Tuesday, April 05, 2016

Traditional And Alternative Methods Of Treating Morton's Neuroma - I've Tried Them All!

Morton's Neuroma is an extremely painful condition.
Here's what you can do about it.
Morton's Neuroma
About 4 years ago I started getting intermittent pains in the front of my feet, especially when I walked barefoot on hard surfaces. I was an avid Zumba dancer and wore these tight dance sneakers which crowded my toes. Of course this followed a 36 year corporate career where I wore high heals every day. Then, to make matters worse, I injured a toe on my right foot when I opened a heavy door over it. Now, every step I took created a sharp, electrical pain in the ball of my foot. I was diagnosed with Morton's neuroma.

Morton's neuroma is when the tissue around the nerves leading to your toes begins to thicken or becomes inflamed. Typically this occurs in the area between the third and fourth toes (or metatarsals) although it also can occur between the second and third toes. This thickening pinches and compresses the nerve causing various sensations and pain. Some people feel as if they are standing on a pebble in their shoe, or on a fold in their sock. I have not experienced this to a large degree. My symptoms were sharp and burning pain in the ball of my foot that radiated through my toes.

My search for a cure was a long one. I have tried practically every traditional treatment, from cortisone to surgery, as well as every alternative treatment, from acupuncture to cannabis. If you are reading this, I know how much pain you are in so I am going to share everything that I tried to relieve my pain and be able to resume my active life.

Sorry ladies, but that closet full of cute, pointy-toed shoes may have to go. Women's shoes are especially harmful to feet because they crowd the toes. About three out of four people who suffer from Morton's neuroma are women and I'm pretty sure our shoe wardrobe has a lot to do with it. But even men's shoes and most athletic shoes have a curvature from side to side that "cradles" your feet and causes your toes to scrunch up. So the first thing you should try to do is wear shoes that give you plenty of room.

Here are some of the shoes I've tried.
I particularly like Hoka's, which is a running shoe. I'm not back to running yet but if you are, these are great shoes. 

My most comfortable shoes that I now live in are Altra running shoes. The Olympus model, and perhaps some of their others, have a very large toe box. It's so wide, I affectionately call these my "clown shoes". I wear them almost every day.

The Olympus model is on close out so I just bought a second pair.

OESH shoes were designed specifically for women by Dr. Casey Kerrigan, specifically "to minimize the stress and strain that footwear inflicts on a woman's muscles, tendons, ligaments, and joints." For me, the OESH shoes didn't provide enough cushion and they are so shallow that they don't allow enough room for orthotics or other shoe inserts that you might need for better arch support. They are also very flexible and bend easily. Since people with Morton's neuromas feet hurt when their toes bend, it's better to get a shoe that has more structure. They might be a good shoe to prevent a neuroma in the first place.

Good shoes to prevent a neuroma but 
not stiff enough if you already have one.
Besides running shoes, some Keen shoes are quite comfortable because they provide room in the toe. They are also quite stiff and don't bend easily. 

When I dress up, I wear these SAS women's Nudu sandals. The straps allow you to customize the shoe to your foot and the cushioning is amazingly comfortable. It's like walking on a memory foam bed. 

Super comfortable and somewhat dressy
Metatarsal Pads
If your shoes don't provide enough relief, you might try placing a metatarsal pad on the insert of your shoe. When used correctly (have your foot doctor, chiropractor, or physical therapist place them for you), they can relieve the pressure from the neuroma. I suggest you start with a thin one first (1/8") and if that doesn't work, try a thicker one. Bigger is not better in this case so start off small. 

Proper placement is key 
Yoga Toes
By the end of the day, when your feet are burning and in pain, you might want to try YogiGems toe stretcher and separator. I placed them in the freezer first and slowly and carefully maneuvered them around my toes. Start off with just 5 minutes or so and build yourself up to longer times. After I had surgery, it hurt to stretch my toes apart but if you haven't had surgery yet, these can give you relief. 

Custom Orthotics and Off-The-Shelf Shoe Inserts
Before you spring for custom orthotics, try different off-the-shelf inserts. Sometimes they work just as well and they are a whole lot less expensive. You can buy Dr. Scholl's inserts at your neighborhood pharmacy for around $10. Some have machines you can step on to determine which product works best for your foot, especially your arch. 

