatarsal or previous surgery that leads you to have a residual unevenness to the weight bearing surface of your metatarsals, then you could develop an IPK form that.
- X-rays negative
- Can be confused with a plantar wart.
Metatarsal neck stress fracture
- Ages
- Military recruits, boot camp, “march fracture”
- Distance runners, any age, training error
- 50+ female>>male
- Recent rapid onset
- Recent rise in activity level, especially number of steps! Normal activity to many more steps per day, vacation, new exercise program, etc. Or lower activity as in being down from prolonged inactivity, i.e.illness, heading back to your normal activity level. Jumping out of the back of a pick up truck and breaking your metatarsal is an acute fracture, not a stress fracture, and is different.
- Pain on top of foot
- Swelling top of foot
- Usually 2nd metatarsal, next to big toe metatarsal
- Pain with weight bearing, with or with out shoes
- X-rays negative in first 21 days, then new reparative bone formation is seen and sometimes the fracture is seen.
Morton’s neuroma
- Adults, peak age 40’s thru 50’s.
- Insidious onset, often years.
- Unlike all the others, at first and often even later, the location of the pain can be vague; can’t pinpoint. Can be frustrating for patient and doctor alike. However, knowing this can ultimately be helpful if used correctly.
- Pain mostly on bottom.
- Can take a while to get started with standing/walking.
- Worse in confining shoes, better in sandals or barefoot.
- NO SWELLING…………..EVER. Whoops, caps lock on again.
- Can feel swollen however. Numbness can feel like swelling. Remember the last time you got home from the dentist and you looked in the mirror because you were sure that your tongue was hanging out of your mouth only to find out all was well. I rest my case.
- There can be a sensation of actual, perceptible numbness between the two affected toe which border the neuroma. This sensation or finding by your doc is extremely variable and unreliable. It’s presence or absence really means nothing. I ignore it basically except to support my other findings.
- Mulder’s click is a useless finding. It’s absence means nothing. While I do dismiss it, a Mulder’s click may be supportive if when performed it exactly recreates your pain.
- 3rd web…85-90%, 2nd web 10-15%, 1st or 4th web…….not.
- These are two things that get my attention and often have meaning, but only supportive with other findings and history:
- feeling of folded sock bottom of foot
- urge to take off shoes and rub foot. Does not matter whether you actually ever do it, it is just the urge part.
Second MTP synovitis (AKA, capsulitis)
- Majority in specific demographic, 55 +/- yo female
- Not mentioned as differential diagnosis on Mayo or WebMD sites, but capsulitis is right there on Wikipedia.
- By and far the most common of these four diagnoses
- Primarily 2nd metatarsal. Infrequently the 3rd.
- Insidious onset, few days to weeks.
- Swelling top and bottom often, but not always.
- Painful “lump” or “rock” under ball of foot. Pain on bottom.
- Worse on hard floor barefoot, better on carpet or cushioned shoes.
- Sometimes there is the perception of some form of trauma, but any trauma is just the “straw that broke the camels back” phenomenon. For instance dancing at a wedding in heels to get it started. But here is something you MUST know; it was going to start eventually anyway because it is a result of:
- mostly these occur as a result of calves that are too tight which places more pressure on the forefoot/metatarsal heads. This represents a more recent change and why this is happening now and not before.
- in a very small part due to the anatomy because the 2nd metatarsal is the most prominent in almost all of us. This has been your anatomy forever and has not changed. Your doctor might refer to your 2nd metatarsal that is “too long”, but it has been that length all your life. Seriously, it isn’t as if your metatarsal magically grew longer recently. Now, refer back to calves.
- Transfer metatarsalgia secondary to a bunion. Often blamed, but the calves that are too tight are the larger reason this is going on at this point in your life.
- When this problem is left untreated, eventually a hammertoe will develop if the swelling is allowed to persist. Hey, here is a novel idea. The great majority of isolated 2nd and/or 3rd hammertoes result from MTP synovitis which comes from calves that are too tight, which is almost completely preventable as long as you stretch your calves.
- Often the inflammation from the 2nd MTP synovitis can irritate the adjacent 2nd web space nerve causing neuritis, which is a secondary thing and not a Morton’s neuroma.
