Morton's Neuroma

I seem to have a Morton's neuroma beteween my third & fourth toes. I get a sharp burning pain after I have been running over an hour which is relieved by removing my shoe. Narrow shoes or those with a curved last also cause a similar pain. I can also feel it, even in wide, flat shoes. I've entered the Dublin Marathon in October and I want to try the most conservative treatments first.

I've tried off-the-peg podiatric treatments such as orthotics and metatarsal pads but these, if anything, irritate rather than help. I'm now left with either steriod injections or surgery. Does anyone out there have any experience of either treatment?

I've also heard that there is a newish technique of cryogenic ablation which freezes the neuroma to death rather than excises it. However, this seems to be rare in the UK but common in the USA. Anyone have any experience of this?

I've been to see my G.P. and at the moment I'm waiting for an orthopeadic appointment for ultrasound examination and hopefully steriod injections.

You 'seem to have'?

Is this an actual diagnosis or just you and your doc scratching your heads about what it could be?

I only say this because when I had my metatarsal stress fracture, there was a lot of bouncing around of terms and conditions - the doctor - even the bone specialist were not entirely sure what was going on.

I have had cortisone injections 2 weeks ago for what was suspected Mortons Neuroma but the scan showed inflammation in the toe joints. I had similar pain to what you described and shooting pains in my toes also. I took 10 days off running (was advised to take a week) and have done about 20 miles this week with no pain.  So far so good.

All the best.

After 2 years of slow GP referrals and increasingly bad pain I had a Morton's Neuroma removed from one foot. Then 6 months later had the other one done. When I was eventually referred to the right person, he immediately identified exactly where and what the pain was, sent me for an ultrasound scan which confirmed it and when he'd removed it said it was very big for a neuroma like a large chick-pea, I guess cos I'd had it so long with no effective treatment.

That was 12 years ago. I still very occasionally get phantom pains when it's very cold. As the surgeon removed the damaged nerve I know it is just phantom pain, not actute at all, and it doesn't last long.

I didn't think of this at the time, but now I reckon over-pronation probably exacerbated it. And in my case that's caused to a large extent by hip instability and a weak core. I reckon if I'd worked on them, I might not have developed the neuroma and I could have avoided surgery altogether.

Ian, any news of when your ultrasound is?

Ian,

1. steroid injections are useful but they need to be ultrasound guided. You will also need to find some one that is experienced in ultrasound diagnosis and also that is experienced in administering the steroid injection. The outcome of injections can be very variable so be warned.  You need to make sure that you have got a neuroma and not a stress fracture.

2. Forget crysosurgery abolition it's an new and as yet relatively untried method and once again you need a specialist who is practiced in this procedure. The problem is again guided the cryoprobe to the neuroma.  Several foot surgeons who I know do not use this method. 

3.  Orthotics should with a little luck clear your symptoms. But it's dependent upon the size of the neuroma. Its a space occupying leison which gets larger as the years go by. The larger the nerve becomes the harder it is to alleviate or cure the symptoms. Excessive pronation can cause neuroma but is not always the cause. You need a definitive diagnosis as to the causative factors.

4. Surgery is the last option, but neuroma recurrence can happen, a phenomen known as stump neuroma. 

Hope this humble message helps!

Thanks playmates. I've got an appointment with an orthopaedic surgeon on the 10th of August.

 The point about ultrasound and a proper diagnosis is well made. The reason why I think its not a metatarsal stress fracture is that it doesn't hurt the day after. So I can run but it gets sore after about an hour. Having said that, it's been gettiing better spontainiously of late. The majic effect of an appointment I suppose.

I was also very interested in the point about over pronation. I have some external rotation in both lower limbs and so tend to over pronate somewhat. I've always coped with this by buying shoes wiht stability features (Asics Kayanos). More recently, I've saved a few quid by buying Asics 20somthing or others. Maybe I needed the stability thing more than I thought...

Thanks for the advice about cryogenic doo dah. Hopefully, a proper ultrasound guided steroid injection should see me right and a move back to Kayanos... Failing that I'll take up snooker and accept that I'm an old git.

Ian,

2 things :-

1. If you have neuroma surgery do not have a plantar incision as this can cause a hypertrophic scar,

2. External rotation does not cause excessive pronation, it usually generates Supination so you may just want to get your shoes checked out as it may be these aggrevating your forefoot.

just some thoughts.....

Well, I had the appointment. I don't think it was that useful really. The orthopaedic surgeon said that he didn't do steroid injections as the evidence for their effectiveness was weak and it makes it more difficult when he does have to operate (didn't say why). So, it's surgery or nothing. At the moment the pain seems to have eased off. I did 16m on Sunday with no problems. I can phone up and arrange for the surgery anytime in the next six months or just see whether I can do without. I'll see if I can get through the Dublin marathon OK first and maybe then...

 I've no way of knowing whether a different surgeon would have taken another view. Ultrasound examination was never offered. I was X-rayed but I suppose that was just to rule out anything else (or just to bump up the cost - it was a private hospital doing contract work for the NHS under an NHS logo). Call me cynical if you want.

I can recommend going to a good podiatrist and getting custom made orthotics. I suffered with Morton's Neuroma for years before taking advice and now I can run marathons because the orthotics I have take the weight off the neuroma. I wear orthotics in my normal shoes as well and I'm now pain free most of the time without the need of injections or surgery.

Got to be worth a try! Hope it works for you!