Saturday, January 16, 2016

The Curious Tale of Morton’s Neuroma, Pt. I

In June of 2013, more than two years ago, anyone reading this blog for ideas on how to beat knee pain would have been astounded to see me in person. I was a mess -- a limping mess. At the time, I thought (my dark sense of humor) that if someone posted a video of me walking on YouTube, sales of Saving My Knees would evaporate overnight.

But it wasn’t my knees.

It was my right foot.

Here’s the narrative of what happened (which, during a search for a cure, I later repeated to three different podiatrists).

One Saturday morning in mid-June, I went for my usual grueling bike ride of 45 miles or so. That afternoon, about five hours after I climbed off the bike, I got out of a chair in my apartment and began limping. Right out of the blue. It felt like I had pulled a little muscle in the ball of my foot. I remember shrugging and thinking, “Ah, just walk it off.”

But the nagging little injury persisted. Over the next week, it got better, but didn’t go away. Then, the following weekend, I made what turned out to be a huge blunder. I was house hunting and ended up walking for hours, checking out homes and neighborhoods in a town we were thinking of moving to. The next morning, my foot was really hurting. I was limping badly.

Now let’s fast forward about six months, or this will get really long.

The foot still hurt, though the pain had subsided to an occasional numbness/soreness. During the summer, I had taken a month or so off from cycling (I should’ve taken a few months, right after the initial incident, but I was dumb in that macho male way). I had experimented with a few things, at one point even taping a partly inflated balloon to the bottom of my foot for relief (this actually wasn’t a bad idea, but I never found a balloon made of sturdy-enough material to avoid popping). Still, I had that numb feeling in the ball of my right foot that came and went, as if I were walking on a bunched-up sock.

So I went to see a podiatrist.

He checked me out, did an ultrasound, pointed to a shape on the scan and said, “There, you have a Morton’s neuroma.”

A what?, I’m thinking.

It turns out that Morton’s neuroma refers to a nerve in the ball of the foot that develops a bunch of scar tissue around it after chronic irritation. A numb feeling in the bottom of the foot is a typical symptom. Depressingly, once you have a neuroma, you always have it. It doesn’t magically vanish if you stay off the foot for a month or two.

I let the podiatrist shoot cortisone into the area (not without some reluctance, I might add). The cortisone did little good. So at this point I had a bad foot and cortisone residue in my joint. Great.

Of course by then I was reading a lot about Morton’s neuromas online. That led me to observe some oddities about my “neuroma.”

* A typical Morton’s neuroma (in fact, one podiatrist online claimed the only true Morton’s neuroma) occurs between the third and fourth toe joints. Mine was between the second and third.

* The same online podiatrist said a Morton’s neuroma is never the result of injury. I was pretty sure my condition was, even if it wasn’t a dramatic, foot-caught-in-the-door type of injury.

* This podiatrist also said a Morton’s neuroma becomes apparent very slowly, over months to years. My symptoms manifested themselves rather quickly.

* He maintained as well that a Morton’s neuroma is never accompanied by swelling. But at one point, a podiatrist observed swelling in my painful foot.

Had this been Me before my ordeal in Saving My Knees, I probably would have just gotten my three recommended cortisone shots, spaced weeks apart, then scheduled surgery to extract the nerve (the only permanent solution) when they failed (which I suspect they would have).

Instead, as a smarter patient who knows doctors can sometimes be wrong, I wound up seeing two other podiatrists.

#2 didn’t think it was a Morton’s neuroma and put me in a boot, which helped a lot. But, as luck would have it, she wasn’t in my PPO network, so I chose not to see her again. Some months later, still hurting, I saw #3. He didn’t think it was a Morton’s neuroma either, and ordered an MRI, which came back clean. The next time I saw him, he greeted me, looked at the test results, and changed his mind, telling me, “You have a neuroma!”

Argh. So I really did have a neuroma?

I began mentally preparing myself for some kind of surgery (I was leaning toward cryosurgery). In the meantime, I decided to try my hardest to beat this thing. I bought wide, well-padded shoes and Crocs to wear. I also bought a roll of Neoprene padding to cut out inserts for my shoes, for even more cushioning. I cut a slit in the side of my right cycling shoe, to give my foot more freedom.

I did more stuff, but I’ll spare you the details, as this post has already gotten really long.

The critical thing you need to know: My foot got better. It feels pretty much normal again.

So my neuroma healed?

I don’t think so. I don’t think I had a neuroma in the first place, or if I did, it wasn’t the primary issue.

If you’ve read this far, you’ll want to come back for Part II in a couple of weeks. I’ll explain what I learned about Morton’s neuroma. And, in doing so, I’ll tell you why Morton’s neuroma is almost certainly one of the most overdiagnosed conditions in podiatry offices everywhere.


  1. Hi Richard

    Thank you for this blog. It's very helpful for everyone who suffers from knee problems. Your story is very encouraging.

    Recently I've found interesting discussion on ReserchGate about spontaneous cartilage regeneration, take a look:

    Sorry for any mistakes, english is not my native language.

