Is it worth it to go to the podiatrist for a possible Morton's neuroma?
October 13, 2021 10:21 AM   Subscribe

Basically, had to stop running a mile into a four mile run yesterday because my third and fourth toes got really numb and then painful. Googled around last night and this seems to be pretty characteristic of a Morton's neuroma. This has been going on, on and off, for a few years, but for example today they feel 95% fine and there's no "pebble in my shoe" feeling, so it hasn't really occurred to me as a pattern until now. With good shoes, I only get the tingly/numb/pain sensations on especially long runs. Wondering if it kind of has to get worse for a doctor to be able to do more than say take it easy?

YANMD, but wondering if getting better shoes will be the sum total of their advice right now or if it's worth it to go in. My shoes definitely need to go and I probably need to take a few days off. But basically would a podiatrist be able to do much for me right now other than confirm and tell me to rest?

I am 26. As for why not go anyway, I have been doctored to death lately and don't really want to go through the hassle if it's a broken toe sort of situation. But I'll make an effort if something beyond common sense and Google could help here.

posted by clarinet to Health & Fitness (15 answers total) 2 users marked this as a favorite
I have this and got custom orthotics from a podiatrist in my late 20s which (combined with acupuncture which seems to help me) has kept it from getting worse. It flares up occasionally but mostly I don't notice it.

One of the main features of the orthotic is a metatarsal cushion, which you can buy separately.
posted by kbuxton at 10:29 AM on October 13

I had something like this last year, and it was not Morton’s Neuroma, FWIW. Apparently if it hurts when you squeeze your foot from the sides, it’s probably MN; otherwise probably not. Anyway I took it easy and stopped going barefoot in the house and it got better BUT I had a related problem (Achilles tendinitis) emerge this spring - maybe if I’d gone to PT last year I could have treated the underlying weakness that caused both problems and avoided the Achilles stuff? I mean, I probably couldn’t even have done PT last year because of the pandemic.

Anyway - I don’t know about a podiatrist but it might be worth seeing your GP/PCP and maybe getting a referral for physio.
posted by mskyle at 10:31 AM on October 13 [1 favorite]

I had this, it would happen after around a mile. Wearing wider sneakers completely eliminated it.
posted by mareli at 10:42 AM on October 13

If your shoes are trashed, I would get new shoes before going to a podiatrist. I also had issues with foot numbness off and on on longer runs (usually 1-3 miles in) and adjusting my lacing helped.
posted by MadamM at 11:40 AM on October 13 [1 favorite]

nthing that you may want to check the fit and fitness of your footware. Any time I get tingling in my middle toes it is directly attributable to wearing shows that are too narrow.
posted by slkinsey at 11:46 AM on October 13

Get different shoes.
posted by Oyéah at 1:58 PM on October 13

I have what fits all the symptoms of Morton's neuroma (numbness, tingling and feeling of a pebble under the foot) but wider shoes didn’t help. Orthodics were prescribed but didn’t do anything to elevate the issue. I have to admit that being home due to COVID over the last couple of years means I wasn’t wearing orthotics/shoes as often but I tried them repeatedly for running and didn't find enough relief to resume the activity (or distance walking).

The only thing I've found somewhat helpful is stretching the fascia several times a day over a block of wood or the edge of a stair tread. I'm late middle age, with nodules on the tendons of my hands and feet and a shortening of the tendons associated with that.
posted by brachiopod at 3:20 PM on October 13

I went to a podiatrist after my (suspected, then confirmed) diagnosis of Morton's neuroma from my GP and the option he offered was to inject the 70% ethanol into the nueroma. I took that option, there was a few more days of light pain post injection, and then I've never had an issue with it since. That was maybe 6 years ago? I was in my late 20s then.

Found a paper about it if you want to read more
posted by lizjohn at 3:47 PM on October 13

Many of my toes were going numb (and eventually painful) on long elliptical runs. I tried a bunch of different sneakers across multiple brands with some being better than others. Then I sized up a half size. That worked for a bit and then it started up again. I tried a few other shoes out. Then I sized up another half size (so a full size total from the start). That, finally, was the trick (so far anyway).
posted by vegartanipla at 5:56 PM on October 13

Ah, that type of pain happened to me, too. I thought it might be Morton's neuroma. I suffered for a few years and tried three different podiatrists over that time-period. First podiatrist automatically made me orthotic inserts. Didn't help. Second podiatrist automatically gave me a cortisone shot. Didn't help. Third podiatrist said, "Let's get you a diagnosis." She ordered an MRI, which showed I did not have Morton's neuroma. Turns out, I just needed shoes with a wider toe box. (She also prescribed some sort of analgesic gel, but I didn't like the smooshiness of it so I didn't use it, but just wearing toe-splay-friendly shoes solved the problem, so I didn't need the gel.) Wide toe box is different than wide shoes. It is the toe box that needs to be wide in order to allow for toe splay. Wide shoes are too wide for my heels, and they don't necessarily have the right toe-box shape (squarish rather than pointed-ish) that allows proper toe splay. Hoka running shoes were the answer. I never feel pain in my left foot anymore, and only sometimes feel mild pain in my right foot. Sadly, Hoka has changed the shape of their shoes. I think Topo shoes have the right type of toe box, though, so I might try those when my Hokas wear out (when I found out Hoka was changing the shape of their toe box, I bought enough pairs of the old style to last me a few years). p.s. I had to make sure ALL of my shoes have wide toe-boxes ... toes need to splay all day long to keep my feet pain-free.
posted by SageTrail at 9:46 PM on October 13

