A Tale of Two Podiatrists: Relieving A Runner’s Morton’s Neuroma

I had a sudden onset of Morton’s Neuroma a few weeks before the Boston Marathon last year. Not even sure it was from running – could have also been too many hours and miles in those damn European-style, pointy-toed dress shoes on tradeshow floors and airports – but no matter how I got it, I got it. I didn’t know it was Morton’s at first – never had anything like it. I was running a short, easy-pace taper run and got this weird sensation in my foot, like my sock was pulling up between my third and fourth toes on my right foot, tighter and tighter until, ouch, I actually stopped and checked it and re-laced my shoe. Dull ache evolved into sharp ache and by the next morning the top of my foot was bruised and sore. Stress fracture, I thought, panicking and then moving quickly to resignation. There goes Boston. There goes my hope of a sub-three-hour run. There goes 16 weeks of the best training I’d ever done.

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Here’s an example of a homemade met pad – I carved it out of an old insole. I was experimenting to see if I could get something to the exactly perfect height and shape. The pad is set just before the metatarsal heads, and helps lift and spread the bones so the nerve doesn’t pinch.

A surgeon friend talked me off the ledge and helped figure out the problem. It got well enough so I could run on it, and being confident it wasn’t a fracture, I did. By the end of the race it hurt like the dickens, I got my goal time. It turned out my neuroma, and my happy race time for that matter, were small concerns in the grand scheme of that terrible day.

Flash forward past a post-marathon doctor’s appointment where Morton’s was formally diagnosed, cortisone shot administered, some relief felt, on through summer travel, work and running, and the return with a vengeance of the problem, and then on through the build-up to my fall 50 miler, the week before which, in New York for work, I could barely walk on that foot. Each step would send what felt like a painful electric shock through my third and fourth toes, and the ball of my foot felt like a ball of fire. I’d been tapering, and that week wasn’t running at all, and it was still getting worse.

Morton’s is a swollen nerve, or a nerve encased in scar tissue, between the 3rd and 4th metatarsals. Narrow shoes can bring it on, or high heels (I do not spend a lot of time in high heels). In trying to alleviate it I ended up realizing my running shoes were about a size and half to small. All those years of pounding must have widened my feet. I stopped wearing my narrow dress shoes and went to a wide toed loafer for work. And I mastered all sorts of ingenious metatarsal pad placements, including, for races and long runs, a self-constructed custom pad carved from old insoles applied directly to my foot with kinesio tape. Oddly, this made it possible for me to run without much pain. Walking hurt, though.

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Here’s a look at one version of a tape job I did before a race. Not the prettiest thing to look at, but it got me through running as the pacer for the 3:30 group at the Baystate Marathon. The pad is set just before the metatarsal heads, and helps lift and spread the bones so the nerve doesn’t pinch.

I ran the 50 miler and after, finally, went to see the podiatrist my doctor had referred me to.

Worst patient-doctor fit ever.  She didn’t ask any of my history (running, work, tradeshow floors and airports, shoe choices). Didn’t ask me to stand up once during the exam to see how I was on my feet, didn’t want to see gait. She felt my foot, said yes it was Morton’s and then sighed and suggested I had a lot of nerve complaining about it after all that running. My options would be a series of cortisone shots, and if that didn’t work, which it might not, surgery. Oh, and expensive orthotics.

Anyway, I left with a brochure on Morton’s and a sour taste in my mouth. And what’s this – right in the brochure handed me by this doctor, a third way! Alcohol sclerosing injections. Why hadn’t she mentioned this? And why had my being a runner seemed to piss her off so much? Maybe running’s hard on the feet, but so is being overweight and sedentary. I had more foot and ankle pain just from walking around when I was weighing in at 220 pounds than I do now.

I canceled the follow-up appointment and for the first time ever got back in touch with my primary care doctor (a wonderful, amazing doc) and asked for a different referral. This was tough – I’m the kind of guy who doesn’t like to send a plate back in a restaurant, I sure don’t want to condemn a doctor’s referral.  My doc, an endurance athlete himself, immediately had a replacement to suggest.

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One way I got some relief was to take a pair of older running shoes and slice the sides as shown here. These doesn’t seem to have a negative impact on the structure of the shoe.

A few months pass, and I have my first appointment with the new guy. Bearded, amiable and curious. First appointment, he wants to see me stand, walk. Wants to talk about running. Very concerned to get this fixed in a way that will accommodate my training schedule. He has run, played sports, helped train marathoners.

I have always considered my cycle and ski-racing GP to be the perfect doctor for me. A few years ago, I saw him about a particularly acute pain before a big race. I wanted to know if I could run, or if it would cause significant long term damage. Given the nature of the pain, he replied, oh, you can run. It’s going to hurt a lot, and it will take longer to heal afterward, but if this race is something you really want to do, you can run.

Anyhow this podiatrist is the same deal. A good fit.

And for those of you runners with Morton’s who might have ended up here hoping for some relief, here’s his prescription, which I trust for the aforementioned reasons.

Cortisone shots are yesterday, he said. We don’t do those anymore. The non-surgical, non-orthotics answer is alcohol nerve sclerosing injections. This is an alcohol solution injected directly into the foot near the nerve. The point is to stop the ability of the nerve to transmit pain. After almost a year of searing foot pain, that sounded quite nice. Do you want to start today, he asked? Heck yeah, I said!

There will be a series of five injections over the next few months. For the first one, he warned, this is going to hurt. Meh. After so many months of so much pain in that foot, it wasn’t even wince-worthy. But the immediate after-effect was amazing.

No pain. It was like my I’d never had the neuroma. It probably wouldn’t last, he warned. But over the course of the five shots, the pain free sensation would be longer and longer, until at some point during the course, permanent. Hopefully. Die nerve. There is always some percentage chance that it won’t work, but we’re optimistic. That night, my toes felt numb. The next day, pain free. The day after that, a bit of the sensation returned, but no real pain. It seems to be working.

And that’s where I’ll leave you. Updates to come as the treatment continues, but I’d like to believe that I’ve finally found the guy who is going to fix this thing.

If you have wrestled with this condition and found solutions, or have a story to share, please do in the comments section! I’d love to hear from other runners who beat this.

RELATED: Positive results of injection therapy: http://www.ajronline.org/doi/full/10.2214/AJR.06.1463