Morton’s neuroma:  Essentially, this is a bunch of tangled nerves between your foot bones.  Your greatest pain is between toes three and four. The most common cause is wearing shoes which do not fit correctly.  They are either too short or too narrow.  Or high heels; but running in those is really hard unless you are being chased by someone with a chainsaw.

History: Almost all are insidious onset but occasionally the patient will recall a hard landing.  If you have not changed your running shoes recently, then think about changes in your regular running.  Have you added a trail running or added more hills or speed work?

Treatment: We need to reduce the compression of the nerve in the front of the foot.  Changing shoe can make an immediate difference in these patients.  Just because a shoe works well for your running buddy or spouse does not mean to will be right for you.  Trying to get just two more marathons on those comfy shoes may not be the best idea.

1)      Manage the pain:

a.      Check your running shoes!  Just because it is the highest rated running shoe on your favorite website does not mean it is the best shoe for you.

b.      Check your running log to see if you made any big changes in recent weeks.

c.       NSAIDS will help. 

d.      Plantar fascia stretches

e.      Kinesiology taping to the bottom of your foot can relieve some of the stress on the muscle and increase blood flow.  LIN

                                                              i.      Across metatarsal heads VID

                                                            ii.      Taping for plantar fasciitis may help VID

f.        Ice or heat can relieve your pain.

                                                              i.      Ice right after you get done running

                                                            ii.      Heat on non-running days

g.      Continue running but avoid aggressive speed work and hill repeats, especially downhill running.

2)      Restore full motion:

a.      Stretching to your plantar fascia may help.

                                                              i.      Sequential short-term running will address these muscles.  VID

                                                            ii.      Plantar fascia stretches

                                                          iii.      Rolling the bottom of your foot on a coke bottle or lacrosse ball may help. VID

b.      Stretching does not have to be part of your warm-up or cool-down.  But it HAS to be part of your training program. LIN

3)      Begin non-weightbearing exercises to restore strength without all the pressure on the joints

a.      Exercises to increase your foot mobility.

                                                              i.      Begin with forefoot strengthening.  Alphabets, maybe ‘short foot’ exercises, towel scrunch, marbles  VID

b.      You will not be at this level very long; we just need to increase your strength while minimizing stress on your foot.

4)      Begin body weight exercises.

a.      Apply the kinesiology tape to your foot before you start your weight-bearing exercises.

b.      Double leg heel raises?, eccentric heel raises, heel raises.  Be careful these may make your foot more sore. Static lunges, dynamic lunges,  LIN

c.       Standing hip abduction, heel raises (double progressing to single), dynamic lunges

d.      Click here for video to know if you are ready to progress to more aggressive exercises.

5)      Correct running mechanics. 

a.      Gradually return to your previous running.  Start on relatively flat ground or even on a treadmill.  The best part of returning to running with a treadmill is that you can actually hear your footsteps.  Also, a lot of treadmills are in front of a mirror so you can see your hands move and your feet move.  If your arms or legs swing weird, you may want to have a physical therapist complete an evaluation before you return to full running.  Listen and ‘feel’ how you run.  Is one leg hitting the ground harder than the other?  Does one arm swing differently than the other?  Until you can run without pain and with fairly symmetrical running mechanics, you are still at risk of reproducing your old injury or creating a whole new injury to another part of your body.

b.      As soon as you can run without pain and without a limp you can return to your normal running routine.

6)      Return to running speedwork and hills.  After you have been able to run on flat ground for a week with your with your normal training and have not had any pain, you can begin to add speed and hill training to your program.

7)      My favorite step, get back to full running!  Have fun.  Eventually you will bust something else and be back to the website to fix that. 

8)      If you follow the steps on the website for 2-6 weeks (depending on how badly you hurt yourself the first time and on how long you tried to ‘run through the pain’) and your problem does not resolve, then call our clinic for an appointment and we can do something Dr. Google cannot do.  We can complete a hands-on evaluation, in-person evaluation to determine the cause of your pain.