When are x-rays useful for a runner with a Morton’s neuroma? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Let’s say you’re out on a run and you start getting some aching pain in the ball of the foot. It persists for a while. It’s not really that bad, it’s not killing you, but it starts to bother you more and more over the course of a few weeks. And so you go see a podiatrist and the podiatrist tells you that he thinks you have something called a Morton’s neuroma.
So he does an x-ray of your foot and what do you see? Well, nothing. Why? Because there’s soft tissue injury when you have a Morton’s neuroma and what shows up on x-rays is actually the bones, not the soft tissue. So if you’re there and you know that, you’ve read about it before you go in to see the doctor, you might be scratching your head when they first recommend x-rays of your foot. And you would be right to think about that.
Do you really need the expense? Do you really need the radiation? Probably not. But there are times when you actually can have x-rays that could be contributing to a neuroma that might show up on that x-ray. What am I talking about? Well, let’s say you’re a runner and you actually developed a subtle stress fracture, maybe of the fourth metatarsal. And what can happen is that in the healing of that stress fracture, the skinny little shaft of the bone actually gets a bulge in it, and that bulge can push against the nerve that actually causes a Morton’s neuroma.
Now that’s obviously useful information if you have a Morton’s neuroma. If you’re getting mechanical irritation in the nerve, you’ve got to stop it. And sometimes if you have what is a true non-union where you actually crack the bone but you didn’t realize it because you’re a runner and you’re tough and you have a high pain threshold and you keep running on it and there’s a lot of motion at the stress fracture, it can actually develop a very large bone callous or a huge bulge in the bone. And that bulge can push on the nerves that run right between those metatarsal bones as it heads out to your toes.
So if your doctor recommends x-rays, it’s not completely out of the question, it’s not crazy. It’s just one option. If your doctor’s really trying to figure out why it is that you’re having this pain in your foot that is suspected to be a neuroma, but could be contributing or caused by a bulge in the bone, like if you’ve had an undiagnosed stress fracture even from a long time ago, even if it’s completely healed, it’s a great question.
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