If you are reading this, chances are you fit in one of these four groups. Certainly you’ve gotten loads of information from the stranger on the bus next to you, or your nosey neighbor (everybody is an expert), or from the internet, or even your doctor. Again, the mere fact that you are reading this means things probably aren’t going so well. No matter what you have heard from these sources statistically your problem is second MTP synovitis, and not a Morton’s neuroma.
IPK, seed callus under second metatarsal head
AP radiograph right foot 2nd metatarsal stress fracture, oldest with mature fracture callus; 4th metatarsal stress fracture, newer with early maturing fracture callus; 3rd metatarsal stress fracture, newest with minimal fracture callus
3rd web space Morton’s neuroma, plantar or bottom view
3rd web space Morton’s neuroma, dorsal or top view
Pedobarograph, 2nd metatarsal overload
2nd hammertoe
Thank you for everything you do. I have recently been diagnosed with a Morton’s neuroma (by two different podiatrists) and was wondering if a slant board would be helpful for calf stretching. I travel for work (by car) and don’t always have access to a step. Something like this… StrongTek Foot Rest Under Desk, Slant Board, Foot Stool for Work at Office and Home (Footrest for Desk), Anti Slip Design, Ankle Stretching, 4 Positions Calve Stretch Wedge (300LB Capacity) https://www.amazon.com/dp/B06XR6GJ3S/ref=cm_sw_r_cp_api_i_0pjoDbYRP31ZH
Here are my symptoms…
Worse first thing in the morning.
Stairs hurt, more when going down
Shooting pain in between 2nd and 3rd toes
Sneakers and closed toes shoes make the shooting pain much much worse
Barefoot is typically fine. Except for first thing in the morning. By the evening it’s mostly fine to walk barefoot on hardwoods
3 cortisone shots did nothing to help
No swelling
Started 2 months ago
Hiya Jennifer,
No matter the diagnosis (Morton’s neuroma vs. synovitis) it is clear calf stretching is your answer no matter how you get it done. Stair, slant board, One Stretch (the only stretching product I unofficially endorse), stairs, etc., just do it!
Stay healthy my friends,
AO
Hiya Jennifer,
No matter the diagnosis (Morton’s neuroma vs. synovitis) it is clear calf stretching is your answer no matter how you get it done. Stair, slant board, One Stretch (the only stretching product I unofficially endorse), stairs, etc., just do it!
Stay healthy my friends,
AO
Thanks so much for the wonderful site!
Here’s my situation:
About six months ago I began to have pain in my right foot. Later side around midfoot. I surf, and had been more sedentary since covid, so figured it was general aches and pains of new use. Pain has come and gone, but past couple months much worse. But in new spots!
Baby toe feels like I slammed it in a door (I didn’t), and when I wake up in the morning, or after sitting for a while, my foot is incredibly stiff and painful when I first walk. Assumed it was a whacked out PF but doc says MN.
Pain on palpation is between baby toe and next toe (5th and 4th meta). Acute pain to touch. Feels nervey.
Walking helps. Sitting does not.
Xray shows plenty of space between the 4/5 MT, but my baby toes are crooked, turned on side slightly, and facing in toward the center, and up, as if dorsal flexed. Not crazy, but enough to notice. Always have been. My feeling is that when I’m standing or walking the space widens and provides relief. But, when I’m seated or sleeping the space decreases?
I am 40 yo me, relatively fit, 180 lbs, 5’10, get all my vitamins and minerals etc.
Stretching helps. Calf massage feels good!
Doc wants to avoid any surgery for a whole. Has me on strong anti-inflammatory pills, those pad things that go in the shoe to make space on the MTs, stretches, Epsom salt baths, topical nsaid,.
Thoughts?
Hi Bob,
I have lots of thoughts, but the punch line is to stretch your calves, my way. You, my friend, have the perfect story of several seemingly unrelated acquired foot issues due to equinus, which is secondary to COVID. Thanks for bringing this effect up for the AO Nation.