    Best regards

    1. Thanks for the link, Paul. Interesting discussion in the comment section. I'm not quite clear on the procedure that the doctor is advocating, but glad to see someone in the field is optimistic about cartilage healing.

    2. Really interesting, thanks for sharing! Hopefully more and more doctors realize that there is hope and that cartilage can heal. How come are we going to have a tissue inside our body that is dead/inert? That is not possible. Cartilage can heal. Slowly. Very slowly. We need to find what's the key for healing, or for speeding up the healing a bit more. What to do? For sure it's not gonna be sitting on a chair for more than 8 hours a day... Our body is meant for movement.

  2. Hi Richard,

    I always look forward to your posts. They are informative, entertaining and eloquently written. I too have been having trouble with my feet (&still struggling with knee pain). I'm convinced I have a pinched nerve near the arch of my foot (medial plantar nerve entrapment) and I'm convinced it was caused by my orthotics (I quite wearing them!) and the weakening of foot muscles caused by those orthotics. Every health professional I've seen says its plantar fasciltis which I've researched extensively and the symptoms just don't add up. In my experience, health professionals are wrong more than they are right.

    Oddly enough, I can no longer wear shoes that have lots and lots of support, it puts pressure on that area! I can't sit for long periods of time in a low to the ground car either, the way I sit puts pressure on a nerve supply somewhere triggering the pain in my feet. I feel it is another example of why knee pain suffers need to focus on KNEES and not everything else. I wish our health professionals did this.

    As for my knees, I've been in a major set back for about 3 months. I tried introducing cycling - 6mins at level 1, slow and controlled and I've had horrible pain ever since.

    Hope everyone is winning their fight.


    1. Hi Alex,

      Sorry to hear about your set back. That's a long time to have to endure one. Are you still working with your coach? What are they saying about it?

      Keep moving forward, you'll get through it.


    2. Yeah, sorry to hear of that setback, Alex -- sounds like a bad one too. If you're still working with one of the Sports Center coaches, I'd be interested in hearing what they suggest.

  3. Good luck with the foot Richard! It is encouraging to read your stories of perseverance in trying to find what's wrong.

    Alex, sorry to hear about the set back, sounds like your knees are telling you to stay off the cycling...

    I wanted to share some good news.. Ever since I read Richard's book and some blog posts here, that is last October, I've made strides with my knee. I began with a "long term" plan like everyone here was recommending. It consisted of different experiments in exercises from the runner knee bible book and in walks at the local park. It has been 4 months now and my whole outlook on the knee issue has changed. My life has changed you could say :-) I began to walk in the park every day, and at first was dismayed with how little I could do without pain (around a mile) Soon things began to change.. I was doing 2 miles 2-3 times a week. I would park the car at the park.. walk through the park to the gym work out the upper body, abs etc and walk back to the car.. about 2.1 miles total. Some days I would do a big loop in the park.. about 2.4 miles and amazingly the walks got a lot easier and a lot more pain free. It does take careful attention to the distance (I measure my steps) the pace etc to track progress and figure out what caused pain, if there was pain afterwards. I learned to "listen to my knee" as described in the book... this means I can pretty much tell now when walking when I need to cut it short, with the result that I feel no or minimal pain the next day.

    The walking has changed my life, first of all it has changed my outlook on the knee issue. I had to get used to people 20 years my senior jogging by me as I walked on the path.. (it's OK I survived!) Then I found out the regular walks made me feel better emotionally and mentally as well. To complement the walking I do core exercises at home 2-3 times a week and upper body at the gym once a week. I feel better and I see slow, incremental improvement in the distances I can walk.

    I even began a very very slow "jog" as an experiment, and quickly learned the limits of this new activity.. I can now slow jog (walk-jog you could call it) about a 1/4 mile, and I have been making progress there as well. I do this on the softest surface I can find: wood chip trail, or grass, or light snow, to help soften impact. It is a very slow jog indeed... but it is certainly more than a walk! It contiunes to amaze me how my knee keeps adjusting to all the activity. The progress is slow, but I can tell by the decreased pain, and ability to go longer distances and do so more times during the week. All this takes more time than I am used to giving to physical activity but the rewards have been wonderful not just for the knee but improved self-esteem and less stress. I found the walking and gym to be most effective, and discontinued the running bible exercises. My next plan is to introduce some exercises on the leg press machine (I have already begun)

    I am just in a different place, since my knee issues began 7 years ago. Like someone wrote on here, primarily it was a change of mindset concerning what physical exercise means for me. I am willing to accept that it is much much less than what I was doing 7 years ago and move on. I believe the knee will continue to slowly improve.. and who knows one day maybe even grow strong enough to do new activities...

    1. This is great, FrTom. It really sounds like you made the mental adjustment to the "go slow" program very well -- that's usually one of the hardest things for people.

    2. The walking has changed my life, first of all it has changed my outlook on the knee issue. I had to get used to people 20 years my senior jogging by me as I walked on the path.. (it's OK I survived!) Then I found out the regular walks made me feel better emotionally and mentally as well. To complement the walking I do core exercises at home 2-3 times a week and upper body at the gym once a week. I feel better and I see slow, incremental improvement in the distances I can walk.

