Saturday, September 17, 2011

Morton's Neuroma

Today, I saw my podiatrist, along with a bag of shoes, pedals, and foot beds.  After deep palpation of my 3rd inter-metatarsal spaces, which elicited a few whimpers, my doc said,  "I believe you have a Morton's neuroma in both feet.  I also had the classic gap sign between my third and fourth toes where the fibrotic nerve is so large it is pushing apart my metatarsal heads.

See the space between the 3rd and 4th piggies!

Radiographs ruled out any bony pathologies.  When he placed the ultrasound on the area of suspicion, he outlined the two neuromas.  Basically, the nerve that runs between the metatarsal heads is normally the size of angel hair pasta.  My neuromas, however, are the size of large green peas!  No wonder the pain was so intense!  

Doc then outlines different methods of treatment.  One is a series of 5 alcohol injections over 5 weeks to kill the nerve.  He sees a 50% success rate.  The other is surgical removal.  Two small incisions over the top of the foot, and cut out the offending portion of nerve. No real down time; I could be back on the bike the next day!  The only potential complication is a stump neuroma, which he said happens about 10% of the time.

For the short term, he injected the area with marcaine and dexamethasone, bringing about instant relief!  If you look closely at the picture above, you can see a needle mark on each foot at the 3rd inter-metatarsal space.  I love any doctor that can relieve pain without prescription drugs!

He agreed on all my methods of orthotic management with the wide toebox, the Specialized BG footpeds with the metatarsal bump, and the XTR pedals.  But he said that more than likely, until the neuroma is excised, I will have recurring episodes of pain.

He said the injections could help for 1 week, 1 month, 6 months, or maybe even a year.  We shall see, I guess.  But I am prepared to have those little bastards cut out if necessary.  As much as I am on my feet at work and on the bike when not, I will probably have to undergo the knife in the future.

Today was the first pain free day on the bike since TNGA.  I felt so good I almost cried!  I did not feel every friggin little bump and for once forgot about my feet.  I also tried out my modified Specialized MTB shoes.  I was able to move the cleats back 1 cm with the modification.

I was able to drill out the carbon sole and move the cleat plate further aft.

Riding my SS today, I really did not notice any difference in this new cleat position or power transfer.  It might be more noticeable when riding gears and staying in the saddle more.  I suspect I will have to make saddle adjustments and will defer to Eddie for that.

11 comments:

Teri Harker said...

Carey,
my name is Teri. I need your help. I saw your picture of your feet and mine look just like yours. However, i was diagnosed with what ends up as life threatening in the last stages. My metatarsals looks just like yours. they just appeared like that 3 weeks ago. I'm not saying you have what I have and you are misdiagnosed, I'm thinking I WAS MISDIAGNOSED. I need to talk to you please. do you have email? mine is tharker@cinmar.com. Please please contact me. thank you!!!! Teri

Anonymous said...

I too suffer from Morton's, especially when biking. Thanks for the tips! How long did the pain relief last from the shots??

Carey said...

The injection was only had a band aid effect ... about a week.

Journey of the big red mountain bike said...

How are your feet now??? I've just been diagnosed with Morton's but havent been told yet of my treatment, I have 2 in my right foot.
When you had the injections did you have to stop riding etc for any length of time??

Really enjoyed reading your blog :-)
Thanks for the advice and info
Kat

Journey of the big red mountain bike said...

How are your feet now??? I've just been diagnosed with Morton's but havent been told yet of my treatment, I have 2 in my right foot.
When you had the injections did you have to stop riding etc for any length of time??

Really enjoyed reading your blog :-)
Thanks for the advice and info
Kat

Carey said...

Kat,

Where the one has been removed is doing o.k. But the scar tissue from the surgery is causing some discomfort. Doc said the tissues can take up to a year to soften.

I am still having issues along the remainder of the balls of my feet: numbness, tingling, some dull pain, and an occasional mild electrical jolt.

I am trying to get in to see a specialist, but the going has been slow.

I only had one injections and it just helped for about two weeks. And no, I did not have to stop riding.

I need to make a follow up post to this foot adventure soon. I had been doing great up until about 1 month ago, when the metatarsalgia has come back with a vengeance.

At times, i just want to have my feet amputated and carbon fiber legs installed, complete with bike cleats! :)

Carey

Journey of the big red mountain bike said...

Hi Carey,
Thanks for sharing your experience. I had my first (x2) cortisone injections nearly 2 weeks ago, apart from the inital intence pain (hmmm no one tells you about that side affect do they!!!) I think its been pretty successful... fingers crossed, still bruised though and tender around the injection sites.

Love your idea about the carbon fiber legs and cleats!
Who needs to walk when you can bike!!!!

Thanks heaps!

Journey of the big red mountain bike said...

Hi Carey,
Thanks for sharing your experience. I had my first (x2) cortisone injections nearly 2 weeks ago, apart from the inital intence pain (hmmm no one tells you about that side affect do they!!!) I think its been pretty successful... fingers crossed, still bruised though and tender around the injection sites.

Love your idea about the carbon fiber legs and cleats!
Who needs to walk when you can bike!!!!

Thanks heaps!
Kat

Anonymous said...

Any updates? I'm learning this issue is thornier and more common than I'd thought.

Steve K. said...

Hi Carey. Sorry to comment on an older post but I was wondering if you had any updates regarding your neuromas? I was just diagnosed with them and the pain never goes away. I can't walk more than a block. Long story, but I kind of put my life on hold for 6 years to take care of my mom who was in the advanced stages of Alzheimer's Disease, and I was so focused on her I didn't take care of myself and I let the numbness and constant pain go on too long--almost 3 years. I got a referral to see a podiatrist but it will be some time before I can get an appointment. The only two things that have kept me going are Crocs loafers and metatarsal teardrop pads!

Hope you're doing better.

Carey Lowery said...

Steve,

2016 is the first year I have been able to take up running/jogging again. It has taken this long, but I thought I would never be able to run again.

Looking back on things, I am not sure if surgery was the right thing for me. But I was so eager to be rid of the pain, I jumped into it, but probably should have sought a second opinion.

After about a year of still having post op pain, I went and saw a foot/ankle surgeon. She was awesome and urged me to get custom footbeds. So I did. They were pricey, $275, but within 3 months of wearing them, my footpain started to diminish in both feet. (Remember, I just had surgery on my left foot). My doc said she would have started me in these had I seen her, instead of rushing into surgery.

It took 3 years of wearing them before I ever thought about trying to run again. While over those years I was able to ride longer and longer, it still was uncomfortable/some pain to walk barefoot in my house on the hardwood. During 2012-2015, I did some epic races where there was plenty of hike a bikes, and my feet did pretty well there.

I am happy to say I can run 3 miles without an issue. Granted, my feet are not 100% pain-free, but I guess you can say I have just reset the "normal" button, and now they feel normal.

I urge you to seek someone, be it a podiatrist or foot/ankle surgeon, who would steer you towards medical management first. You can always have surgery later.

Hope this helps!