It is no surprise to me that foot and ankle acquired issues have risen with COVID, especially as we climb out of COVID and reactivate ourselves. I am published on why our calves tighten and it is no surprise that lack of activity and movement associated with COVID shutdowns, etc., is a situational cause of equinus. I find it thoroughly amusing to see what several of my foot and ankle colleagues are proffering as the cause of this phenomenon. They mostly talk about shoe-wear
This whole scenario is completely predictable. Sadly, what is just as predictable is that just about everyone will waste their time with the usual and often dangerous and expensive nonsense such as new shoes, orthotics, NSAIDS, etc. I jest at being angry, but this, my friend, indeed makes me angry.
To be clear, these less invasive, nonoperative, non-stretching treatments are fine to do as palliative treatments, but they DO NOT address the root cause- equinus or calves that are too tight. I am glad your doc wants to avoid surgery! But for some reason, most people want to do everything, except calf stretching. Can you feel me fuming?
Trust it and do the work.
Stay healthy, my friends,
AO
Thanks so much for the response. You, my friend, are a gem in the online orthopod world.
Funny thing is, when I first started getting this pain, which was a bit more diffused and hard to pin down (fracture? wicked plantar fa?), the first thing I started doing was massaging my calves. I do sports medicine, and was just like, I don’t know what it is, but calves are involved in everything like this, sooo…
And, when I saw your sight (6 months later) and the emphasis on calf stretching, it just clicked. I’ve been deep stretching my calves on a foam roller (foot in dorsiflexion then leaning forward), and there is IMMEDIATE relief. Doesn’t last forever, but I can tell it’s working.
Also, because my baby toes tend to dorsiflex up and medially, I’m also sitting on my heels to stretch the anterior side. I just wish I could get those baby toes to straighten out! At rest, they just press on the nerve me thinks.
Anyway, sorry to chew your ears (and eyes) off.
Thanks again.
Also, the tight shoes thing is lol. They mention it everywhere. I’ve been on the wide toe box train for fifteen years! It ain’t m’shoes.
LOL. There only three inconvertible facts about shoes:
1. If the shoe fits wear it. It is amazing how many folks wear shoes that don’t fit and hurt.
2. You get what you pay for. This rule does not apply to Nike.
3. Wearing shoes is optional.
Stay healthy, my friends,
AO
I just found your website. I believe my foot problem is Morton’s neuroma. My ball of foot problem just came on in the last month. I have not worn narrow shoes, or been running but I am a senior citizen, did a lot of sitting, and just took it easy this winter. All last year I walked everywhere putting in 20,000 steps at least daily in my walks and no problems whatsoever. So I am thinking the stretches will work.
Hi Ann,
Here is the stupid thing about this, everyone makes these things too complicated. I am not referring to you, I am referring to us doctors, etc. For the majority of non-injury, or non-traumatic acquired foot and ankle pathologies calf stretching will usually solve the problem. Why you ask? Because the majority of these issues are caused by one thing, equinus or calves that have become too short over time. So, I agree with you, stretch.
Stay healthy my friends,
AO
Hello, this is the followup to my March 19th post. Here it is September and I have been to the podiatrist. 1st time he said my shoes were to blame, 2nd time he says he can find nothing wrong with my foot. But it still hurts. He diagnosed me with high arches, inner pronation when I walk, and tight calves. Said I need orthotics. Said I don’t have Morton’s neuroma or planter fasciitis. He gave me a handout with calf muscle exercises: towel stretch (10 reps 10 seconds 3 x day) and stair stretches (10 reps 30 seconds 3 x day). I have been doing these faithfully for 2 weeks, no better yet. Help!!! I just want to be able to walk again with no ball-of-foot pain!
Yo Ann,
First, did you do my stretching? If you have not done them my way we are done. I am confused when I hear, “diagnosed me with high arches, inner pronation when I walk”. These two terms are polar opposite. If you have high arches this is the one situation where stretching has a low batting average because of the local anatomy. So, I suggest you stretch my way or the highway, seriously.
Finally, stretching takes time especially for second MTP synovitis, so hang in there and be patient.