Sof Sole makes a good product that ranges from $20 to $40. Aetrex Lynco Sport makes a very good insert that already has a built in metatarsal pad for around $60. 

From left to right, Dr. Scholl's, Sof Sol, and Aetrex Lynco Sport.
If you have an unusually high arch or foot condition that needs special attention (and you have $500 to burn), you can have custom-made orthotics made by your podiatrist. 

Podiatrist and surgeon, Dr. Chang 
making a cast of my feet
Resulting orthotics
The most important thing about orthotics is breaking them in slowly. A well-made pair of orthotics can be very helpful but I'm not sure they are worth the money. First of all, some of the off-the-shelf products are pretty darn good for a tenth of the price or less. Secondly, if you have more than one pair of shoes, it's a pain to constantly move your orthotics to another shoe. If you find a well-priced off-the-shelf product, you can buy a set for each pair of your shoes and it will still be cheaper than one set of orthotics. And you can trim each pair up to specifically fit each shoe.

I went to 4 different chiropractors, each of whom did something a little different to try and break up my neuroma. 
One doctor manipulated and "cracked" the bones in my foot numerous times - didn't work.
Another used a metal flat tool to break up the scar tissue and perhaps release the entrapment - this didn't work either.
A third doctor (Dr. Richard Fourzon in Santa Rosa) used a cold laser so many times and so intensely, he literally "fried" my nerves in my foot and lower back. I still have burning up and down my legs from this treatment. Avoid this guy at all costs.
A forth doctor gently manipulated my toes - this didn't work either. 
Bottom line, I did not get any relief from any of the chiropractic treatments. Three out of four of these doctors are extremely competent and have provided me relief for other issues but not for Morton's neuroma.

Foot Massage
John Crutchfield, a specialist in foot massage, brought my pain from a 10 to a 6. I drove hours to see him and it was worth it but unfortunately he has moved overseas. You can, however, get his Foot Self-Massage, The Basics DVD on how to massage your feet. This takes dedication but can help immensely. 

Integrative Practitioners
I have two naturopaths that are also board certified doctors.
One tried a TENS unit for pain - it didn't work. 
The other doctor, Dr. Lois Johnson, who is also an herbalist, put me on a regimen of herbs and supplements. They include R-lipoic acid and a tonic of St. John's wort, oats, ashwaganda, and motherwort. To this I add a good B-complex and additional benfotiamine (an oil-soluble form of vitamin B1 - thiamine). These help a lot to dull my nerve pain. 

Since Podiatrists specialize in feet, I visited three of them in my quest for foot relief.

Cortisone Injections
The very first thing a podiatrist will do is give you an x-ray. An x-ray cannot detect a Morton's neuroma but it will rule out some other causes of foot pain, such as a stress fracture. When they diagnose Morton's neuroma, they will most likely suggest a cortisone injection. And if it doesn't work, they will administer another one. Although cortisone is a powerful anti-inflammatory and, for some, can offer quick relief, these have never worked for me. Plus, too many cortisone injections can cause tissue damage and even rupture tendons. The worse part is, the relief doesn't usually last. I had three, none them worked, and I am sorry I ever allowed the doctors to administer them. There are more effective treatments.

Alcohol Injections
If you are open to having injections, you might consider skipping the cortisone and go directly to alcohol injections. Although it sounds scary, alcohol injections, or sclerotherapy, is where they shoot a dilute mixture of alcohol into the neuroma area. They freeze up the foot with a numbing spray first. Dr. Chang gives a great shot and it didn't hurt nearly as bad as one would expect sticking a needle full of alcohol directly into a nerve would feel. You can get up to 7 shots. I opted for all 7. These injections eventually kill the nerve so you no longer feel the pain. But, I still felt the little "click" with every step I took because the physical neuroma was still there and it was large. If it had been smaller, I would have declared victory after the shots. You guessed it, the next step I took was surgery.

Dr. Thomas Chang freezing my foot and
giving me an alcohol injection
It took me 3 years before I decided to have surgery. During this time, I did all the things I described above and more. So I didn't take this lightly. Reading various chat groups, you will quickly see that recovery can sometimes take a very long time. But some lucky people claim they are out jogging in a matter of weeks or months while others are still in pain a year or more later. Everyone is going to react differently.

