Morton’s neuroma

Training
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This is a really helpful thread as I don’t find much out there on the internet about Morton’s Neuroma in cycling. I have neuromas in both feet and have been dealing with issues off and on since 2017. It wasn’t until I started to do consistent 50+ mile rides that I would get to the point where the neuroma-related pain would be overwhelming bringing me to the point of having to get off the bike to let it calm down (and probably the point of tears too…).

Once I first started to deal with this, I freaked out, sold my high end S-Works shoes because I was convinced they were too narrow for my feet, and bought a pair of Lake shoes thinking their wider toebox would help. Unfortunately, I ran into the same issues. I don’t measure as a wide foot so I never thought it had to do with toebox width and the failure of the Lake shoes confirmed that. I also spent countless amounts of money (d’oh!) on insoles including ones off amazon and the specialized website. Nothing worked.

It wasn’t until the last year or so when the pain started to become overwhelming, including on the bike and during running (wrinkled sock feel), that I decided to seek professional help instead of trying to self diagnose. I finally saw a podiatrist, something I highly recommend for anyone dealing with this, and I received the Morton’s Neuroma diagnosis. This opened my eyes to what I was dealing with and how far off I was in trying to treat it.

I think at some point I got a cortisone shot but it didn’t do anything. The podiatrist recommended shifting my cleats back a bit in order to take pressure off the forefoot. That didn’t help either and probably screwed up my bike fit. I also have been riding with high end S-Works road shoes (again) for a couple of years now thinking the stiff sole would distribute pressure evenly across the foot but that has also not worked.

Ultimately, I had my foot scanned and I ordered a pair of custom orthotics (insoles). I didn’t have high hopes because I thought I had already tried every “custom” insole under the sun and everyone told me podiatrists try to sell you expensive custom orthotics because that is how they make all their money. However, when I got the orthotics and immediately tried them for some runs, I noticed immediate relief. I was surprised at how aggressive the pad was on the insole. I felt almost like a massive lump on my foot just behind the metatarsal heads. This, however, was exactly what I needed. I liken it to an extremely thick version of the pedag pads mentioned in this thread. I had actually tried some of these pedag-like disposable pads that my podiatrist gave me and felt some relief so I guess that was an indication that the orthotics would work.

I’m now at the point where I use my orthotics 100% of the time for running. I’ve been experimenting with using them in my cycling shoes but I notice they are slightly too long for my cycling shoes which causes them to scrunch up a bit at the end. I also notice that the extremely high metatarsal pad pushes my foot up to the top of my cycling shoe and almost creates its own version of discomfort.

I’m now thinking two things: 1) I need a second pair of custom orthotics ($$); 2) I need a cycling shoe that accommodates a higher volume foot. On the latter point, I’ve done a bit of digging online but it seems like volume and width get conflated a lot. It seems like I want to go back to Lake or Sidi or Bontrager who specialize in foot-related cycling shoe issues. I’m hoping to do a bit more digging and come up with a better solution because it seems my S Works road shoes may not work full time with my custom orthotics.

Hopefully this post helps someone reading it. It’s a bit of a personal diary but hopefully it shows all the steps I took and mistakes I made so he or she can get to a successful conclusion more quickly and less expensively.

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I forgot to mention that I also tried shoe wedges to no avail as well as the silicone gel pads that loop around your toes. I’m probably forgetting a few others things too. It really wasn’t until I went down the custom orthotic route that I finally found some relief.

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I tried these as well. I will say they definitely helped. Unfortunately I didn’t want to wear shoes every day of my life and barefoot was just always painful, no relief. If you catch it early, buy wide toe box shoes, custom insoles, I think the pain can be mild enough to not need surgery.

Being a hard headed person I’ve had few pains that pushing through didn’t eventually work. This is one of those few. It just got worse and worse ever so slightly day by day. Eventually it was just not something I wanted to deal with daily.

Then I had surgery. Wow, this surgery sucks! Holy crap I still can’t believe how bad this is. I’ve already illustrated above to me surgery has never been a big deal. This one has been a big deal. The infection I am positive played it’s part in this. Perhaps without the infection, I’m back on the bike.

Ironically, yesterday was my first time post infection that I did not need pain meds. Also, my doctor has cleared me to ride easy. 30 minutes at 30% of FTP kind of easy. Unfortunately I don’t think I can do it. I can’t get my bike shoe on over my foot and I could probably swing it if I rode in flat pedals but I’m just going to give it another week. The swelling and pain that’s still in there makes the ride very unappealing. I averaged 6 days a week for a year leading up to my surgery so this has been a very disruptive process.