Stay healthy my friends,
AO
Hello Dr. AO
I had surgery on my right foot back in August of 2013 after having horrible lightening bolt pain for a year and a half. It became so bad that there were nights with NO sleep. I saw 7 doctors. Most of them seemed clueless (A GP, 2 Pods, a Chiropractor, and 3 Ortho). Then the last Ortho answered the question “What happens to the nerve after it is excised?” When he answered that he would cut it and imbed the end of the nerve into the interosseous muscle I knew I had found an experienced surgeon (he also was fellowship trained in the foot and ankle) . There is one in my left foot but it’s not nearly as bad so I am calf stretching daily as you recommend. Kudos for a wonderful blog about a not so easily diagnosed foot problem!
Hi Cheryl,
So sorry for the delayed response. Thanks for the love. I agree with all you say. So, how are things today?
Stay healthy my friends,
AO
So sorry for my delay in answering. I am doing pretty well; continuing the calf stretching however, if I do too much work using ladders (up and down) the feet will begin to feel as if they are burning. Most of the time this does not happen so I am counting it all good.
Way to go Cheryl! You have discovered the simple truth. Keep on stretching and enjoy your feet.
Stay healthy my friends,
AO
Dear AO,
Some valuable advise throughout the blog. Thanks for helping a lot of people.
I developed pain under my toes 6 months ago, barefoot and hard shoes is a pain, sometime radiates up until the calf. I have been managing with one shoe thats soft on my toes. No swelling or redness.
Xray had no findings. Ultrasound reported a 4mm cystic lesion in the 2nd metatarsaphalangeal space, suspected MN. MRI has been advised. But the radiologist says that the morphology of the lesion is unlikely to be MN, however bcos of the location, a MRI is advised.
I’m booked for MRI, however wanted know what else could the cystic lesion be if its not a MN? Do other small cysts cause such pain?
Hi Sudha,
I know I am late for this request. My apologies. I would agree with the radiologist. Please let us know how things are going and don’t put all your eggs in the MRI basket.
Stay healthy my friends,
AO
Hi AO
Firstly thank you, love your advice and have begun stretching madly.
Pain from MN has finally driven me to make the decision to try Radio-frequency Ablation, guided by ultrasound rather than have the operation. Do you have any experience with this procedure? The radiographer does a test injection first to make sure it is a Neuroma. I have no doubt as I fit every description on your site.
Funnily enough my podiatrist told me he would be 95% out of business if it werent for tight calf muscles. Will spread the good word on stretching.
Kind Regards
Darlene from Oz
Hi Darlene,
Better late than never. I hope you are stretching. I love your podiatrist. They get this so much more than my orthopedic buddies.
Stay healthy my friends,
AO
What do you tell people with a stump neuroma or what is also called entrapped nerve – who realize another surgery could make the pain worse.. should we seek out a peripheral neurosurgeon. Is there any safe option?please help me know where to go?
Hi Judi,
I feel your pain. While physical therapists know this simple trick, most surgeons do not or they don’t want to know. While not as sexy as more surgery, good old deep cross friction massage to the stump neuroma works about 80% of the time, and it is free.
I have commented before on this treatment. Please find my spiffy Search function in the right column of the home page. Search “cross friction” under the COMMENTS pull-down list just below. You will find your answer there.
Stay healthy my friends,
AO
Dear Doctor! I would like to ask for your help. I have got a problem with my foot. My toes are very long, on my left foot especially my second toe is much longer ( Morton toe) than the first one. It does not bother me esthetically, but I have got big pains in my toe when I wear Shoes, sometimes even sandals. Even socks cause me milder pain. I visited 3 doctors, I got orthotics, I got one steroid shot, which made me terrible side effects, so I did not get the another one. I started your calf streching ( I can not tell you any result yet, because I have been doing it only for 10 days) I have got this problem for 2 years, but it is getting worse. I have been ma king 35 minutes foot exersices for 10 days which was recommended by the orthoped doctor, I have not got any relief yet, may be, it is even a bit worse after making the exersices. I think, I was not wearing proper shoes, may be too tight, this could be the reason, but now I really can not wear any of them- It is hard to get shoes for me ( my shoe number is 8, 42) each year bigger, may be it is also not normal. However I have been wearing orthotics for 30 years and still have this problem. May be wearing orthotics make foot problems more serious. I am 65 years old. Thank you for your answer in advance.
