Finally went to the podiatrist this week to seek diagnosis and treatment of pain in the balls of both feet radiating to the third and fourth toes - sure enough, Morton's neuroma in both feet as my cycling friend (who also suffers from this) predicted! Morton's neuroma is an enlargement/thickening of the nerve due to compression and irritation. Got an injection of cortisone and lidocaine to temporarily reduce the swelling, and started physical therapy today (combination of laser, ultrasound, and ice/electrical stimulation). Custom orthotics on order. My doctor knew better to tell me to quit cycling (I average 180 miles per week). The pain becomes unbearable after about 50 miles, so I am trying to balance intensity, hills and mileage so I can keep building and at the same time give this thing a chance to heal. Will also work on my pedaling efficiency. Wondering how frequent this is in cyclists, and if any of you have experienced this, how you fared with treatment. For some reason, I am told this condition is more prevalent in women.

I have it in my right foot as we speak. I tried the 3 cortisone injections but it didnt help enough. I started a 6 injection alcohol treatment to actually kill the nerve at the point of the scar tissue buildup. You get the same result as surgery (removal of the nerve). True, that toe will lose feeling but the doctor said it will barely be noticeable. After 2 injections I do see an improvement.

https://www.medscape.com/viewarticle/557978

Sorry to hear of your affliction.

Is the lidocaine to reduce the pain from the cortisone injection?

That is correct.

I have a neuroma in my right foot and had custom orthodics made 9 years ago to help.

The orthodic has an extra thick pad (bump) that pushes the third and fourth joints apart to prevent the pinching that causes the nerve to hurt.

I haven't worn my orthodics for a while because I'm too lazy to get back to a podiatrist, but as long as I have on shoes that are wide across the forefoot, then I'm okay. Narrow shoes absolutely kill my right foot with pain from the neuroma.

I wear a pair of Sidi Genius Megas (the wide version) for riding and can ride all day with little to no discomfort from the nerve.

My wife had Morton's neuroma. One foot, then the other a few years later. Injections and orthotics didn't work, so she had the surgery both times.

Did she have the cortisone or the alcohol injection?

So is it probably the fact that the foot is compressed sideways by narrow shoes that leads to this? Or ...?

Cheri is in the process of scheduling surgery for hers. Nothing else has helped. To get her through till now she gets cortisone injections about once a month, she's on Celebrex, I have hollowed out the sole of her riding sandals (shoes are way too painful) and she brings along one of those chemical ice packs in her bag so she can take a break and ice it down when it starts bothering her. Normal routine when we stop someplace to get a drink or ice cream is to get a cup of ice for her foot too.

I hope the surgery helps - thing really limits her ability to both train and do any distance riding.

From a previous thread...

A Morton's neuroma describes a nerve inflammation in the 3rd interspace. A Joplin's neuroma describes a nerve inflammation in the 1st interspace. Morton is just the guy who described the nerve inflammation within that interspace.

The nerve inflammation is generally due to compression of the nerve between the metatarsal heads. There is not a whole lot of conservative treatment for them but conservative therapy generally works well.

Most important is to support the transverse metatarsal arch (the arch from the great to the the 5th toe) and prevent pronation, which causes the metatarsal heads to 'cross' and pinch the nerve. Use a metatarsal pad with an orthotic. This control needs to happen all the time, not just when cycling. So control the motion walking and what inflammation you have may not cause pain when cycling. Also, shoes that are the right width are crucial. Any compression of the metatarsal heads will cause compression on the nerve.

Then the usual inflammatory treatments. Ice, NSAID's, cortisone injection, etc...

Surgery is always a last resort. One can try to sclerosis the nerve with dehydrated alcohol prior to surgery. Surgery to decompress the interspace by releasing the intermetatarsal ligament and remove the common digital nerve is not uncommon but as with any surgery it comes with its own possible complications....

Not sure that narrow shoes are a cause, but they will exacerbate the problem if it's present.

At least that's been my experience.

From what I understand that is one of the factors that lead to a neuroma.

Thanks to all for the information. My podiatrist told me that conservative treatment solves the problem 75-80% of the time, and surgery is the next option. I think the orthotics will definitely help. I have the Sidi Genius 6.6 Carbon Women’s - they fit great & are not the cause of the problem. I think some people are predisposed to this - the computerized orthotic scan showed I put a lot of weight on the balls of my feet when I walk, and lost the fat pads on my soles.

Remain vigilant with your rehabilitation and management, and hopefully you will recover before needing surgery. Good Luck.

Good luck with it!!!

I had an episode of this several years ago, and boy, was it exquisitely painful! My case resolved after two injections of a long-lasting anesthetic and depot steroid. I take care to avoid narrow shoes and look for a wider toebox when I buy men's business shoes. I have had no recurrence.

Apparently, women who were shoes that tend to compress the forefoot are more at risk for developing this. So if your wife/partner/significant other starts to develop forefoot pain, switching to a wider shoe can help.

Cortisone. I don't know if the alcohol injection was a treatment 12 years ago.
Surgery worked both times. No complication, but is did have her off her feet and out of work for a couple of weeks each time.

Sorry to hear about your neuroma. I too had one in the right foot. I tried every treatment known to mankind. Nothing worked for more than a few weeks. This too shall happen to you. I had all the shots of cortisone and even meds to disintegrate the nerve via injections. Nothing worked completely, not even orthotics. So, I took the plunge and had the surgery. NOT the old style of digging out the neuroma. IT comes back. Talk to your pod and ask for the referral to a surgeon that does interligamental release. I was off my feet for a week, back on the bike in 6 weeks. The rest time will do you good, you will survive, and much luck to you in your cycling endeavors.

Sincerely,
NFields

Rode 43 miles today at a good pace (17.8 mph avg.) and the feet felt great! I rubbed them with BioFreeze before the ride and that may have made a difference - who knows?

Could this be what I have? I get a pain on the top of my foot. It sometimes goes to the toes. I haven't had it for a while, until this past week when I did th edumb thing of using fins when I was swimming. The left fin (the pain is in the left foot) was quite tight. The only time I get the pain is after using fins or sometimes when running.