Why Neuromas & How I Cured Them
When I learned I had Morton's neuromas, my whole athletic life flashed before my eyes. I couldn't run, jump or play sports without the balls of my feet screaming in pain, and the more inflamed they got from trying, the more painful they were to bear.
Neuromas are inflammation of the nerve tissue between your metatarsal bones in the ball of your foot - the base of all athletic positions. Doctors think they're caused by tight-fitting shoes and activities with constant forefoot impact like running, but overall the cause of neuromas is largely misunderstood and there is supposedly no cure.
I first experienced pain in the ball of my L foot in June 2018 while split jerking. My L foot was my back foot and every time it hit the ground it felt like I was stabbing a sharp pebble. Those with neuromas know exactly what I mean, but at the time I didn't yet know I had neuromas so I switched to power jerks (both feet land flat) and kept training around the somewhat bearable discomfort.
Six months later the pain wasn't going away, so I consulted with 2 podiatrists and got an MRI to officially diagnose that it was in fact Morton's neuroma. The first podiatrist prescribed several rounds of steroid and alcohol injections, which ultimately did nothing for my symptoms, and the second podiatrist (who was a surgeon that did not recommend I do the surgery) performed a radio-frequency ablation procedure to essentially burn the nerve endings of the neuroma, but that also did nothing for my symptoms.
The MRI imaging showed I have two neuromas the size of fat blueberries in my left foot, in addition to some bursal sac inflammation that needed to calm down. I was advised to stay off the balls of my feet and away from any activity that would further aggravate symptoms. Nevertheless, I eventually felt them develop in my right foot too.
Despite no success from being a patient to the above foot experts, I kept an open mind hoping I would meet someone in a different field that knew how to cure my symptoms. After a one-time consultation with an athletic trainer, I walked away with half a dozen foot and toe exercises to work on daily, many which helped me connect my feet to my core but ultimately provided no symptomatic relief to be able to return to athletic activity. I tried asking my chiropractor to manually work on my shins thinking it might help tissues and bones to glide better together, but that also did nothing for my symptoms.
Up until that point all of the "conservative treatments" I underwent provided short term relief at best, but my pain lingered and unpredictably worsened in the months following. I was also frustrated that I'd spent $3,350 for essentially no return on investment only to be left feeling hopeless that I would ever alleviate my symptoms and be able to run, jump and play sports again.
(Related: How Training Cured Her Neuroma)
Out of desperation I almost considered surgery to excise the neuromas, but the procedure had little promise and would require snipping my transverse metatarsal ligament in order to take out the inflamed nerve tissue, leaving me with a destabilized foot and partially numb toes. As a trainer I understood too well that sacrificing the integrity of my foot would guarantee more complications down the road, regardless of whether the surgery turned out to be successful in removing the inflamed nerve. For that reason I decided not to undergo a surgical excision, but I didn't stop seeking out other opinions on how to resolve the nerve pain.
I also kept noticing that nobody had examined the rest of my body above my feet nor considered how other positional factors might be perpetuating symptoms. Looking back it's astounding that no one thought to seek out the origin of my symptoms or to understand why I developed neuromas in the first place and work backwards to problem solve. After all, this is how my brain works!
I took a chance in consulting with one more PT, knowing that like me he would take a holistic approach in assessing and treating the human body. In our one single session he pointed out my flat thoracic spine between winging shoulder blades, something I've always noticed about myself, and helped me understand that the position my skeleton was stuck in was shifting my weight onto my toes. This was an ah-ha! moment for me as a trainer because in 2017 I had started to grasp principles of respiration and pressure management, and was therefore able to manipulate exercises so as to drive long-term changes in posture.
Clearly my body (far left) had been living on its toes 24/7, lacking the normal convex kyphotic curve in the upper back, and presenting an excessive lordotic curve from the middle back down to my sacrum. (Please note: neuroma patients can vary greatly in their postures and don't always present the same.) With all that backside compression shoving me forwards, it was no surprise that my forefeet took the bullet for a global compensatory strategy that kept from falling on my face. It finally hit me that in order to get my neuromas to quiet down I had to start training in positions that restored balance to the left and right sides of my body so that every joint from head to toe (including the 33 joints that make up the foot and ankle!) would gain back sufficient range of motion to glide and slide more happily upon each other.
Decreasing my neuroma symptoms meant addressing how my body was managing and distributing pressure throughout, else experience no meaningful change.