Hi Judit,
I am going to cut you a break and not get angry this one time. You have a constellation of things going on and I suspect a single root cause- equinus or calves that are too tight. I am glad you are stretching and to see you said you are only stretching 10 days. This means you read all the way through and you are patient. It may not fix everything, such as your long toe, but it will blow you away dear. So, keep on stretching!
Consider this regarding your second toe. Did that second toe magically grow longer two years ago when this all started? Emphatically I say NO. So, forget about what you can SEE, what is obvious, and think about WHAT YOU CAN”T SEE OR FEEL- your tight calves.
Yes, everyone’s feet get longer, wider, and thicker as we age. This is particularly worse in women and seems to get a bump with each childbirth. We know why, but I will not go into that here.
I have one question for you. You have been wearing orthotics for 30 years, why? Here are my two guesses:
1. Some doctor told you that needed to wear them for no reason or you were told you have flat feet. OR
2. You had plantar fasciitis and this was the treatment that continued for 30 years.
I wish you the best.
Stay healthy my friends,
AO
Dear Doctor! Thanks for your quick reply,. Yes, I have been wearing orthotics for 30 years, I was recommended by the doctor because of flat feet and strong pain in my leg ( achilles) I do not have plantar facs. Is wearig orthotics harmful , there are several views abaut this? Do you think, foot exercise makes any sence, beside calf streching, because orthotics are net very comfortable, I do not like wearig them.
Hi Judit,
Your story and history of orthotic use are par for the course, and it does make me angry. Orthotics are helpful to some folks, but that is the exception. Here is some common sense applied to orthotics:
* First and foremost, orthotics are like beauty; their utility is 100% in the eyes of the beholder. Somehow when they are recommended, there is a mysterious spell placed upon the patient, and they cease to think for themselves and walk around in pain with these hard lumps under their arch. Maybe their blind use is the cost, or maybe it is hypnosis, but most likely, it is exceedingly strong opinions from friends and family about how great these devices are. So, you, and ONLY YOU have to decide whether this or that orthotic is good you if at all.
* I get great joy reading where laypeople endorse these orthotics or shoes with such enthusiasm and bravado. Keep in mind that these are one-off recommendations. Just like orthotics, shoes must be vetted individually. What works for you may not work for me. Unlike orthotics with shoes, you generally get what you pay for.
* Generally speaking, orthotics dispensed for asymptomatic and most symptomatic flatfeet are a waste of time and money. There is no evidence that orthotics make any change to flatfeet, and again if one’s flatfeet are symptomatic, they more often than not provide and help.
* Orthotics are most helpful outside the foot. For instance, making slight changes in the foot attitude during stance phase of gait can be symptomatically helpful problems up higher such as the knee hip or even the back.
* Wearing orthotics is rarely harmful, and whatever pain they might cause resolves with removal.
Foot exercises seem to be the rage right now. While I have nothing against them and they certainly can’t hurt, they are like so many treatments are aimed at the wrong target. These other treatments can certainly help symptomatically. The problem I have with all other treatments (shoes, orthotics, foot exercises, medications, injections, ultrasound) other than calf stretching it that they tend to make us take our eye off the ball and quit stretching. And they can be expensive. This is a continual battle I have with patients in my practice.
So, Judit, stop wearing orthotics and move to a normal low arch shoe, but you be the judge of what works for you. And don’t forget to stretch.
