Today on the Doc On the Run Podcast, we’re talking about how you should not let Morton’s neuroma stop you from running.
Morton’s neuroma is a common cause of pain in the ball of the foot in runners.
Doctors often tell runners to stop running when when they get a neuroma. Sometimes doctors even tell runners they need surgery to remove the inflamed nerve.
But don’t be confused. Runners should always figure out how to keep running! This episode is inspired by Cathy, who sent a comment which all runners with Morton’s neuroma should find encouraging.
Today’s episode is short but it’s based on a comment sent in from a listener.
This comes from Cathy who wrote in and said,
“Hey, thanks for this article. I have “chronic Morton’s”. I am 60, still run, love it and deal with it. Yoga helps, wide shoes and determination. I’ve taken off my shoes and walked home in socks twice. It can be done.”
So Cathy, thanks for sending in your comment. I really appreciate it, and I think it’s important for people to realize that with most of these chronic, as you said, “chronic issues”, like Morton’s neuroma, one of the common things is that doctors will just tell you to stop running.
You have to figure out what works for you. There’s always some combination of treatments that will work for anyone who wants to run. You just have to figure out what that is.
Now there are lots of different options. You also have to remember that when it comes to chronic Morton’s Neuroma, the most common treatment that doctors will recommend to you is surgery, but surgery comes with problems.
One problem is that if you make an incision on the top of the foot to go down and take out the nerve, then we have to cut through this ligament called the inner metatarsal ligament, in order to get to the nerve to take it out. That can cause instability in your foot.
Now that sort of instability won’t normally hurt or harm or even become noticeable to most nonathletic patients because they’re not doing that much. But for runners, someone like you, someone who runs, someone who’s active, someone who thinks about their running form, who tries to figure out whether they can run more efficiently as a forefoot or midfoot striker instead of a heel striker, that instability may be really noticeable to you.
So that’s why I don’t really like taking out Morton’s neuromas surgically because we can cause some instability in your foot that just might be more noticeable to you, the runner, than it would be to the average patient.
I don’t work with average patients. I work with athletes, I work with runners, I work with triathletes and I like to run, and I understand the importance of you wanting to continue to run. Just like Cathy, she really wants to continue to run and she’s figured out a way to do it and she’s not letting this thing get in her way.
Now if have an incision on the bottom of the foot when you take out a Morton’s neuroma, that can cause a painful scar on the bottom of your foot. Obviously if you’re running and you develop a thick, painful scar, well, that’s not good either.
So if you take out the nerve from the bottom, you don’t have to cut through the inner metatarsal ligament and you don’t have to worry about any kind of stability issues in your foot, but you can wind up with a painful scar and that can be a real problem.
So don’t let any doctor push you into surgery right off the bat just because you have a “chronic Morton’s neuroma.” There are other options. It’s always better to try to figure out a nonsurgical solution instead of a surgical solution. Surgery comes with lots of risk and that risk is, I think, more significant for runners because you want to continue to run, so you have to do whatever’s best for you.
It may be that just doing some stretching, using wider shoes, really paying attention to your running form, trying to figure out what really aggravates it, like which particular surfaces.
Does it become more aggravated if you run on the right side of the street versus the left side of the street? Does it get more aggravated when you run on trails or on the road or on asphalt or on grass? Does it bother you more if you want to run the normal direction around the track instead of the other direction around the track? You can experiment with all of these things and try to figure out what is really aggravating the neuroma the most and then obviously don’t do that.
Sometimes custom orthotics will help, sometimes wider shoes or will help. Sometimes you can tape the toe to stabilize it. There’s always a combination of things that will help it feel better. You have to figure out what that is. If you can’t figure it out, if you cannot seem to get better and some doctor starts telling you you need to have surgery, keep in mind there’s still another option.
So one option is to inject it with cortisone and if you have a neuroma that’s new and it hasn’t been a chronic one, it hasn’t been around for many years, a cortisone injection sometimes can shrink down that swollen tissue in the nerve and make it feel a whole lot better and get it to improve and go away.
Sometimes that won’t work, but there’s still another option and that is alcohol sclerosing injections, where we actually inject a solution of 4% alcohol or 6% alcohol directly into the nerve, which causes the nerve basically to wither up and die away. Then you wind up with the same end result of surgery without having surgery so you don’t have any painful scar on the bottom of your foot, so don’t have any destabilization of your foot because you cut through the inner metatarsal ligament. You can get the same result with a whole lot less risk.
Again, it just depends on whether or not that’s even necessary for you. So you have to really think about what it is that aggravates the neuroma, what it is that makes it worse. Then you have to figure out how to modify it in some way so that you can keep running. Kathy figured out how to do that. If she can figure it out, so can you.
How can I tell if I really have a neuroma without seeing a doctor?
What are all the tricks Dr. Segler uses with elite athletes to keep them running?
When I started seeing runners with pain in the ball of the foot, I realized that a lot of them are losing their fitness unnecessarily.
Whenever I see a runner in person, I walk them through the diagnosis process and I actually show them how to figure out whether they have a plantar plate sprain or a neuroma or a stress fracture. Then I’ll just show them how to reduce the stress on that one injured structure so you can stay active and get back to running and not lose all your fitness.
After sitting down with individual runners over and over, guiding them through this process, I realized I could just put the same information in a video course and show you exactly how I do this so you can do the same thing right now in your own home.
Sign up for the Ball Of Foot Pain Course For Runners so you can get back to running.
If you have a question that you would like answered as a future edition the Doc On The Run Podcast, send it to me, and then make sure you join me in the next edition of the Doc On The Run Podcast. Thanks again for listening!