- One cortisone shot. Did not help.
- Started schlerosing alcohol injections every two weeks. Did 5 of them. I thought they might be minimally helping, but in the end, the doctor chose to stop the injections because I wasn't seeing significant improvements.
- Doctor did an MRI scan of my foot and concluded that I have a Morton's Neuroma, and also some edema in the 3rd metatarsal. However, google searches on this seem to confirm that MRIs are typically inconclusive.
- Doctor suggested neuroma surgery. Forums of those who have received the surgery had a lot of horror stories. I decided to get a second opinion.
- Gave me several pairs of metatarsal pads to use in my running shoes.
- Thought there wasn't much he could do about a MR in terms of physical therapy.
- Showed me some foot massage techniques to loosen up the area between 3rd and 4th toes.
- Showed me how to place metatarsal pads in my shoes.
- Did several manual tests on my foot.
- Did not think it was a Morton's Neuroma. Suggested metatarsalgia or synovitis. Why? Because I found being barefoot the most painful over wearing shoes, and he says the symptom is the other way around for MR.
- Wanted me to pick up marbles with my toes, 250 times per day. Sounds silly, but I started doing this. Not as much as he suggested and not every day, but I did this mostly at work at my desk with one shoe and sock removed. He said it would feel better after five weeks of this exercise, and he was correct.
- Suggested Powerstep Pinnacle Plus insoles in my shoes. At first I was against insoles in running shoes, being a proud minimalist. However, a month ago I finally hung up my stupid pride and tried some Powerstel Originals that I already had in my closet. Immediate pain improvement. So I bought the Powerstep Pulse insoles and tried those. Way better. Decreased discomfort 80%. Why? Because arch supports off load the pressure on your metatarsals and back onto your arches, where some of that pressure is supposed to falling anyway.
- Started a routine of at least one icing daily, a gel pack that folds so I get both top and bottom of my foot. Google searches often say icing is useless esp through a metatarsal pad, but my met pad is VERY thin and at the least, applying ice to an injury can't hurt it.
- Ordered a home TENS unit from Amazon. Started applying at least 15 min daily of therapy to the top and bottom of my foot. Another Google search concludes this is also useless, but again it doesn't hurt.
- Then I started reading about the link between gastrocnemius tightness and plantar fascitis. Calf muscles being tight seems to be the foundation for most foot injuries from running. So, maybe tight calves are exacerbating my metatarsalgia? Started massaging my calves manually and with a lacrosse ball and foam roller. Going to try the TENS electrodes next. One solution might be to go back to shoes that have a slight heel lift as this relieves some of the tension on the calves.
Running: I've been wearing Altra Olympus as recommended by the podiatrist as he said that I have some of the thinnest metatarsal pads and feet he's seen. He said "you need to add padding to your foot since naturally you don't have much". Also these shoes are wide and can handle the insoles and allow my toes to spread wide. But the Altra's disadvantages is that they offer no arch support and are zero drop. The Powerstep insoles resolve the arch support issue. And I think zero drop is great but possibly it is causing me issues. I'm not ready to give up on zero drop yet, but I have totally given up on shoes lacking a wide toe box. Currently the only brands out there offering the square toe box shape are Altra and Topo Athletic. I can't understand why other manufacturers dont at least add lines of shoes with this shape. People do not have arrow-shaped feet. Most of them don't. But most people also don't run many miles, so they can get by with shoes that cram their toes together and are the hottest designs and colors currently - features I do not value as someone who wants to put in a lot of miles without getting injured.
Casual/Work: I have had to give up on feminine shoes and heels. Here's what I finally figured out, me and my stubborn brain. Just ONE infraction causes at least one week of pain and suffering. The mindset you have to adopt is ZERO TOLERANCE for shoes that aren't geared towards alleviating your foot pain. That dinner at a fancy restaurant? Gotta wear the right shoes, not heels. End of story. What I found works for me: (a) flat boots that are a size too big with Powerstep insoles in them (b) Danskos (c) Chacos. I dont have to wear insoles in the Chacos or Danskos; they already have arch support.
Therapies I haven't tried:
Ultrasound - the effectiveness is inconclusive, but a home ultrasound unit is fairly affordable at this point and may be worth a shot.
Stuff that didn't seem to work:
- Toe spreaders/yoga toes - Didn't do anything for me. Too static.
- Advil - Not recommended for long term use. I do take some turmeric supplements daily but can't say if it helps.
If you want to see a PT for this condition, have them massage your foot and spread your toes out wide. Have them ice your foot and use TENS electrodes both top and bottom of your foot. Have them massage and stretch your gastrocnemius muscle. Try ultrasound as well.
Probably the best thing is to stop running. I haven't stopped (but have cut down to 15-20 miles per week on trails), and am reserving this course of action for the last straw.
My ortho doctor said he does not recommend MR surgery as it has lower than a 90% success rate and too many complications. Besides, removing a neuroma doesn't address the cause of the problem which is why so many people get a recurrence. Your feet are so delicate - don't cut into them unless your problem is very debilitating.