Stay healthy my friends,
AO
I only have one request. I don’t ask for money, I don’t have advertising, and I do this for free. My mission is to help as many people as I can and to bring awareness of the benefits of simple calf stretching to as many people as possible, everyone. The only thing I ask of you is to “Pay It Forward”. Whether it be what you learned on the website or the benefits of calf stretching, please let anyone and everyone know about this site and the AngryOrthopod. Your social media and word of mouth support will help you help others. Thanks, AO
Hello
I am a female runner (orienteering and trail ultrarunning) with some forefoot-issues. It startet in june this summer after a longer run in the forest (5 hours). I felt like “walking on the bones” in my right foot, no pain, only this strange feeling. After some weeks I got some burning/tingling sensations in my toes (number 3.-5) after an interval training. I can feel this burning/tingling sensation typical the first steps on the floor after put shoes off/on. When I am running, I can feel this burning/tingling irritation after 30-40 minuts. When I am running in the forest and step on a little stone or root un, I can feel an irritation/nervesensation (?), not pain. I also feel a lump under the forefoot. I have hammertoes in my toes (toe number 3.-5.), cause a lot of running in narrow and small shoes, supination and stiff calves, I think. Since I started ultrarunning, I have had some burning sensations in my toes in every race (50-100 km). Also in longer training runs (4-5 hours).
I have tried icing, spiky ball rolling, met pads, Hoka shoes, wider shoes, different insoles and orthotics , toe separators. The foot and ankle specialist (doctor) told me I have an irritation in the nerve between 3. and 4. th metatars. He said it was some swelling around the nerve, not Mortons neuroma (yet). I also told me that I have an unstable joint under the 4. metatars; the precursor to a plantar plate injury. I have no pain on the plantar plate, so I think this “diagnose” was strange, but I am note a docotor. He told me to relieve the pressure of my right foot for 6 weeks; wear shoes with stiff outsoles and with a lot of cushioning, met pads and do some alternative training like swimming and cycling. I do not feel that there is such a great improvement after 3 weeks of relief; maybe a little less nerve irritation in the toes.
I began this calves stretching-program this week; my calves are really stiff!
Do you think it is a Mortons neuroma? Do you think I can get well so I can run again? Running means a lot to me and I have anxiety about not getting well again. Sorry my bad English; English is not my native Language.
Hi Helen,
First, a couple of quick observations. I would have to respectfully disagree, your English is very good. Second, no matter what your forefoot issue is the root cause, in my opinion, is highly likely equinus or calves that are too tight, and therefore addressing it with calf stretching is the one essential thing that should be on your list of things to do. Anything else may help the symptoms, which s a good thing, but the equinus goes untreated to continue to cause damage in your foot, ankle, or both.
To your questions. You tell a good story for Morton’s neuroma with a mixture of MTP synovitis and forefoot overload all of which are chased by equinus. Can you get well and run again? I am quite certain if you stretch using the method I recommend or really any number of methods, but do it consistently, you will be blown away in short order. I have a question for you. Why are you not running now? There are only two reasons. One, you symptoms are bad enough that it is difficult to do it at this point. Or two, you have been told not to by someone. Rest is death to a runner, and as I have stated here often, if you can run to any degree and there is no significant pain and there is not a trend to getting progressively worse over time, go for it. Just listen to your body.
Finally, a short rant on Hoka shoes. These are quite possibly the dumbest shoes ever made, especially for running and even walking. They have great cushioning no doubt, but the rocker style sole coupled with the deep cushion is like walking in loose sand. They actually do not allow the user to assimilate anything like a normal gait. I am sorry you bought them and I would welcome some discussion on them from you Hellen and any others out there. The goofy rage for these really makes me angry mainly because like so many of these stopgap, palliative measures they deflect one’s attention from what counts.
Helen, you are on your way.
Stay healthy my friends,
AO
Hi. I have done the 3*3 calf stretching every day in 7 weeks. I noticed progress the first two weeks, now there is no progress. I run a little, but do not feel that it is so good. Do you think I can be good? How long do you think it might take? I’m incredibly frustrated now and afraid I can not run normally again.
Hi Helen,
Pretty much answered with your last comment. Hang in there.
Stay healthy my friends,
AO
Hello! THANKS A LOT FOR THE STRETCHING ADVICE! I have been stretching my calves every morning (3×3 min.) and after training for about a year now. I`m running a lot and thats great! My longest run is now about 5 hours and I can run every day, but I try to do some cycling, swimming and strength training too.
