Runners, triathletes, dancers, hikers, cyclists, almost all athletes, and even couch potatoes have shown up in my office looking for alternatives to surgery for neuromas. A Morton's neuroma occurs when the tissue in the foot (next to a nerve that leads to a toe) thickens and becomes fibrous. The result is pressure on the nerve causing irritation, usually between the third and fourth toes.

In athletes who run or perform on their feet the repetitive motion of extensive training increases their chances of developing a Morton's neuroma. Shoes are incredibly important. Unfortunately, many of the shoes don't provide proper structural support or cushioning for their feet.

This is also a challenge for women because of high heeled shoes forcing the weight forward onto the balls of their feet. Yet, some women and athletes do not develop Morton's neuromas even with extensive training. Obviously the quality of the shoes is a factor, but the structural support that includes the foot and the entire leg is just as important.

Ironman Training

Meghan, a 26-year-old Ironman competitor, developed a neuroma during her training for her second Ironman competition. She first noticed it when the running phase of her training reached approximately 15 miles. The pain was severe—to the point that she couldn't walk at all for several days and felt like there was a nail in her foot. After several trips to the podiatrist, cortisone shots, Botox shot, orthotics, and missed weeks of training, the medical solution for her Morton's neuroma was surgery, which meant missing a minimum of six weeks of training. This would eliminate her ability to participate in the Ironman competition for which she was currently training.

She came in for treatment with a goal of continuing her training and being in shape to better her time from last year's Ironman competition. Since her neuroma had developed in the long distance running phase of her training we examined the shoes that she had been wearing to see if they were contributing to the problem. They were suspect because she had gotten new, supposedly better running shoes just two weeks before the Morton's neuroma appeared.

One of the great things about applied kinesiology is the structural support of shoes, as it affects the structure, can be tested. We tested her new shoes with the orthotics that had been custom made for her and she tested weak. Her body was saying it was obvious that the orthotics were not helping. Her shoes were then tested without the orthotics and they again tested weak. So, not only were the orthotics exacerbating her neuroma, but her shoes were not providing proper support. I taught her how to take a friend to test for appropriate running shoes, which she promised to do.

My Evaluation

It was now time for a structural evaluation. She had a left anteriorly rotated ilium, a medially rotated left knee, and the left foot with the neuroma was laterally rotated with a collapsed arch. It was easy to determine this was part of the spiral twist in her body, the core distortion, and changing the lack of structural support by applying Cranial/Structural Core Distortion Releases (CSCDR) was necessary.

After it was applied there was significant improvement in her structure. Her left ilium showed approximately a 15 degree improvement from its anteriorly rotated position—so it was now supporting her sacrum, her functional leg length had evened out, and her left knee was no longer as medially rotated.

Her foot and lower leg were no longer as laterally rotated, and the arch was not as collapsed. There was a more even triangulation of weight distribution in her foot at the calcaneus and ball of the foot, behind the big toe and little toe. Also, there was improved strength and function in her quadriceps, adductors, gastrocnemius, soleus and popliteus, which were evaluated with kinesiology.

The Rehabilitation

There was now a structure for rehabilitation. Specialized myofascial soft tissue protocols were applied to bring the leg further into balance and increased support to the ilium/sacrum relationship. The lower leg was treated to bring the foot further into support and balance. Specific myofascial fiber strokes were then applied to spread and soften the thickened tissue of the Morton's neuroma. This work was sensational, but after each stroke there was a noticeable decrease in her pain.

After the session Meghan was able to walk with minimal pain and asked if she could work out right away. Ideally she should wait until all the pain was gone and then start working out slowly.

However, given her training regimen and her desire to be ready for her Ironman competition, I knew this wasn't going to happen. So, she agreed to ice the foot and not train the day of the session.

Usually, when treating a Morton's neuroma, sessions are scheduled once a week, but since Meghan was going to continue her training she was scheduled twice a week, as the training would continue to irritate the tissue while it was healing. Meghan had a total of six sessions, twice a week while she continued to train. In each session she was evaluated structurally.

Cranial/Structural techniques and specialized myofascial techniques were applied to improve her structure, especially the weight bearing support of her left leg and foot. The work on the neuroma progressed to the point it could no longer be palpated or located. The tension was released in the fibers in her lower leg relating directly to the neuroma, which no longer stood out either by palpation or by sensation. By her sixth session her running had reached the 20-mile mark and the pain and discomfort from the neuroma was gone.

Meghan competed in the Ironman competition and posted her best time. The key to Meghan's recovery from her neuroma was correcting the structural collapse that went down her body into her foot.

Resource

1. Don McCann, The Evolution of Releasing the Core Distortion. Massage Today, July 2014.