I got MN in my left foot in my 20's while pregnant. I saw a podiatrist when it had gotten really bad and did cortisone shots. He did X-rays to make sure there were no other problems. I tried to wear better shoes and took it easy (as much as a new mom can). This definitely helped for a while. Eventually, nothing helped and I had surgery to remove the nerve. I was given custom orthotics because he said it was very likely to happen in my right foot.

Flash forward a few decades and MN developed in my right foot but not nearly as bad. I am much better about wearing shoes to avoid flare-ups. You definitely want a wide-toe box. I am not a runner but do walk. Altra brand is highly recommended for people with MN because they are shaped like a foot with a wide toe box. I just bought my 2nd pair and it helps so much.
posted by maxg94 at 6:10 AM on October 14

Don’t trust podiatrists. They’re not doctors, and the don’t have to go to medical school. Don’t let them cut the nerve in your foot — they may say the operation has an 85% chance at success, but if you look at the actual research on this, you’ll see that the actual success rate (in terms of positive outcomes) is far, far lower. Don’t let them talk you into any of the “noninvasive” procedures like radiofrequency ablation — these procedures are plenty invasive, will damage your nerve for life, and you very well may wind up in worse shape then when you started.

Don’t, I repeat don’t trust podiatrists. They aren’t real doctors. See a real foot and ankle surgeon. I recommend the ones at Hospital for Special Surgery in Manhattan. Best ortho department in the country. They’ll give you the straight dope on the various surgeries and procedures. Be forewarned, surgeons are predisposed to “cut” things, because it’s their job. So do approach the conversation with skepticism. But they’re far less profit-driven then podiatrists, far less likely to misrepresent the success rate of the surgery, and they never push highly-profitable (but harmful) “non-invasive” procedures.

Morton’s neuroma is probably a con, and may not even exist. There’s no real definitive test for it. The “test” they are most likely to give you is where they squeeze your foot in a certain place, and if it hurts, they’re like, “yup, you got Morton’s neuroma.” You’re really going to let someone cut or burn your nerve based on that???

I went to a crooked podiatrist in NYC years ago who had hundreds of positive fake reviews on Yelp. He performed a “non-invasive” procedure (radiofrequency ablation) that ruined the nerve in my foot for life. It took me years to recover, and I’m still not 100%. I’ll never be. He took a mildly annoying problem and made if much much worse. For life.

My recommendation? Wear really wide shoes. Widest you can find. Like 6x wide. I recommend Drew Shoes. It’s the only thing that’s worked for me. Their shoes are a godsend. Also, they look nice and aren’t ugly as hell like most orthopedic shoes.

At very least, if you are considering the neurectomy or any of the “non-invasive” procedures, please do your research. Read some message boards where people talk about their outcomes. And for god’s sake, don’t trust podiatrists.
posted by panama joe at 6:30 AM on October 14

I had a similar problem and went to a well-regarded pedorthist (person who does shoe orthotics) who has her own shoe store. To boil it way down, she said: you want a wide toe box plus an insole or orthotic that gives metatarsal support (basically it's a little raised area underneath the place where you're having pain, it prevents the bones squishing together around the painful nerve). She recommended a few things, but Birkenstocks with their normal insole are the simplest and have worked well for me.
posted by LobsterMitten at 7:58 AM on October 14

I went down the ladder of recommended treatments for Morton’s Neuroma. Wider shoes. Custom orthotics. Injections. None of it ultimately worked. It got to the point that even walking around the grocery store was painful.

I was nervous to get the surgery but eventually did and my foot is now back to normal. I lost some feeling in my fourth toe but I hardly notice it at all.

I got numerous second opinions. Some podiatrists will want to cut open the top of your foot. Some will want to go through bottom. My podiatrist convinced me to go through the top. I forget why now but I am so glad I eventually went under the knife.

Not sure about the above poster claiming the diagnosis for this is by squeezing your foot. I had to get a MRI and could clearly see a extremely swollen nerve in the metatarsal.
posted by jasondigitized at 11:53 AM on October 14

p.s. I also no longer wear socks with my running shoes. Socks squeeze feet. When I do need to wear socks, I wear Injinji brand toes socks. Makes a big difference.
posted by SageTrail at 6:43 AM on October 16

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