If you have already tried changing footwear, expensive insoles, anti-inflammatory medications, and other supplementary tactics to treat Morton’s neuroma to no avail, you may be considering surgery or alcohol sclerosing injections to effectively kill the ‘malfunctioning’ nerve. Don’t go permanently severing the feeling from part of your body too hastily. Morton’s neuroma, has a simple, effective, and no gimmicks solution that I have used effectively to treat countless patients with persistent foot pain.
Feel the sensation
Walking barefoot is less common in this modern age with the proliferation of communicable diseases. The slim chance of stepping on a used hypodermic needle or other questionable street paraphernalia is too much for many to bear and shoes are worn unequivocally whenever setting foot out the front door.
The spread of blood-born pathogens delivered a severe two pronged blow to the hippy-nation of the 70s in that two of their fundamental precepts; free love and walking barefoot, now posed dire consequences and only the die-hard fundamentalist hippies could carry on as they once did.
But this article is not about hippies or STDs, it’s about foot pain, so let’s get back to walking barefoot. Although treading shoeless is less common now for the aforementioned reasons, it still happens, and now and again the walker will unintentionally step on a rock or thorn, which then persistently presses on the foot in the same location as consequent steps are taken. But as soon as the loathsome pebble is brushed away, walking can continue with comfort and ease.
With Morton’s neuroma, however, it is as though that pebble (now invisible) has been adhered to their foot like some permanent unwanted fixture whose sole purpose is inconvenience, like an ornate statue that has to be stepped over (or else tripped over) every time one enters or exits a building. People feel as though a small ball has grown on the bottom of their foot and sensitivity has been increased to the level of the princess and the pea, so anything firmer than the softest cotton is stepped upon with caution and aggravation. Standing draws attention away from less pressing matters towards pain, the ultimate thought vacuum.
One may seek out padding for their feet in the form of inserts and insoles, softer shoes, and dread walking barefoot on any uncarpeted floors. Some turn to Western medicine’s options of alcohol injections or surgical removal of sensory tissues (nerves) to permanently dull the pain, which unfortunately leaves part of their foot permanently dull and numb.
My goal in this article is to help you better understand this annoying phenomenon, as well as take the appropriate steps to correct it, so that you can be pain-free without permanently weakening and numbing your foot.
What’s with the name?
Usually any disease that ends in -oma means you need to flip the panic switch or at least seek a second opinion because the suffix -oma means a tumor or swelling, and in some cases it denotes cancer.
This is not the case, however with a neuroma. Morton’s neuroma is not a tumor, or swelling, or cancer. It is more aptly named ‘perineural fibrosis,’ as this denomination correctly describes the condition as the development of excess fibrous tissue around the nerve.
Perineural fibrosis also correctly points to the etiology of Morton’s neuroma, which is scar tissue formation around the nerve due to repeated trauma. One of the reasons this condition is treated so barbarically today (surgical removal of the nerve, or killing it with alcohol injections) is due to the misnomer ‘neuroma,’ which connotates a malfunction of the nerve itself.
The reality is, this is not a disease of the nerve itself, the actual disease is around the nerve, where scar tissue has formed. This scar tissue can be treated without removing or destroying the otherwise healthy nerve tissue.
Morton’s neuroma usually wreaks its own distinctive breed of havoc between the second and third, or third and forth metatarsal bones. Between the third and forth metatarsals branches of the lateral and medial plantar nerves meet up and then continue on to innervate the lateral side of the third toe and the medial side of the forth toe.
At the junction the nerve is surrounded on the sides by the metatarsal bones, on the top by the deep metatarsal ligament, and on the bottom by the ground below. Similarly hazardous anatomy greets the nerve between the 2nd and 3rd metatarsals before it branches off to the toes.
Do to the inauspicious feng shui provided by the anatomical surroundings of the nerves at these locations; they are more likely to fall victim to repeated trauma, from the ground below, from the ligament above, or from the bones at their sides. Runners develop this condition due to repeated impact on the ground.
Those who sport high heeled shoes attack the nerve from three sides. The tight toe boxes press the bones together surrounding the nerve, and the toes are stretched up so that the nerve strikes the ground when they walk.
A lesser known cause of nerve scarring is excessive desk work. Sitting with poor posture for extended periods can decrease circulation to the foot, leading to microscopic necrosis (tissue death) in various places in the foot, and the gradual build up of scar tissue. Some desk sitters also develop plantar fasciitis for this reason.
Believe it or not for successful treatment of both of these conditions (Morton’s neuroma and plantar fasciitis) I have occasionally had to treat the lower back as well as the foot itself. This is not as common a cause of scar tissue formation as injury due to direct trauma to the foot, but it happens.
Any time there is pain on the ball of the foot that is metatarsalgia, which just means pain in or near the metatarsals (bones of the ball of the foot). When the pain radiates down between the toes; that means there is some sort of impingement of one of the plantar nerves. In the case of morton’s neuroma, scar tissue (fibrosis) forms around the nerve, pressing on the nerve, causing the nerve to malfunction so that pain is felt down the length of the nerve, instead of being isolated only at the point of impingement.
This isn’t the only issue that results in this sensation. Problems with the other tissues surrounding the nerve can and will impinge upon it producing a very similar sensation of a small ball on the bottom of the foot and pain or numbness radiating to the toes.
The experts of western medicine terminology have partly borrowed, partly developed terminology to make their diagnostic vocabulary sound complicated, intricate, and accurate. The ultimate goal of using these terms alone to communicate with patients in lieu of a simplified explanation is to create an impression of intellectual superiority.
