They say doctors make terrible patients… I think physio’s do too and I have several reasons why; firstly we have an inability to take our own advice (most of the time); secondly we usually fail to get treatment on our problem areas because let’s be honest the last thing you want to do at the end of a long days work is have to treat your colleague… and thirdly is the case of too much knowledge being a potentially dangerous thing,. Naturally as humans and also medical practitioners I think we are programmed to think the worst and then work our way backwards. Makes sense, rule out the worst possible diagnosis immediately which leaves your mind at ease to focus on the other potential problems that may be occurring.
Recently I was out enjoying a Sunday jog on the famous Bondi to Bronte coastal track when my two middle toes started aching and tingling. I kept running, it got worse, I kept running, by the end my jog was a hobble and surprise surprise for the rest of the day my foot was killing me. By 8pm that night I had convinced myself that I had a stress fracture (always jumping to the worst case scenario) I had visions of a walking boot, no running, no gym… Over the coming days I monitored my symptoms, it wasn’t behaving like a stress fracture, the pain was very intermittent, it didn’t throb at night, and by far the worst thing was bare feet on the bathroom tiles = nightmare. I took a week off running and slowly it improved but my toes felt cold, achy and occasionally tingly. It was by far the most irritating feeling I have ever experienced I just wanted someone to yank on my toe and make it go away.
Anyway cutting to the chase I knew now it wasn’t a fracture but saw the Doc, got an MRI and as I suspected I had a Morton’s Neuroma in between by 2nd and 3rd toe.
What is a Morton’s Neuroma? I’m so glad you asked as I’m sure this personal account has had you on the edge of your seats….
A neuroma is a growth that arises within the nerve cells. A Morton’s neuroma is the name given to an inflamed nerve between the metatarsals at the ball of the foot. It most commonly occurs between the second and third toe and is caused by irritation and compression of the intermetatarsal nerve. Patients will often present with pain and/or numbness in the involved area that can radiate into the toes. Symptoms are usually aggravated by weight bearing activities such as running, however if the neuroma is very large simply walking can be enough to cause pain.
Your physio or doctor will usually be able to make a diagnosis based on your history and symptoms, however further investigation such as an x-ray or MRI may be warranted to rule out the presence of a stress fracture.
Why do people get this injury? Like most overuse injuries certain people are often predisposed to developing this problem as a result of biomechanics; with pronated feet (flat feet) being one of the main risk factors. Other things include wearing too tight fitting shoes which can cause chronic compression of the nerve sheath.
What does the treatment involve?
First thing is first REST from aggravating activities. So running, jumping etc. Ladies this may also mean popping the stilettos away for a while as the excessive forefoot loading can compress the nerve further. Your physiotherapist can provide local treatment which may involve soft tissue massage to tight muscles both within the foot ad into the calf / shin; dry needling can also be effective. Management also needs to involve a proper biomechanical assessment looking at why you have developed the problem in the first place. Foot alignment, size, footwear etc all play an important role in an injury like this. Some people may require referral onto a podiatrist to be fitted with orthotics.
Steroid injections and anti-inflammatory medication can provide short term relief. This should be discussed with your doctor.
If any of this sounds familiar I would advise getting it checked out. Don’t be a bad patient like me and let it linger on!