Friday Q A Mortons Neuroma

Q: I have a question about flat feet and Morton's toe. I'm a 57 YO man who walks a lot and I have both. I always have difficulty balancing on one foot—tree, eagle pose, etc., and have recently had a bout with Plantar Fasciitis showing up in my left heel. No fun. I was at a yoga class yesterday and some poses felt good, others hurt. When I left the class, I literally limped home and iced it for 1/2 hr. then heat, then rest. I had acupuncture at Quan Yin this morning for it and bought new, sturdy shoes and heel pads. It feels a little better today. Can you suggest any asana or other treatment I can do at home that may help speed the healing process and prevent future trouble?

A: This question from last week was really a three-parter, and I covered flat feet with you all last week (see Friday Q&A: Flat Feet), so let’s turn to the second issue that came up for our student last week, Morton’s neuroma. It turns out this particular condition can cause pain in the ball of the foot, as we shall see below. 

According to the Mayo Clinic, “Morton's neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. When it develops, it may feel as if you are standing on a pebble in your shoe or on a fold in your sock. Morton's neuroma involves a thickening of the tissue around one of the nerves leading to your toes. In some cases, Morton's neuroma causes a sharp, burning pain in the ball of your foot. Your toes also may sting, burn or feel numb. Morton's neuroma may occur in response to irritation, injury or pressure. Common treatments for Morton's neuroma include changing footwear or using arch supports. Sometimes corticosteroid injections or surgery may be necessary.”

Interestingly, there's no outward sign of this condition, such as a lump or swelling on top or bottom of the foot. Instead, any of the following symptoms could appear: a feeling as if you're standing on a pebble in your shoe, a burning pain in the ball of your foot that may radiate into your toes, or tingling or numbness in your toes. We don’t know what causes this problem to develop, but it is theorized that irritation, pressure or injury to one of the nerves that lead to your toes may be the culprit. High-heel shoes, high-impact sports or sports with tight fitting shoes (can you say sport rock climbing?) or the presence of other foot deformities are all considered risk factors for developing a Morton’s neuroma. I could hypothesize that our student’s flat feet may have put him at risk for developing one of these buggers, but I don’t know about other activities that he was doing when it showed up. Obviously, the first two risk factors are addressable with lifestyle changes and choices.  Not so much the foot deformities.

If you go in for evaluation for foot pain on the ball of your foot, your doc will likely press around on the foot, especially between the third and fourth toes, to see if you are tender there or have a fullness that is not visible from the exterior. In addition, X-rays may be ordered to rule out a fracture as a cause for your pain, or an ultrasound may be used to look for the swelling of the nerve indicative of a neuroma. Typical western medical treatment usually starts with the least expensive and simplest approach. This could include over the counter arch supports and pads to take pressure off the neuroma. Your doc might go so far as to recommend you get special customized arch supports made for your shoes. Another fairly common treatment involves injection a steroid medication into the swollen area, as it is a strong anti-inflammatory medication. There are three other more extreme surgical approaches that are invasive and beyond the scope of this blog post. My hope is that you would not have to go to that extreme.

The folks at the Mayo Clinic do have some other ideas that could help, which are pretty common sense, too, like taking anti-inflammatory medications like aspirin or ibuprofen, as they can help with pain and swelling. Or try an ice massage. Regular ice massage may help reduce pain. If you have not already changed your footwear, what are you waiting for? Get rid of those heels and make sure the box of your shoes is wide enough!  Finally, they suggest you give your foot a break. For a few weeks, reduce activities such as jogging, aerobic exercise or dancing that subject your feet to high impact.

How might yoga fit into this healing process? Well, I, and many of my students, have noted that regular asana practice leads to a slight widening of the feet. This may be because the practice is done with bare feet (no shoes!). Regardless, this additional space might translate into enough space between your metatarsals to relieve the pressure on the nerve and allow healing to take place. We also often encourage students to spread their toes wide, which could travel upstream a few inches and also provide some much-needed space in the front foot. Finally, a modified practice, done with the buttocks supported on a chair for standing pose variations, as an example, could keep much of your body active while allowing your feet to have less pressure on them. And, of course, a regular practice of inverted poses could relieve all of the blood pressure effects of normal upright walking and standing, giving your feet a real rest. I’d recommend Legs Up the Wall as a “must do” on a daily basis for healing and recovery.

Next time, we’ll look at heal spurs in the mix of the other things our student has going on.  Until then, tread lightly!

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