Immediately after surgery, you have to wear a surgical shoe and you may need crutches or a cane. But it's best to just lay still for a while with ice and your foot elevated. They put some kind of pain block in because you really don't feel your foot for a day or two. But then the fun begins. 

A few days after surgery. Even the
unaffected toes were black and blue.
My recovery was long and painful. For months I had shooting pains in the toes surrounding the neuroma surgical site. My doctor seemed surprised at this, as if I were the only person whose foot hurt months after surgery. But it's not uncommon so if you are still having pain for months or even a year after surgery, don't give up hope. It just takes a long time to heal.

Day 16 - removal of stitches.
6 weeks after surgery
One year after surgery

During the first few weeks after Morton neuroma surgery I had lots of nerve pain which I didn't expect. After all, didn't they just cut out my nerve? I took the drug Gabapentin which worked very well in mitigating the nerve pain. However, after people in various chat groups talked about how it hurt their vision, I quickly stopped taking it. My daughter also had vision problems after taking this drug. 

I honestly thought my pain would never go away, even after surgery, until I starting seeing Dale White, a Sebastopol acupuncturist. I went once a week for several months. His treatments were nothing short of miraculous. I had tried another acupuncturist before and after my surgery but it didn't do much good. But Dale is an experienced and skilled practitioner. So ask around and find the best.

Medical Cannabis
One of the other things I did for pain was to get my medical cannabis card. Being a farmer, I immediately planted a CBD-rich plant (similar to hemp with little THC and no psychoactive properties). It seems ridiculous that this hemp-like plant is considered marijuana, but it is. Anyway, I developed a salve using this plant along with other healing herbs and essential oils and I rub this on my feet two to three times a day. 

Walk on the Beach
One final thing I recommend is to walk barefoot in the ocean to soak your feet in cold salt water and walk in the sand to strengthen your feet. After surgery, your toes will feel really tight and weird - like they are held together with a rubber band. Stretching them out, gently bending them, walking on your toes, and especially walking in the sand, will loosen them up again. But take your time. I didn't get to this for many months.

I know my four year journey is probably worse than some and not as bad as others. Some people have double neuromas in both feet and face far greater pain and suffering. But after seeing 4 chiropractors, 2 naturopaths, 1 foot massage specialist, 3 podiatrists, 2 acupuncturists and a cannabis doctor to finally get some relief, here's what I have learned and what I would advise someone to do if they have Morton's neuroma:

1. First of all, throw out all of your tight fitting shoes. Get shoes with a big toe box and use inserts for additional cushioning.

2. Do self-massage foot care nightly.

3. Find the the best acupuncturist you can, like Dale White, and try acupuncture for 6 to 8 weeks. Don't give up - it takes time.

4. If that doesn't work, I would skip the cortisone shot and get alcohol injections.Try finding someone who will use ultrasound-guided techniques. My doctor didn't but I think if he did, it wouldn't have taken as many shots to get relief.

5. Work with an herbalist or naturopath and start on a regimen of supplements and herbs to address your nervous system and pain. I know the drug Gabapentin (also known as Neurontin) works pretty well, but avoid it if you can and try going natural.

6. If you live in a civilized state where medical cannabis is legal, play around with cannabis salves and maybe some edibles (be careful with dosing on the edibles) for pain relief.

7. As a last resort, consider surgery if none of this works and you cannot bare the pain. Interview doctors and talk to people who have had the surgery. But only do this as a last resort. Having said that, I'm sure there are many people who have had more successful surgical outcomes and wish they had done it sooner. But it's hard to tell if you are going to be one of the lucky ones.

8. Months after surgery, to help recover, walk in the cold ocean and the sand.

I'm happy to report that I'm back to Zumba dancing but only on a thick, cushiony rug and I recently walked 6 miles, two days in a row. It's still hard to walk barefoot on hardwood or tile floors but I'm pretty happy to be mobile again!

Good luck with your journey. Pain is hard to deal with but don't give up on finding the right doctor or alternative practitioner to help you.

Latest Update February 24, 2020
I've developed a new neuroma right next to the last one. It occurred when I was jumping and twisting - an exercise I found on UTube that targets love handles. So now my foot is killing me and I still have love handles! 