I still have this problem: When I am running in the forest and step on a little rock or root, I can feel an irritation/nervesensation (?), not pain. This can be felt on different places under my right foot. What is it? Nervepain/mortons neuroma/fat pad antrophy? I can`t run relaxed because I`m afraid of stepping at at rock or similar. I think that tendoms and muscles under my feet are very tight. Do you have any advice? Is it OK to run with this issues? Best regards Helen
Hi Helen,
Thanks for reading the AngryOrthopod. You sound like a serious runner and like all runners I am glad you are out there doing your thing. I will start by saying what I say to a lot of patients with issues like yours. Honestly, I may not know what it is, but I know what it isn’t. It isn’t something that is likely to get worse or needs work up or attention beyond something simple or better ignoring it and move on.
If it is like you say a “nerve sensation” that basically is short lived and does not worsen over time then the occasional “firing” or whatever it is sounds benign. If the trend is that it gets worse as you step up your milage or trail running then maybe a further look see might be in order. However, beware, it is best to stay away from docs, especially surgeons, unless you really want to dive in. As I suspect you have experienced before, you may be taken down a path you don’t want to go and you might not return. Be careful Helen and that goes for all the rest of you. Surgeons typically have the misconception that you are there wanting surgery, and they are all too happy to oblige and lead things down that path. The scorpion got to be the scorpion. They are looking for something to fix when sometimes it just needs advice and nothing actually done, like your issue.
I did have many patients with a Morton’s neuromas that were painless, but would have an annoying snapping or nerve sensation as you describe. “Threatening” them with surgery vs. reassuring advice always worked and they appreciated it.Too many come to me as a last resort and are basically asking for surgery and if ai suggested it it would happen. You have what sounds like multiple sites of random areas of this sensation which is different. Again, I do not know what it is, but fat pat atrophy (FPA) is a possibility, but very unlikely. FPA would manifest on a 5 hour run with plantar pain and not a trail related occasional root or rock landing and is basically rare. Tight foot muscles is also a possibility (again, I doubt it, and there you could do some plantar fascial stretching is you want and just see what happens. My best advice is keep running and as they say in New Jersey, “fuggetaboutit”.
Some smart person could comment that it is your shoes, but I have two good reasons why not. First, you sound like a serious, knowledgeable runner who knows shoes, so no advice there sister. Second, both feet should feel this sensation if shoes were the root cause.
Finally, if it is something brewing (I doubt it!) and slowly gets worse, the symptoms would eventually be more defined and make a diagnosis easier. On the other hand, I do not know how long you have stretched. A year? But if shorter, the right foot may pass with continued stretching. I hope so.
So, it is OK to run as you are doing based on what you have said. Relax out there and keep it up. Please tell others about the AngryOrthopod.
Stay healthy my friends,
AO
Thanks a lot!
My pleasure.
Thank you; you give me hope! My doctor told me to “relieve” my foot for six weeks and not run. He also recommend Hoka one one Bondi shoes with a met pad to “relieve” the foot as much as possible. He also told me to wear trainers/sneakers with a lot of cushioning both outside and inside. The last three weeks I have run 2-3 times in wet “bog” in the forest. Hoka one one is great for longer runs on hard surfaces like asphalt.
After nine days with even more than 3 x 3 minuts calf stretching, I recognize less “pins and needles” and “nerve sensations”. I hope and dream of long distance running again. Maybe one day…
Hi
Thanks for the informative answer I received.
I have a few more questions for you that I hope you have the opportunity to answer:
1. How many months do you think it takes to get rid of MN and synovitis with stretching every day 3 x 3 minutes as you recommend? Some days I stretch 6 x 3 minutes. Will the vast majority get well again? I need hope and faith that I will be completely well again 🙂
2. Is it OK to run? Will not running prolong the duration of the “injury”? I’m starting to run a bit again. It goes relatively well on even ground. On paths with roots and stones it does not go so well. Pins and needles…
Hi Helen,
I am going to be nothing but positive. Sight unseen the odds of you getting over this completely are over 90%. For synovitis, there are two timeframes for recovery. The first phase takes from 6-12 weeks to get to the point where you know it is “about “ gone. But, there is a feeling in the background like it will come back. Continue to stretch and stay away from barefoot on hard floors and running unless it agrees with you. Phase 2 takes several months where the problem finally returns to “normal”, it is gone. Really!