      ..... I could have written this! I started to actually enjoy walking slower. After all, I had no choice so I might as well make the most of it.
      Eventually, I realised I was walking that tad bit faster, with no pain. But sometimes, I will just slow down, even if there is no pain, for the sheer joy of walking through a nice scenery at a leisure pace. There, I'm ready for the retirement home with a daily shuffle in the park, lol

      I must thank the person who posted here about the TENS machine. This has been an amazing help. I still use it from time to time when I have ligaments and tendons tenderness around the knee, and it works wonder

    3. The TENS is great. Pretty sure it does not heal damaged cartilage but certainly helps me with pain relief and relaxing the joint. After not using it for months, I've had to a few times after a bit of an Xmas setback. I'm also finding wearing Thermoskin knee sleeves help keep the knees warm and feeling more robust. I'll have to stay away from cycling and jogging again for a while, after starting to re-introduce them late last year. I probably went too hard too soon, and combined with gym leg work, it was all too much. Let the pain subside (which it does more quickly these days) and build more slowly.

  4. Hey guys, congrats on the recovery! currently I have pain after only about 400-500 steps. So I do about 400 steps every hour or so. Also, I am experimenting with Runners Bible exercises. It has been a month since I started implementing SavingsMyKnees and Runner's Bible suggestions. However, I haven't noticed too much improvement. But I am hopeful that I will see some progress soon! Were you guys in similar situations before? If so, was walking the key to improvement for you or the exercises (sliders, light squats, quad strengthening)? Did shoes matter too much? I think I have more pain walking outside than at home. I will give the TENS a shot, any particular one you guys recommend?

  5. also, where are the TENS patches usually placed? on the knee, on the quad?

    1. capojay, I put the TENS pads on either side of my kneecap and a little below centre. The brand I have is called 'Comffit', my physio sold it to me for $AU125. A set of 4 pads cost $AU10 and last for a few months if you don't get oil etc on them. So with my setup I can do both knees at once (2 pads per knee). I don't believe the TENS is a cure, but if you have constant burning/aching pain like I did/do, it provided glorious relief.

      One month is nowhere near enough time to see improvement. It took me at least 2yrs of just walking, swimming with no kicking, stretching, TENS machine, PRP injections and avoiding other aggravators before I got any improvement. And even now nearly 4yrs on, I'm still only 50-70% better.

      However, I could walk for 3000+ steps OK, in fact my knees seemed to like walking, as long as it was fairly flat and not too fast. Shoes did not matter, though I bought some Hoka's which I really like. But I've walked in everything from minimalist Nike Frees to my old Brooks Trance racing shoes which have lots of padding and heel drop and can't tell the difference if just walking (running however is another matter).

      As for the Kelsey etc. exercises, I started trying sliders the other day and boy did they send me backwards fast! The only things of his I could do were tailgaters, quad sets (tensing) and the less than full body weight Total Trainer squats (though I use a rowing machine with a sliding seat and prop it up on a box to increase resistance).

      In my observation, it can be a very long road, and while you can get good clues from books etc, there is a large element of trial and error and working out what works for you. Everyday activities (e.g. housework) can add to the knee stress, even if you are doing everything else right.

      This whole process makes triathlon look like a kids tea party, but there are enough examples out there of people who have won the battle (and people who have lost badly by opting for surgery) to give me hope ansd keep plodding the path.

    2. TriAgain,

      What sort of problems did you start seeing when you did the sliders? I'm asking because I'm working with a coach and that's a regular part of the routine. I will admit that sometimes I feel like they don't do me many favors either, but I'm putting my trust in them and doing what they suggest. So far it's been better than my previous pt. I started on level 3 on a total trainer and so far I'm up to 7 (about 50%body weight according to the manual) after my appointment today. Been working with them since early december, so I'm fairly happy with that progress, but my knees have a long way to go yet.

    3. My old symptoms started coming back with sliders - increased burning/stiffness under kneecaps.

      However, it may have been a combination of things as over that period I'd also introduced a little cycling and jogging, plus there were more stairs than usual involved. However, after 2 sessions of sliders, I def felt increased pain levels.

      So now I'm just sticking to things that I know don't increase my problems, let it all settle, then gradually re-introduce things and see what I can handle/what I can't. Could take a few months.

    4. Tri, I just ordered a TENS machine, should be here in about a week, we'll see how it works out for me. Thanks for the suggestion. I did 500+500 steps three times today. It felt pretty good. Also, I've been using this Sonoid massager on my knees afterward the walk, so far my knees seem okay.

      When you talk to "sliders", do you mean sit on a chair and slide your feet on a furniture mover? Just want to make sure we are talking about the same "sliders".

      Have you done your MRI yet? What is the problem with your knee?

    5. capojay, my last response disappeared.

      Sliders are the standing back sliders in Kelseys book, like a backward lunge holding cords.

      I've not had an MRI in 4yrs since my meniscus surgery. Previous MRIs showed chondromalacia patella mostly in R knee but it was L knee which had meniscus tear trimmed and OS said everything else in there looked good. But meniscus surgery triggered pain in BOTH knees (loss of tissue homeostasis as described by Dr Dye I believe, but probably also caused by other factors).