I tried many of my favorite treatments like acupuncture, supplements, cannabis salve, massage, etc. but nothing was working. I returned to my surgeon but he was really relying on me to tell him exactly where the neuroma was before we administered alcohol injections. The pain seemed to be all over and I really couldn't pinpoint it. I really wanted to find a doctor who did ultrasound-guided injections so that we would be certain we were hitting the correct spot. So I did some research and found Dr. Peter Redko in Petaluma, CA. 

I went to visit Peter to ask for ultrasound-guided alcohol injections. I knew that I did pretty well with the alcohol treatments for my last neuroma so I wanted to skip the cortisone (which never worked for me) and go straight to the alcohol injections. 

He suggested I try something less invasive first, specifically MLS (Multiwave Locked System) laser treatments. So I signed up for 6 treatments (it could possibly take 10). I'm taking 2 laser sessions per week. I've taken 3 treatments so far and I'm really hoping that this works. He's even treating the adjacent area where I had surgery since it still feels spongy and is occasionally painful. Although I don't have results yet, I was very excited to share this new development and treatment option with you. Stay tuned ........

MLS laser

July 13,2020 update:
So I completed 6 MLS laser treatments and they were actually starting to work when Dr. Redko suggested I take a stem cell injection. BIG MISTAKE!! After the injection, I was in severe pain (couldn't even walk for a day) and then I started having worse symptoms than before - like the classic feeling that you are walking on a rolled up sock.

Then the pandemic hit so I just lived with the pain for a few months. I went back for more MLS laser treatments thinking that would help counteract the pain from the stem cell injection. After 5 more MLS laser treatments, I just gave up as they seem to be making it worse. And, at a $100 a pop (not covered by insurance), why keep doing something that wasn't helping. I do think, however, had I not had the stem cell injection, the MLS treatments would have improved the pain.

Today, I am returning to my surgeon, Dr. Chang, for alcohol injections. Wish me luck!!


Unknown said...

Any chance you would consider making a batch of the salve and selling it? My daughter is 15 years old and a ballet dancer. She dances about 30 hours per week and her neuroma is making her miserable. We have tried many of the things you mentioned and her podiatrist wants to do surgery, but we have been told that could end her quest to be a professional ballerina. The schlerosing injections worked for a time after having 7 of them, but she did still have the clicking. A little more than a year later the neuroma is as bad as it was previously. She had an additional 4 injections and her podiatrist said no more. Not willing to give up.

Dr. Joanne L. Mumola Williams said...

So sorry to hear about your daughter's pain. I can't imagine dancing on a neuroma for 30 hours a week. Forget the surgery, my foot is so numb that I have a hard time with balance. Yet, it did not get rid of the pain!
Check out my salve at turtlebud.com.

Unknown said...

This blogpost was so, so helpful to me. I was just diagnosed with neuromas six months ago and they have been getting progressively worse. Your recounting the steps of your journey felt like a blueprint of my future path, advising me of pitfalls to avoid along the way. My only question is: How do you feel now that you've had the surgery, and would you recommend it to others with your same problem now that you've had it? Thanks again for your very detailed sharing of your experience. Laura, NYC

Dr. Joanne L. Mumola Williams said...

Hi Laura,
In retrospect, I would not have had the surgery. What has helped the most was:
1. wearing comfortable shoes with a large toe box
2. the alcohol injections got me most of the way there
3. acupuncture
4. the salve and tincture that I developed (check out turtlebud.com) and use every day
5. foot massage

The surgery left my foot numb in places which I hate and still feels tender from the surgery. I do know some people who have had good results with the surgery but I would exhaust all other avenues before you do that. Feel free to write me at joanne@foodsforlonglife.com.

Unknown said...

Hi! I went to turtle bud.com but can't find a place to purchase the salve? Any ideas how to get it?

Dr. Joanne L. Mumola Williams said...

Send an email to joanne@turtlebud.com with your request.

Unknown said...

I had my surgery a month ago and am extremely happy with the results. The doctor told me it was a fairly large neuroma. I am still going through the healing process, but the progression is going well. I went through all of the conservative methods before considering surgery. I have one in my other foot and if the conservative methods do not work, I will have surgery again. I also have complete faith in my doctor. I reside in New Jersey.

Dr. Joanne L. Mumola Williams said...

So glad that worked out for you!