I like your analysis of running in question 2. Just take it as you can. The thing to avoid is a trend over time of it getting worse. A run today that flares it just a bit only to be back the next day where it was rerun is OK.
It sounds to me like you are on your way.
Stay healthy my friends,
AO
I’m 48F and was diagnosed with Morton’s Neuroma in my left foot. I have no idea what caused it as I do not wear heels or run. I do go to the gym and am fairly active — or I was. Quite some time ago I noticed the feeling of a marble when I stepped barefoot into the shower. No pain and I couldn’t feel it with shoes on. Over time it grew sensitive and recently became very painful. I saw a podiatrist two weeks ago and he confirmed it was a MN. He gave me a steroid shot (WOW that hurt.) My foot was so angry for 3-4 days and I couldn’t walk at all! I thought the shot might have helped because it seemed to be a bit better, but the past few days it seems to hurt just as much as before. I go back to the doc in 2 weeks. I’ve been doing some foot exercises, icing, massage, got wider shoes, gel pads, toe separators , toe socks, and I just started your calf stretches. I know it takes time, but I’m hoping to see some improvement soon. Just so defeated and depressed!
Hi Melani,
Angry, angry, angry! I am angry because of your despair. It is almost impossible to explain to someone how debilitating and depressing foot problems can be. They don’t understand unless they have walked in your shoes.
Let’s start off by saying you may have a Morton’s neuroma, but it really does not matter. I hate to keep singing the same old tune (stretch calves), but I do so because it is right. Let’s assume this is a Morton’s neuroma. As far as how you got this I would say all the traditional/status quo alleged causes (heels, tight shoes, running, etc.) are completely wrong. I drank that Kool-Aid for at least half of my career. I even wrote a seminal article on the subject. Then, by a reverse process, observation, I discovered the root cause, equinus, by more or less serendipity. I have commented here on this before.
To my great surprise, I discovered the root cause of Morton’s neuromas as I listened to the stories my patients were telling me, or more often calling to cancel the next appointment gladly telling my staff why they were not returning. So, the story goes that on many occasions as I would be treating one foot, for plantar fasciitis for instance, and they had a Morton’s neuroma on the opposite foot or even the same foot. Keep in mind that my treatment plan for each issue was completely different. The plantar fasciitis treatment plan was just calf stretching knowing it almost always worked as long as the patient actually stretched. At the same time, my plan for the Morton’s neuroma was the standard fare of met pads, wider shoes, and in time a possible cortisone injection or two and eventually surgery. Over time I made routine observations that these patients resolved their plantar fasciitis problem as expected, but their Morton’s neuroma resolved as well. Know this, Morton’s neuromas rarely resolve using the standard playbook and the majority (>50%) go on to surgery, bummer, right? In no way did I see this coming and I was resistant to this unlikely cause and effect until the anecdotal evidence was undeniable. Once this discovery stuck, I started treating my Morton’s neuroma patients with stretching as the definitive treatment and the results were stunning at greater than 85-90% achieving resolution. I went from 30+ Morton’s neuroma surgeries per year to 3 or less over the last 10 years after this light went on for me. How cool is that for you, the patient?
Stay healthy my friends,
AO
dear sir/ Mrs
i suffer from forfoot supinatus in my right foot as well as mortons neuroma in my right foot
stretching and yoga toes are helping my neuroma however my forefoot varus is terrible
and all the orthotics i have tried are not comfortable and not helping this issue a lot
is this condition fixable ? and what can be please done to correct it
i have a picture of my footprint but cannot attach it here
thank you
Hi Gilbert,
I saw your Harris foot mat print you sent and it looks pretty normal. This means your foot structure is probably reasonably normal as well. I would turn your focus away from forefoot varus, Likely you were told this, and focus on calf stretching, which you say is working. As far as orthotics, they create more pain (temporary, gone as soon as you remove them) than they help. But they make someone a lot of money and a lot of docs genuinely think they are a good solution for many foot and ankle problems. They are not! Get back to us after you have stretched for 3 months and let us know how you are doing. Your CRPS mentioned in another comment is another issue altogether sir. Answer for that coupled with comment.
Stay healthy my friends,
AO