Morton’s neuroma - Colorado Front Range doctors

My partner has a Morton’s neuroma that is interfering with running, skiing, etc. She is considering surgery. Can anyone share recent experiences with the surgery, recovery, and outcome, either positive or negative? For folks in Colorado Front Range, any doctors you would recommend or avoid? Thanks!

Aaron

I am seeing an orthopaedic surgeon for my ankle replacement named Daniel Moon in Denver. He is part of UC health and does only foot and ankle.He reomved a large ganglion cyst from my foot when he removed some screws a few months ago. Podiatrists do that work as well but I dont know any of them.

Has she tried conservative treatment, i.e. wearing shoes with lots of room for the forefoot?  After suffering from Morton's neuroma for several years, I was able to significantly ease symptoms in about a week by switching to wide daily work shoes, and completely eliminate symptoms after a few months.  I did consider surgery, and was being pushed in this direction by the podiatrist I was seeing at the time, but am very glad to have been able to avoid this step.

Thanks for the replies (and to those who reached out via PM).

Ubu: Yes, she has been pursuing conservative treatment (wide shoes, pain management, etc.) for years which has helped manage the symptoms but without full resolution.

surgical removal of the neuroma is the nuclear option.  Why straight to that and not try steroid injections or radio frequency ablation first?

Steve Colegrove wrote:

surgical removal of the neuroma is the nuclear option.  Why straight to that and not try steroid injections or radio frequency ablation first?

Time

Why spend the next two years dicking around with injections, special treatments, new shoes, and time off, only to end up needing surgery anyway.

Cut that sucker out, take 6-8 weeks off, and move on with your life.

The insurance company is going to require some injections and maybe PT to prove that it’s not going to work before they’ll pay for surgery. It’s best to get that ball rolling.

Aaron Ray wrote:

My partner has a Morton’s neuroma that is interfering with running, skiing, etc. She is considering surgery. Can anyone share recent experiences with the surgery, recovery, and outcome, either positive or negative? For folks in Colorado Front Range, any doctors you would recommend or avoid? Thanks!

I've had Morton's Neuroma in both feet for almost 40 years.  Above I see a number of useless or misleading comments.  I assume she has sharp, debilitating, 10/10 pain, like I did.

Last I looked, the surgical option is to cut the the nerve to eliminate the pain.  This results in nearly complete numbness in the toes, not the best outcome for a climber or any kind of athlete.  In order to eliminate the problem surgically, you would need to reconstruct the ligaments in the metatarsals to create an arch for the nerve to pass through and I don't believe that is possible with today's medical technology.

Wider shoes is wrong.  This just allows the feet to flatten out even more and, of course, her climbing shoes are not wide with extra room in the toe!   

In the short run, metatarsal pads (e.g. "Hapad" brand) added to her footbeds should provide some immediate relief from the pain.  Although with distance running there might not be a good solution.  In the long term, add a custom orthotic with a pad.

Over time, like decades, the nerves will degenerate from being pinched millions of times.  What you want is the orthotic and pads to slow this process and/or stop it so that she'll reach equilibrium. What this means is that she'll sacrifice some tactile feeling in order to get rid of the pain.   

In my case, the nerves have degenerated to the point that I don't have that horrible pain, a good thing.  What I've lost is fine surface feeling in the skin of my toes, and sometimes my feet feel cold when they are not.   However, I still have good enough "deep" sensation that I can feel small footholds and just about everything else in everyday life.  I ski, hike, skate, etc. but I gave up running long ago.  YMMV.

Echoing John, the Hapad pads / orthotics to reduce the pressure on the neuroma have been successful for my Morton's Neuroma for the last 6 years. However, I have found wide forefoots helpful (such as Topo & Altra shoes) Now, I only get mild pain after long approaches and hiking. I believe the standard of care is to proceed to radiofrequency ablation if it can't be managed with footbed changes. The success rate is ~85% with 2-3 cycles. RF Ablation study, 2018. 

Steroid injections are out of favor because they don't typically providing lasting relief (~20-50% success rate), I don't believe your insurance will require them. 

Surgical options do include decompression, not just nerve removal. Surgical Comparison. However, it involves cutting ligaments (so does the standard approach for nerve removal), which could lead to other issues with a high volume of weightbearing activity. Nerve removal also includes a risk of persistent pain from the nerve stump, beyond standard issues of infection.

Best of luck for your partner, it's a miserable condition.

I had successful results with orthopedics from podiatrist I saw + wearing Hokas (also his recommendations). It was so painful I was considering surgery.

I know 3 climbers, one with multiple surgeries for this who have zero issues and climbs. I know one climber who got a bad result and she had to quit climbing. As long as you know that no surgery is without risks. 

