lhancock wrote:
How about some pros and cons on surgery for the Morton's neuroma?
the surgeons I know all recommend it, oddly enough.. ;-)
I've had neuromas for forty years, had a couple of bad years but running unhindered and mostly pain-free for the last few decades.
What's worked well for me is a trick Johnny Halberstadt at the Boulder Running Co. showed me: cut a small circle of orthopaedic felt and stick it to the bottom of the inner of the shoe, just behind the metatarsals. It usually takes a few tries with each new pair of shoes to get the pad situated just right, but once it's there, it lifts and separates the metatarsals and relieves the pressure on the neuroma. This helps with the pain and helps prevent further damage.
Placement of the pads is critical - this is why any consumer product except a custom orthotic probably won't work. Doing it yourself allows for cheap trial-and-error until the pads are exactly right.
I tried some expensive custom orthotics, but they didn't work as well as the pads, so junked them.
it's critical to have plenty of room in the toe box of ALL your shoes, running, bike, and work/casual. Compression of the metatarsals is a factor in this injury. Make sure to get running shoes with excellent forefoot cushion, that's the primary characteristic I look for these days; and replace them often. Try running on softer surfaces - grass, dirt roads, or synthetic tracks. Concrete is a terrible surface to run on..
Also, be careful of running with the pain. A few years ago, I didn't put the pads in a new pair of racing shoes, and consequently tore a calf muscle because I was compensating for the neuroma pain by altering my pushoff. Stupid stupid stupid.
I use these inserts in all my work and casual shoes:
http://www.footsmart.com/Product.aspx?ProductId=96&cmx=YFor the surgery, I do respect those surgeon's opinions. However their judgement may not be accurate, since they might be among the good/lucky ones..
Actual studies on the surgery,
http://www.ncbi.nlm.nih.gov/pubmed/1156819365% pain-free after 5 years, but the same percentage have mild or major shoe-wear restrictions.
Those odds aren't good enough for me.
A newer study,
http://www.ncbi.nlm.nih.gov/pubmed/1948423782% excellent or good, but 71% restrictions with footwear.