In this manner you will be willingly led to the conclusion that they know what’s going on and you don’t, that they are the experts and you are not, and ultimately that their opinion is the final edict (no discussions or objections please).
Many diagnoses sound exceedingly elaborate but they mean basically the same thing, and if you look closely you realize a lot of so-called experts are taking a simple phenomenon and convoluting it into an illusory labyrinth of mind numbing complexity.
For pain on the bottom of the foot you may hear arthritis, capsulitis, synovitis, tendonitis, intermetatarsal bursitis, or periostitis.
Arthritis is the most generic of all of these terms, which just means inflammation at the joint (the place the bones connect to each other).
Capsulitis means you have an inflamed joint capsule. The articular capsule, or joint capsule, is a ligamentous (made of ligaments) sack that encloses synovial fluid and connects two bones together, in this case the metatarsals (bones of the ball of the foot) with the phalanges (toe bones).
Synovitis means the synovial fluid (lubricating fluid) inside the capsule is inflamed. This pretty much goes hand and hand with capsulitis because if the ligament portion of the capsule is inflamed, the synovial fluid is probably inflamed and vice versa.
Tendonitis means an inflamed tendon, of which there are four tendons on the bottom of the foot that can mimic Morton’s neuroma pain, the four flexor digitorum brevis tendons, those that are responsible for pulling the 2nd through 5th toes into a curled position.
Bursitis means the bursa is inflamed, in this case the bursa being referred to is between the metatarsal bones (intermetatarsal bursa); a fluid filled sack that provides cushions between the bones, tendons and ligaments.
Periostitis is inflammation of the periostium, the connective tissue covering of the bone. This is a fibrous membrane that the tendons and ligaments attach to, and in so doing attach to the bones. Periostitis can be a problem because it can lead to small stress fractures of the metatarsal bones.
If you’ve patiently waded through this sea of muck without merely skipping ahead you now know that as complicated as arthritis, capsulitis, synovitis, tendonitis, intermetatarsal bursitis, and periostitis sound when they are listed back to back, it all just means inflammation, just in different places (and maybe you already knew, I guess that Latin root knowledge counted for something after all).
All of these issues may lead to the pain described with morton’s neuroma, do to the fact that all of these tissues are in close proximity to the plantar nerves.
The overuse of cortisone injections and other anti-inflammatory medications is due to the misconception that all pain is inflammation. Inflammation, in the case of joint injuries is a result of the injury, the necessary healing process of the injury, not the cause of the injury.
Using inflammation as a last ditch scapegoat to explain away pain without thinking further is the reason Western medicine is generally clumsy and inferior to Chinese medicine in the management of muscluloskeletal pain. If you haven’t yet found an adequate solution for your pain through conventional methods there is a good chance this is the reason why.
Inflammation in and of itself is usually only a fundamental disorder in the case of autoimmune diseases (rheumatoid arthritis, multiple sclerosis), when the body attacks itself unnecessarily. But with joint injuries the inflammatory response is a necessary part of healing.
-Itis or -osis, place your bets
In spite of what the experts say it’s no real mystery what causes Morton’s neuroma and what causes most of the issues listed above in the inflammation section for that matter. It is trauma; either direct trauma to the feet from athletic impact and poor footwear choices, or indirect trauma due to poor circulation. This trauma results in micro-tears or possibly micro-necrosis to the soft tissue, and eventual scar tissue formation, known as fibrosis.
So where they say capsulitis, I say capsule fibrosis came first. They’ll tell you tendonitis, but I say that tendon fibrosis resulted in tendonitis. You say arthritis, I say arthrosis. Treat the fibrosis and unlock the key to the inflammation. Scar tissue blocks circulation, especially in the joint connective tissues, and the body responds to this blockage with inflammatory chemicals to break down and remodel the scar tissue.
For a side note, alcohol sclerosing injections involve injecting the pathological nerve with an alcohol solution which scleroses (scars) the inside of the nerve. So scar tissue is what was originally causing pain, and the treatment plan is the proliferation of more scar tissue (fight fire with fire). This may or may not eliminate the pain, and if treatment is truly successful it will eliminate not only the pain, but any other sensation originally provided by the nerve.
There are many techniques for diagnosing morton’s neuroma, but most are indeterminate, short of cutting open the foot and seeing an enlarged nerve with the naked eye. Mulder’s sign is a technique whereby the foot is squeezed and pressed upon to produce a palpable click, which is supposed to confirm Morton’s neuroma, but tendon fibrosis as well as bursa fibrosis can produce this same click in the absence of any neuroma. MRIs may show nerve enlargement, but even this is not necessarily the gold standard in diagnostic methodology; imagery is often inconclusive.
The good news is, because most pain on the ball of the foot is due to scar tissue formation, whether it has formed on the nerve, the ligament, the tendon, or the periosteum doesn’t really matter, the treatment is the same, just in a slightly different location. This principle holds true even when Morton’s neuroma is complicated by a bunion or hammertoe. There’s no better treatment for scar tissue formation and connective tissue injuries than Connective Tissue Acceleration.
All the medicine required for you to heal is already in your body. The problem is one of distribution, what your body needs to heal is already in your blood, but due to anatomical properties of the joints, circulation there is poor. Connective tissue acceleration is extremely effective because it pumps the blood to where it needs to be manually, ultimately resolving scar tissue, resolving the cause of inflammation and the cause of pain. Make an appointment at Roots of Eastern Medicine Acupuncture Clinic today to finally put your foot pain to an end. A plantar nerve is a terrible thing to waste.