I think the way Morton's presents varies in the individual. For me, putting any type of insert into my shoes seems to increase the lateral pressure on my foot. That's when the nerve pain starts. And it feels like a hot knife stabbing into the bottom of my foot. I have found that shoes with wide toe beds, such as Keens are helpful in not squeezing my toes together as much as regular shoes. 

I've been using toe spacers for quite a while. I recently purchased a pair of Yoga Toes Jewels, which really spread the toes out dramatically. This makes my feet feel much better during the time I'm not wearing the Yoga Toes. 

I've also used Voltaren in anticipation of long days and I've gotten some relief from that. Soaking my feet in hot water (as hot as I can stand) also helps post activity.

Typically, I can hike per normal on an approach into a climb. It's when I'm hiking out from the climb that I have to slow down and baby my feet. Especially if walking down a steep trail. 

I've suffered from this condition for years, along with severe bunions. I'm currently not open to surgical remedies as they seem to not be a guaranteed success, with a longish recovery. Also, I'm not sure the loss of feeling in the toes would be good for climbing, especially outside climbing (which is what I mostly do). I try to manage the pain, but I have to say this is one condition that has limited my climbing and running more than anything else. 

Something not mentioned is a very strong correlation to tight calf muscles and neuromas.

I saw Dr. Trevor Williams in slc. From what he said I gathered that if you’ve had it more than a year or two and ablations didnt work then you’re probably looking at surgery. The nerve gets larger and larger the longer you aggravate the condition.

I got two ablations and its held off for ~8 months so far. I still feel it sometimes but its not bad. I’ve lost feeling on the inside of my second toe- who cares? No balance or coordination issues and I couldn’t even tell you if you didn’t poke it directly.

John Sigmon wrote:

Something not mentioned is a very strong correlation to tight calf muscles and neuromas.

I don't believe that's true.  Do you have evidence?

I saw Dr. Trevor Williams in slc. From what he said I gathered that if you’ve had it more than a year or two and ablations didnt work then you’re probably looking at surgery. The nerve gets larger and larger the longer you aggravate the condition.

I don't believe this either.   I can believe the nerve and it's sheath gets swollen if you continue to walk on it, and that the swelling diminishes if you stop.  I also believe that scar tissue can build up in the sheath around the nerve, and perhaps that's what your doctor meant.  I do not believe "The nerve gets larger and larger".  Just the opposite.  The nerve atrophies over time, and that is what causes the numbness.

There's an arch that goes across the foot from the base of the big toe to the base of the little toe.  If you look at a footprint in the sand, you can see that this area supports all your weight as you step forward.  The arch is maintained by ligaments that hold the bones of the foot in the proper place. If the ligaments get stretched, the arch gets flattened and then the bones pinch the nerve passing through the bones, causing pain.  Often very severe pain.  

One practical solution is to support the arch using orthotics and metatarsal pads.  

I got two ablations and its held off for ~8 months so far. I still feel it sometimes but its not bad. I’ve lost feeling on the inside of my second toe- who cares? 

Because you're treating the symptom and not the cause, so it will get come back, worse, over time.

I had a neuroma caused by a weight falling on my foot and breaking a bone and a couple of years later the neuroma started. I have orthotics and had 3 steroid shots before I had it removed. I wore a wooden sole shoe, this was in the 80’s so now it is probably a boot for a few weeks. It was worth it to have it done for the pain relief. I noticed no real difference in climbing performance as this is not in the big toe nerve where you need to feel things better. Just have it removed and be done with it. 

John Byrnes wrote:

I don't believe that's true.  Do you have evidence?

I don't believe this either.   I can believe the nerve and it's sheath gets swollen if you continue to walk on it, and that the swelling diminishes if you stop.  I also believe that scar tissue can build up in the sheath around the nerve, and perhaps that's what your doctor meant.  I do not believe "The nerve gets larger and larger".  Just the opposite.  The nerve atrophies over time, and that is what causes the numbness.

There's an arch that goes across the foot from the base of the big toe to the base of the little toe.  If you look at a footprint in the sand, you can see that this area supports all your weight as you step forward.  The arch is maintained by ligaments that hold the bones of the foot in the proper place. If the ligaments get stretched, the arch gets flattened and then the bones pinch the nerve passing through the bones, causing pain.  Often very severe pain.  

One practical solution is to support the arch using orthotics and metatarsal pads.  

Because you're treating the symptom and not the cause, so it will get come back, worse, over time.

You can do the tiniest bit of googling to show that me (or the surgeon) didn't just make it up. A Morton's Neuroma is a complex condition that can come from many different causes and have different presentations. So it's not true that every symptomatic neuroma patient has a tight calf muscle, or that in every single case the nerve gets larger as time goes on.

