Mortons neuroma

Has anyone trained anyone with Morton’s neuroma? I have a client, in his late 50′s, who was an avid basketball player, pounding back and fourth on the gym floor 3 or 4 nights a week.

This is not necessarily why the Morton’s neuroma developed but a possibility.

He had the surgery where the nerve is cut but he still has a lot of pain.

This really inhibits training him as any kind of direct weight on the toes (like heel lifts, calf stretches, lunges etc.) causes pain and makes it worse after.

I have searched the web for exercises and can’t find a thing on re-hab and he has gotten little information from the doctor except what not to do.

I’ve included a little information;

Morton’s neuroma is an enlarged nerve that usually occurs in the

third interspace, which is between the third and fourth toes.

Problems often develop in this area because part of the lateral

plantar nerve combines with part of the medial plantar nerve here.

When

the two nerves combine, they are typically larger in diameter than

those going to the other toes.

Also, the nerve lies in subcutaneous

tissue, just above the fat pad of the foot, close to an artery and vein.

Above the nerve is a structure called the deep transverse metatarsal

ligament.

This ligament is very strong, holds the metatarsal bones

together, and creates the ceiling of the nerve compartment.

With each

step, the ground pushes up on the enlarged nerve and the deep

transverse metatarsal ligament pushes down.

This causes compression in a confined space.

The reason the nerve enlarges has not been determined.

Flatfeet

can cause the nerve to be pulled toward the middle (medially) more than

normal, which can cause irritation and possibly enlargement of the

nerve.

The syndrome is more common in women than men, possibly because

women wear confining shoes more often.

High heels cause more weight to be transferred to the front of the foot and tight toe boxes

create lateral compression.

As a result, there is more force being

applied in the area and the nerve compartment is squeezed on all sides.

Under such conditions, even a minimal enlargement in the nerve can

elicit pain.

Signs and Symptoms

The most common symptom of Morton’s neuroma is localized pain

in the interspace between the third and fourth toes.

It can be sharp or

dull, and is worsened by wearing shoes and by walking.

Pain usually is

less severe when the foot is not bearing weight.

Diagnosis

To diagnose Morton’s neuroma the podiatrist commonly palpates

the area to elicit pain, squeezing the toes from the side.

Next he or

she may try to feel the neuroma by pressing a thumb into the third

interspace.

The podiatrist then tries to elicit Mulder’s sign,

by palpating the affected interspace with one hand and squeezing the

entire foot at the same time with the other hand.

In many cases of

Morton’s neuroma, this causes an audible click, known as Mulder’s sign.

Treatment

In most cases, initial treatment consists of padding and taping to disperse weight away from the neuroma.

If the patient has flatfeet, an arch support is incorporated.

BroadwayFitness

I’ve asked this before but thought I’d try again since we do have some new people on the list.

Anyone have any experience training a client with Morton’s Neuroma? I have a client with this malady and it is truly inhibiting us especially for cardio.

I am specifically wondering if he should try to push through the pain a bit as he stops when it hurts which is most of the time.

Any experience out there? And yes, I have googled it and even spoke to two physical therapists and got their input.

Thanks.

Achievech

I don’t know anything re: pushing through the pain vs.

waiting it out, but are there any options for him to use a rowing ergometer or do deep water cardio with a buoyancy belt?

Hallihan

Swimming works in the summer but his pool is too cold right now.

I tried to get him to use a bike but even pushing on the pedals hurt.

The nueroma is not going to get worse with some use so that’s why I wondered if he should try to work with the pain.

GlitzMuch

Sorry, I don’t know anything about that.

Turevora

I guess for those who haven’t experienced someone with this condition, it would nice to explain it:

Definition

By Mayo Clinic staff

A neuroma is a noncancerous (benign) growth of nerve tissue that can develop in various parts of your body.

Morton’s neuroma occurs in a nerve in your foot, often between your third and fourth toes.

The condition involves a thickening of the tissue around one of the nerves leading to your toes.

Morton’s neuroma causes a sharp, burning pain in the ball of your foot.

Your toes also may sting, burn or feel numb.

Also called plantar neuroma or intermetatarsal neuroma, Morton’s neuroma may occur in response to irritation, injury or pressure.

Morton’s neuroma may also occur for unknown reasons.

Common treatments for Morton’s neuroma include changing footwear or using arch supports.

Sometimes, corticosteroid injections or surgery may be necessary.

I too have a client who suffers from this – in his case better foot wear and using his orthodics brought him some relief.

HealthRelax

Thanks for the giving me the run-down.

I have never run into that.

OutingRunning

Thanks for including the definition, Linda.

I did mean to include it in my email but I forgot.

My client thinks he got it from running hard up and down a basketball court for a few years.

Too bad he can’t play anymore as he loved it very much and it kept his weight down.

Now he is about 50 pounds overweight which of course makes the neuroma worse.

It’s a catch 22.

Injuries suck!

Thanks to everyone who commented.

LyfeBest

You might want to suggest to your client seeing a chiropractor. Sometimes a nerve is compressed in the lower back which mimics the symptoms — in fact, most regular MDs would diagnose it as such without checking out the alignment the spine. I actually had a similar problem which particularly caused that horrid sensation when I was on the elliptical. Fortunately, I mentioned it to my chiropractor before I went further down the path to potential surgery. After just one adjustment there was improvement, within a couple of weeks of chiropractic treatment & physical therapy it was just a memory. That was two years ago.

TasticPT

Here’s some anecdotal information/suggestions:

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A friend of mine is an avid tennis player, she started suffering foot pain which was interrupting her tennis – she immediately went to a podiatrist, was diagnosed with Morton’s Neuroma.

They fitted her with simple orthotics and the problem was solved, she was ecstatic at how well this worked, as she feared having to give up tennis – her passion.

They were just over $100.

 Hope this helps.

SportsSpondee

I would recommend to be seen a podiatrist because they specialize in things like this.

PThypcom

I should have told you all that he has been to one of the “experts” on Morton’s Neuroma and went through the orthodox, the shots and then had surgery.

He thinks he has a second neuroma but the doctor does not want to do surgery.

Sorry, I didn’t include this info because I just didn’t want the post to be too long.

Thanks for all of your input.

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