I keep thinking “tomorrow” will be the day that I don’t need to feel like I should lay in bed all day with an icepack on my foot. To this point I’m still not there and I’m the kind of person that generally doesn’t stop moving from sun up to sun down so again, really a disruptive change to my lifestyle.

It will be fine eventually (I hope :cry:).

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Just a quick update. I’m 5 weeks out from surgery. As mentioned above, I did receive clearance from the surgeon to resume light cardio but there is still too much swelling to get my cycling shoe on and honestly it doesn’t sound too appealing yet as this is just a different kind of pain and I don’t really want to poke the sleeping bear. I think without the infection I’m back riding. With it, still could be a bit. My doctor made a comment, “You would have been much better off crashing and breaking your femur than dealing with a nerve injury.” Kind of a scary thought but puts this into perspective for those that feel the “twinge” and opt to push through it like I did.

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I ws gonna suggest maybe getting some SPD sandals and using MTB pedals on your trainer, but after reading the rest of your post, probably not worth aggravating things further…better to let things heal and resume conservatively rather than pushing through a dodgy situation.

Heal fast(er)!

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Thank you, I didn’t even know those existed. I will check them out. That could be a good intermediate step once I’m able to get back on the trainer. Appreciate it!

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Oh yeah…had a pair for many years back in the day.

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My other half is a runner who successfully had surgery 10 years ago for a Morton’s neuroma that began to ruin her life by excluding her from the activities - running and hiking - that she loved to do.

Prior to that she’d had expensive custom orthotic insoles, which helped, then cortisone injections, which helped, then finally as it got worse took the risk of surgery. She was fortunate to alight upon a surgeon who was a real expert in his field, and had the good luck for it to work out well for her, although the recovery took time and was painful.

So far she’s had a further decade of running (and hiking) which she’d not otherwise have had. On longer runs she’ll get some twinges, but so far nothing worse, and she generally caps the length of runs in order to try to keep a lid on this and not risk poking the bear.

Having an incision through the top of your foot is, I think, a pretty horrible prospect, and an area that can take a lot of time healing. Good luck to anyone who opts for it - it can work out well given a fair wind and sufficient healing time. I hope it turns out well for you, @Stringwise, and that you’re able to get back on the bike and be pain free.

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In the process of self diagnosing myself.
So I started getting numb toes, and it wasnt different between bikes and shoes. Walking around currently the bottom of my foot is sore right at the fourth toe.

Here’s the weird thing. My fourth toe will go numb but then eventually it goes back to normal after about 10-20 minutes. I was out running the other day, and felt my toe go numb. About five minutes later it went away. Same thing on the trainer last night.

I have a theory this may just be my foot placement. Not putting enough pressure on my big toe.

So I’m not really sure if this or Morton’s or just a sore foot from improper foot placement. I did just get thru a high speed running interval block

Anywho- I’m looking around for some insoles with the bump on them. I had them a few years ago and I liked. Not sure what’s out there or what to search. Would like some for running and cycling

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Hi all,

Hope everyone is safe and are back at doing what they love, relatively pain free! This is a long one but I’m beyond grateful that I found this forum and post since you all seem like avid athlete’s with experience which is just what I’m after. Looks like I’m late to the party but I was hoping I may be able to ask a few questions since you all have so much experience here.

I don’t do much cycling but I’m an avid runner, typically doing 10-21 km per day. I’d gotten to a near 200 day run streak which I’m sure contributed to this in the end since I didn’t want to back down and take a rest day.

A few months ago, I noticed numbness /tingling in the forefoot and pain that seemed to often times radiate and jump around, even back to my heel which was curious. The typical pain points however are always just behind the toes. I can’t seem to pinpoint the exact spot. Sometimes it feels more in the centre of the bottom of my foot behind the toes, other times it seem as though it may be slightly closer towards the big toe. Kinda strange. The pain could sometimes get so bad that I couldn’t stand or walk in shoes, stabbing/radiating kinda pain, and other days, it would be vastly different, as a dull ache, or feel just severely bruised behind the toes on the bottom of the foot. I could never figure out why the pain sometimes seemed to change locations or pain type. It always seemed like a split of pins/needles or dull bruised ache.

I have a feeling this all started back in maybe September or so. I purchased a new/different pair of shoes which were very narrow. At the end of the first run in them, my foot was numb and tingling. I chalked it up to them being narrow and assumed they’d loosen up. I ran in them another 5 or so times before abandoning ship. That said, there was one more run where my entire foot just felt crazy pain all of a sudden, stabbing nerve pain, and I had to limp home. Not so great. That was my last time using those shoes. Since then’ I’ve reverted to all my other regular shoes and I’ve been fine. I’d probably ran at least 900km in the time which passed since that first issue with the tight shoes with no relapse of that feeling.