To achieve the posture on the far right required tailored breath work in specific positions to rotate the rib and pelvis bones through degrees of motion in which they were not doing so, followed by loading my skeleton in those new positions (resistance training) so that they would stick. Even as a movement professional myself, strength training in these positions was extremely counterintuitive at first because to the brain it was like trying to learn a different language. With enough repetition and self-coaching though, I developed a newfound awareness of my body positions along with ability to sense whether or not the desired muscles were working to properly execute a given exercise.
Every day that I trained I would first reposition with breath work, then follow it up with movements that reinforced integration among my foot, ankle, knee, hip, rib cage and shoulder. My symptoms would immediately diminish if not disappear to that point I could train planks, skips, jumps, lunges, push ups, split squats, etc. without any pain whatsoever! By July 2019 I had figured out that the only times I would experience symptoms were after a prolonged period of sitting or laying down, like when I got out of bed in the mornings or when I stood up from a chair. But then that pain was so minimal that it would go away by itself after walking a few foot steps. Even if symptoms lingered, I knew exactly what exercises I needed to reposition my skeleton to make them go away.
Little by little I got back into classic olympic lifts (snatch, clean & jerk) and gradually took up sprinting. By the fall of 2019 I was jumping, skipping and running all pain free! If symptoms ever acted up during training, I'd perform a quick restorative breathing exercise between work sets to restore position and then my feet were good to go again. As far as I knew, this was as good as it was going to get and I was willing to put in the work daily.
Fast forward to summer 2020, I discovered a missing piece of the puzzle to disappear my symptoms: teaching my feet to pronate. This includes recognizing what the shin, knee, femur, and hip are doing in relation to the foot.
An Achilles strain and tibial stress reaction (quarantined blessings in disguise) forced me to take a big step back from training and figure out why I got injured in the first place. I sought help from some of the best of the best to gain insight on what had happened from a training perspective, and then understand what I needed to do from a rehab perspective so I could get back to jumping and sprinting without issue. What I learned about my L foot was that it could not truly pronate, despite appearing to be flatter than my R foot. Both feet in fact lacked degrees of motion in the mid-foot, which are necessary for your arches to spring up and down from the floor during walking, running and jumping.
The foot and ankle are a whole beast of a topic, so to keep it simple: An assessment discovered that my L heel would lift off the floor before the arch had a chance to relax down to the floor as I bore weight through it. Instead of my heel staying heavy on the ground, it would come up too soon causing my toes to grip for dear life.
This was a BIG CLUE in appreciating how the inter-metatarsal nerves developed inflammation. The bones surrounding the nerves weren't moving and gliding the way joints are supposed to!
You can see in the video above what is supposed to happen when the foot moves through pronation and back to supination every step we take. The long metatarsal (toe) bones should spread as we load our weight onto the mid-foot, keeping the heel heavy in contact with the floor before going into toe-off in which the foot arch springs back up. Note: the video does not show what the rest of the body is doing above the foot when it moves through pronation-supination, and that matters too!
If you've ever worn a metatarsal pad to manage your neuroma symptoms that's essentially the purpose it serves, only it doesn't teach your foot how to actually pronate like a healthy moving foot should. This means that whether you wear the metatarsal pad or not, your foot still won't pronate properly unless you drive length into the necessary tissues via regular strength training. Furthermore, one's awareness of foot pressure is far too overlooked when training with Morton's neuroma - this is something I teach my clients from day 1.
As soon as I learned how to properly position myself in lower body exercises, my foot was able to move naturally through pronation and supination - something completely new that it hadn't been doing before. Upon regular exposure to that novelty, it started to happen more naturally both during training and outside it because I could actually get into and out of the correct body positions to impact what the foot was doing and vice versa.
When I got out of bed the next few mornings, my feet didn't feel stiff nor did I have to walk around to desensitize the ball of my foot. As I went to prep for training, I felt no symptoms that warranted my usual breathing exercises to shift my weight back to my heels. Years later I'm still pain-free 99% of the day and night, and I can sprint, jump, skip, play tennis, run with my dog and do it all without symptoms, knowing that if they ever do show up on occasion I have the tools to make them disappear. If you ask me how I cured my neuromas, my answer would be coaching myself into better training positions.
This is how we get change to stick long term, and it's how I've helped numerous online training clients do the same. You may read their stories here and learn if the strength training approach is right for you.
If you think you've exhausted your treatment options for MN and are still hopeful for a cure, I'm here to show you what's really going on with your body and provide coaching that will diminish your symptoms for good.