However:
- A surgical release of the gastroc is shown to reduce symptoms in many patients with reduced dorsiflexion.
- Usually, additional scar tissue is laid down around the nerve, making it larger over time. Nerve size over time is hard to measure but the hypothesis has appeared in many papers and when my surgeon (who does hundreds of these a year) tells me that the longer someone complained the more likely the excised nerve is larger, I believe him.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6362341/#section6-2058-5241.4.180025
one excerpt from above: "In the senior authors’ experience PMGR has been shown to be beneficial in patients with symptomatic Morton’s neuromata and tight gastrocnemius that have not responded to nonoperative treatment. "

https://pmc.ncbi.nlm.nih.gov/articles/PMC8277559/
from the first line, emphasis mine: "Morton's neuroma presents as a painful neuropathy resulting from a benign enlargement of the common plantar digital nerve "

and so on, there are many papers out there showing that both these points are valid.

I have never had a diagnosis, but I’m pretty sure this is the issue. I have, a little bit more in than 1 foot than the other, but definitely in both feet.

Mine was first noticed while climbing a fist crack. One of the knuckles popped past the other one, kinda like if somebody shakes your hand and squeezes too tight.
Kept getting numb multiple days in a row.  Of course, on the first day of a climbing trip that the injuryhappened.

When I got home, I took a week off, this did not help.
I went and saw an acupuncturist at the recommendation of a friend.

That worked wonders, I could barely walk for a couple weeks and then after two sessions of acupuncture, it was gone.

I now have to be very careful of the footwear I Use.
Footwear that constricts my forefoot is unbearable

Many climbing shoes do not work for me, though I have found some that do work and have stayed with those for many many years.

I have had mixed luck with getting good orthotics.
I have one pair for ski boots that have a metatarsal pad and they are great.

I spent $300 for a custom pair that do not work at all.
I spent about 10 years and a few thousand dollars trying to find AT ski boots that fit. Finally, the fourth pair works.

With one of the pairs, pain started while I was backcountry skiing. My partner had me take off my boot, and he put a ginger chew right in the metatarsal area, which allowed me to ski tour for the rest of the week. No, I did not eat it afterwards.

I have heard mixed results about the surgery, but have zero experience.

I wear shoes almost all of the time. It gets aggravated while walking barefoot on hard surfaces.
My foot also gets aggravated if I’m not careful while crack, climbing, and can get aggravated if I do tons of slab climbing.

climberz wrote:

I have never had a diagnosis, but I’m pretty sure this is the issue. I have, a little bit more in than 1 foot than the other, but definitely in both feet.

Mine was first noticed while climbing a fist crack. One of the knuckles popped past the other one, kinda like if somebody shakes your hand and squeezes too tight.
Kept getting numb multiple days in a row.  Of course, on the first day of a climbing trip that the injuryhappened.

When I got home, I took a week off, this did not help.
I went and saw an acupuncturist at the recommendation of a friend.

That worked wonders, I could barely walk for a couple weeks and then after two sessions of acupuncture, it was gone.

I now have to be very careful of the footwear I Use.
Footwear that constricts my forefoot is unbearable

Many climbing shoes do not work for me, though I have found some that do work and have stayed with those for many many years.

I have had mixed luck with getting good orthotics.
I have one pair for ski boots that have a metatarsal pad and they are great.

I spent $300 for a custom pair that do not work at all.
I spent about 10 years and a few thousand dollars trying to find AT ski boots that fit. Finally, the fourth pair works.

With one of the pairs, pain started while I was backcountry skiing. My partner had me take off my boot, and he put a ginger chew right in the metatarsal area, which allowed me to ski tour for the rest of the week. No, I did not eat it afterwards.

I have heard mixed results about the surgery, but have zero experience.

I wear shoes almost all of the time. It gets aggravated while walking barefoot on hard surfaces.
My foot also gets aggravated if I’m not careful while crack, climbing, and can get aggravated if I do tons of slab climbing.

You should see a doctor and have a proper diagnosis rather than a climbers forum and have it fixed. To spend all that time money and pain and do nothing except throw garlic salt over your left shoulder and hope for the best is not good. It amazes  me how people will wait for so long to have something simple fixed. It took me less than a year for me to go from diagnosis to full recovery . Or climb and do stuff in pain. On the other I waited for quite a while a while to have my ankle replaced 10 days ago but that is a bit more invasive than a neuroma  

Kevinmurray wrote:

You should see a doctor and have a proper diagnosis rather than a climbers forum and have it fixed. To spend all that time money and pain and do nothing except throw garlic salt over your left shoulder and hope for the best is not good. It amazes  me how people will wait for so long to have something simple fixed. It took me less than a year for me to go from diagnosis to full recovery . Or climb and do stuff in pain. On the other I waited for quite a while a while to have my ankle replaced 10 days ago but that is a bit more invasive than a neuroma  

I am frequently shocked by what people will just live with. I could give examples but this is a climbing forum, not medical weirdness forum.