Fast forward 3 months, hadn’t had an issue since until one day after a 15k really chilly outdoor run. I came in after the run, and put on a new pair of half sized- smaller shoes to try out on the treadmill to see how they were for fit. Ever since that 5 minute treadmill run in tighter shoes, it’s been game over. I tried pushing through the pain with short runs for another 1.5 months but it got to the point where even a 2k run was not possible.

I’ve seen chiros, sports injury doctors, and podiatrists, and have had an ultrasound to check for Morton’s Neuroma and an x-ray to rule out stress fracture. Both those tests came back showing nothing, oddly enough, though those tests were closer to the beginning of this and it’s been almost two months since. I now have an MRI with contrast scheduled in a few weeks and I’m really nervous to see what transpires there. This definitely seems like metatarsalgia/Morton’s to me.

The chiro noticed I had a tight hip on one side when I advised that my foot ground contact time balance was off at a 48% / 52% (tracked via Garmin chest strap with running dynamics) and tight calves which he said is causing my bad foot’s arch to slightly collapse. He believes that the hip may have also contributed to adding additional force to the forefoot with each foot strike, and that coupled with the previously traumatized foot via the tight shoes may have led to this condition, though this is merely speculation. I got some custom orthotics created, though they have not been very helpful so far, and I still have quite a bit of discomfort at the forefoot, even with the orthotics and with wider shoes. I’m finding myself sort of walking on the sides of that foot and curling the forefoot /toes to avoid putting pressure there.

I’ve now been off of running for 25 days which has been a real challenge for me, and I have mostly been a couch potato, with the exception of some daily 2-4k walks (with manageable pain). Oddly enough, my foot seems to hurt now at rest more than when I was pushing through running a month ago. I’ve only cycled 25-50k on two occasions, and it seemed like there was a flare up of sorts after each instance, despite feeling fine while riding. Walking is also uncomfortable.

I guess my questions to anyone who can help would be, does this sound like Morton’s in your opinions? Second question would be that I’ve read some horror stories about the surgery, and have been told that the ligaments they cut through on the top of the foot are never sewn back together (unsure why, if it’s physically impossible or some other reason) and as such, the mechanics/stability of your foot post-surgery is forever altered. I’ve been told that your foot and toes will splay out more like a duck’s foot, and that surgery should be avoided at all costs. Is this true in any of your cases? Does your foot splay out or has your stability been altered? Do you notice any sort of difference in the look or function of your foot?

I am wondering: if this ends up being Morton’s, should surgery only be considered after aggressively trying to tackle the problem via other means for an extended period? I’ve yet to try any types of injections, cortisone or otherwise. I also haven’t tried any physio or rehab on the foot, with the exception of some acupuncture. I’m mostly trying to rest it in hopes that it just goes away, though after a month, seemingly nothing has changed. This is such a frustrating experience.

Thanks so much for any thoughts!

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Are your toes permanently numb where the pain used to be? I was diagnosed with the neuroma but my only symptoms thus far is numbness in my two toes with zero pain. Im hoping that the cortisone injection plus some rest is all that I need to get this before it gets worse. Also did insurance cover anyones insoles?

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My insurance (Cigna) covered my custom orthotics. I even got a second pair the next year and those were covered too. The one issue I have run into is finding a pair of cycling shoes that allow for a higher volume (high, not wide) due to the orthotics. The orthotics effectively elevate my mid foot due to a bump in the orthotic which is meant to take pressure off the pads of my feet and place it more at my mid foot and arch. This higher volume foot set up then creates pressure on the top of my foot from the upper last of my cycling shoe (S Works 7 road shoe). I’m still working on finding the right shoe to accommodate this…

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The doctor warned me that I might lose feeling in that area due to the removal of the nerve, but I actually didn’t lost any feeling at all.

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Hi Balcerski,

Thanks for you story. Do you feel that the custom orthotics have cured your neuroma symptoms? Or did you still deal with pain regularly?

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The custom orthotics plus a shoe with a wider toe box and higher volume last have been a game changer for me. I have not had any pain like I used to.

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That awesome to hear! I am going to take this route as well. Do you feel pain-free (AKA before you neuroma)? Really nice to hear success stories. I am ready to get active again

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Yes, completely pain free.

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Awesome

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Glad you found some relief.

If I’m on the bike for a long time–like 4+ hours–and I start to feel any discomfort at all, I remember the agonizing pain I experienced in my foot prior to having surgery. Luckily I’ve not had any recurrence since then. That was not a fun experience.

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Thanks! To be fair, I haven’t really done any 4+ hour rides which is when the pain would tend to really come out. I’ve got a 100 mile gran fondo in May which should be a good test! The pain while running has completely evaporated though which has been amazing.