Mortons Neuroma is a condition we frequently see at the San Diego Running Institute. This painful foot condition is often misdiagnosed or confused with plantar fasciitis or Metatarsalgia. A runner will complain of pain in the ball of their foot usually just behind the second or third toe that either causes numbness into the toes or shooting pain into the toes. The pain can be intense or just a dull ache that they describe but usually gets progressively worse with activity. The pain can be intense enough to cause you to stop running and even result in a limp. Often, these runners have been to a foot doctor or sports doctor who made them custom sports orthotics with a metatarsal pad. When I ask the runner if it helps they will typically reply “no” and that “it does not help at all and may be making it worse”. The problem is that the metatarsal pad has been placed incorrectly on the custom orthotic. It is essential to have the metatarsal pad in the correct location in order to ease the condition. The nerve between the 2nd and 3rd metatarsals is inflamed due to narrowing of the space between them. This irritates the nerve which then causes the shooting pain and/or numbness into the toes. When the metatarsal pad is placed correctly just behind the metatarsal heads (just behind the painful location) alleviation of the foot and toe pain is achieved. It is not unusual for me to correctly place a metatarsal pad for a patient and have them walk pain free right then and there! There are many different metatarsal pads available but I have found the Pro-Tech Metatarsal pad to be the easiest, most convenient and effective metatarsal pads to use for Mortons Neuroma. While this is a fast and effective treatment for Mortons Neuroma it is sometimes not enough to fix this common foot injury.
Metatarsalgia is related to repetitive high-pressure loading under the metatarsal head (MH) that causes pain. The high pressure under the MH can be reduced by adequately applying metatarsal pads (MPs). Plantar pressure measurements may provide a method to objectively evaluate pressure loading under the MH. However, it is still unclear if the decrease in plantar pressure under the MH after MP treatment is associated with subjective improvement. This study aims to explore the correlations between subjective pain improvement and outcome rating, and the plantar pressure parameters in metatarsalgia patients treated using MPs.
Thirteen patients (a total of 18 feet) with secondary metatarsalgia were included in this study. Teardrop-shaped MPs made of polyurethane foam were applied just proximal to the second MH by an experienced physiatrist. Insole plantar pressure was measured under the second MH before and after MP application. Visual analog scale (VAS) scores of pain were obtained from all subjects before and after 2 weeks of MP treatment. The subjects rated using four-point subjective outcome scales. The Wilcoxon signed-rank test was used to analyze the difference between the plantar pressure parameters and VAS scores before and after treatment. The Kruskal-Wallis test was applied to compare the plantar pressure parameters in each outcome group. Pearson’s correlation was applied to analyze the correlation between the changes in plantar pressure parameters and VAS scores. Statistical significance was set as p < 0.05.
MP application decreased the maximal peak pressure (MPP) and pressure-time integral (PTI) under the second MH and also statistically improved subjective pain scores. However, neither the pre-treatment values of the MPP and PTI shift in the position of the MPP after treatment, nor the age, gender and body mass index (BMI) of the subjects were statistically correlated with subjective improvement. Declines in the PTI and MPP values after MP application were statistically correlated with the improvement in VAS scores (r = 0.77, R2 = 0.59, p < 0.001; r = 0.60, R2 = 0.36, p = 0.009).
We found that the successful decline in the PTI and MPP under the second MH after MP application was correlated to subjective pain improvement. This study provides a strategy for the further design and application of MPs for metatarsalgia treatment.
When this “quick-fix” fails the San Diego Running Institute can refer you to Dr. Victor Runco. He is a foot pain specialist and has helped hundreds of runners and non-runners with Mortons Neuroma and other foot pain conditions. If you have pain in the ball of your foot or have been diagnosed with plantar fasciitis, Mortons Neuroma or Metatarsalgia and have not been helped stop by the San Diego Running Institute and talk to one of our running specialists or if you prefer call and schedule an appointment with Dr. Runco by calling (858) 268-8525.