Thursday, June 7, 2012

Simple Explanation of Morton's Neuroma

I recently had the chance to have a few long conversations with a podiatrist that is pretty famous in my area of Grand Rapids, MI.  He long ago quit doing surgeries in favor of adjusting the bones of the feet to provide "long lasting relief."

He said it came from doing "to many surgeries for a bunion or neuroma and seeing it come back a few years later."

His explanation for how he thinks a neuroma develops is one of the best I've heard.  My personal understanding was that the common neuroma between the 3rd and 4th digit of the metatarsal was from the compression that happened from a tight toe box in a shoe.  He extrapolated on this concept.

When the cuboid bone becomes misaligned, the foot on impact can no longer lock the lateral line of the foot for stability on impact.  This allows for the foot to actually increase the degree of pronation that occurs.  Now, because of this the metatarsal bones rotate.  The lateral 2 rotate laterally, the medial three rotate medially.  With this the plantar nerve is put under quite a stretch, thus irritating it.

Your body has an ingenious way of protecting itself.  It grows a protective coating.  Picture, scraping your hand every day.  What happens?  A callous forms.  Irritate the plantar nerve with each step, a callous will start to form around that structure.  You get a Morton's Neuroma.


Anonymous said...

so, how are the bones of the foot realigned? The doctor I saw recommended a plate be installed to fuse the joint/bones of my big toe. He said this would relieve pressure on the neuroma. Thoughts?

Jason Ross said...

I would get a 2nd opinion. I would exhaust every other possible treatment before a fusion of the big toe.

I have never seen someone that has had the big toe fused happy with the outcome or happy with the results of the big toe fused.

Lack of proper movement in the big toe can lead to repetitive back pain and other ailments.

If you don't plan on ever really being active (in terms of really long walks, hikes or running). There is less risk. But if those are things you enjoy, I would be very, very cautious.

The Podiatrist I work with aligns the bones in proper position through manipulation and tapes them.

J. Bosley, MD said...

Would you be able to share the name of this podiatrist, or encourage him/her to do a video demonstration of the techniques used? This is fascinating stuff.

Jason Ross said...

His name is Dr. Allyn Peelen DPM . He routinely trains other health practitioners that are looking for an alternative treatment. He loves to share his knowledge base.

KH said...

You could see a Chiropractor, they realign bones in the foot all the time. I had a problem with a nerve in my foot and the pain was fixed after 3 treatments.

Alyssa Raterink said...

Do you know of anyone else in the Grand Rapids area who does cuboid adjustment? I recently saw Dr. Peelen and he adjusted my cuboid (which he felt caused my peroneal tendonitis and lower back pain) but he doesn't accept insurance and is quite expensive. Thanks!

Kate Ardinger said...

Alyssa, did you ever find anyone else in Grand Rapids (or elsewhere) who does cuboid adjustment? I have been dealing with peroneal tendonitis for a few months and have been seeing Dr. Peelen, but like you said, he is expensive considering he does not accept insurance.

Alyssa Raterink said...

Kate no I did not

Daniel Ebright said...

If your cuboid is not staying in place, I would suggest you get orthotics from Dr. Peelen. When you get the orthotics, shop for a pair of shoes that have a removable insert and where the sole of the shoe is flat and stable. Take the insert out of the shoe and put the orthotic in the shoe. The orthotic should sit flat in the bottom of the shoe. If it does, then you have a shoe that will work well with the orthotic.

Go to Jo Ann Fabrics and buy a 1/4 in foam padding. It is usually in the kid's craft department and comes in 8.5 x 11.0 sheets. Cut an insert that fits the bottom of the shoe. You can trace the shoe insert to do so, but you will have to contour the arch area so it does not ride up on the side of the shoe. Put the foam insert in the shoe and then tape the heel of the orthotic so it sits tight in the back of the shoe. In essence you are trying to get the orthotic to sit like it sits if you just have it on the floor.

I know this is a lot of steps, but I have been an orthotic wearer for 32 years (and Dr. Peelen patient for that long) and this is the most comfortable way to get the orthotics to work. I figured this out in the late 90's and I haven't needed to see Dr. Peelen often since then, maybe once every 5 years, if that.

Dan Ebright