Morton's Foot?

[zia]

Just read a book on trigger point therapy and realized I have Morton's Foot -- very long second metatarsal. I immediately followed the book's recommendation and added a light moleskin pad (maybe 2 mm?) beneath the ball of my first metatarsal, on the bottom of my insole. But... I saw in another post that someone with this condition was looking for a pad significantly thicker. Is that just personal preference, or is moleskin too thin?

Secondly, does the padding help? I have a nearly endless list of leg/foot/hip injuries (PF, stress fractures, knee pain, ankle pain, hip pain -- primarily from running, but biking doesn't help) and am curious how much difference this will make...

[snapdragen]

I just saw a podiatrist this week for excruciating foot pain when walking. I don't have the same diagnosis as you, but close. My doc has me using these:

http://www.ourhealthnetwork.com/stor...sp?item_id=377

Only I do not put them on the ball of my foot, but back further, same as your moleskin.

[pfunk12]

A few years ago when I was doing a lot of mileage while training for a marathon, I was experiencing a lot of foot pain. I went to a podiatrist and learned that I had Morton's Foot but the pain I was experiencing was from neuromas - in both feet. The pads that the podiatrist gave me were fairly thick - with holes cut out in the middle. To be honest, they didn't help but that's because the neuromas had gotten too big. I used the pads, got cortisone shots, completed the marathon but eventually had to have surgery to remove the neuromas.

I hope the pads that you end up using help ease any pain you have!

[OakLeaf]

That would be me.

They help incredibly well in my walking-around shoes. Yes in pain and trigger points, but most obviously, in balance in everyday activities. I'm still adapting to them in my running shoes, but once I get the size and placement sorted I'm sure they're going to be great.

Molefoam just wasn't nearly enough for me. What you need to do is put your ankle in neutral, see how high your big toe joint is off the ground, and make your pad that thick (taking into account compression of both your foot flesh and the pad itself). One of the sites selling "proprioceptive" insoles has 3 mm and 6 mm sizes. I'm taping and gluing all kinds of stuff inside my running shoes right now but the mouse pad seemed to be roughly the same thickness as what I have in my walking-around shoes.

[OakLeaf]

You might try experimenting with your walking-around shoes first, as I did. When you're running, the forces just make the chance of injury that much greater if things aren't right, plus you don't really want to stop and make adjustments on your shoes in the middle of a run.

Also, the difference in your ability to balance shows up a lot more in your ADLs than it does when you're moving straight ahead on pavement.

I've found that I want at least some padding under my big toes, in addition to under the joint. Otherwise, it's just too long of a reach for my toe to reach the ground.

I'm definitely giving my body some time for the muscles to re-train themselves, too. I'm not running nearly as short as they tell you to when you're adapting to barefooting, but I haven't done a long run in the pads yet, and unfortunately I think I'm going to have to run next week's half-marathon in my old orthotics.

What have you been using up til now? OTC arch supports, custom ones, or nothing?

[zia]

Thanks, OakLeaf -- this is all very interesting. My walk-around shoes are very uncomfortable, and I walk just about everywhere. I'll have to improve those -- they are an old pair of poorly-fitting running shoes.

This morning, I ran for 2 miles in my newly-configured current running shoes. I put a small, 2-3mm moleskin pad under the insole beneath my big toe. I do wear custom orthotics. They are half-sole, and I'd just cut an old insole in half, leaving 1" of overlap at the midsole (probably very bad) so I put a full, flat insole in the shoe and put my orthotic on top of that. The ball of my right foot almost immediately cramped, but relaxed after a mile. I was definitely aware of the moleskin padding, and things felt... different. "Better" will remain to be seen, especially since I have a 10K race on Monday.

I got my first custom orthotics in 1996 after developing a stress fracture on my second metatarsal. I'm on my third pair and am surprised not a single podiatrist has ever mentioned Morton's Foot -- and that every pair of orthotics has focused exclusively on the heel and arch area of my foot, not the forefoot. I was reading "The Trigger Point Therapy Workbook," and when I got to the Morton's Foot section, I felt like was reading about myself. I have all the classic callus patterns, pain in many of the referral points mentioned, and, of course, a freakishly long second metatarsal!

I have been doing much with the Pose method over the past year, which also made me realize how unbalanced I am in regards to my forefoot -- when I deliberately try to land evenly on all my metatarsals (not easy), I notice an **immediate** decrease in pain.

I have my first trigger point therapy session on Friday and I'm very curious to hear what the therapist says about all my self-research.

Yet one more reason barefoot running might be a complete disaster for me. Oh. Well. Somewhere, out there, there's a secret to pain-free legs...

[OakLeaf]

I wouldn't make any changes for your race, but I'd try the padding without the arch support, not with. Assuming you still have the original insoles that came with the shoes? I knew I'd been keeping mine for a reason (other than the fact that I keep everything, no matter how useless).

The reason is, what you want to be doing is letting your muscles support your feet, not slamming your arch down on the orthotic, and that's what the pads let you do. They basically let you ambulate using the muscles that you're supposed to be using - getting the points of contact and push-off that a "normal" foot has. That's why the commercial sellers call them "proprioceptive" insoles - which I think is a misnomer, but it's a way for them to distinguish their product from arch supports (and charge you $50-100 ).

I'm really, really looking forward to getting some of these pads inside a pair of Vibram Five Fingers now. I never thought I'd be able to try those!

I'm on my third pair and am surprised not a single podiatrist has ever mentioned Morton's Foot -- and that every pair of orthotics has focused exclusively on the heel and arch area of my foot, not the forefoot. I was reading "The Trigger Point Therapy Workbook," and when I got to the Morton's Foot section, I felt like was reading about myself. I have all the classic callus patterns, pain in many of the referral points mentioned, and, of course, a freakishly long second metatarsal!

Yep, yep, and yep. And all those arch supports alleviated the arch pain and some of the knee issues, but left me with crummy balance and worse Achilles problems, besides not alleviating any of the myofascial issues all up my back body. And you can add physical therapists and orthopedic surgeons to the list of people who never mentioned it to me (and probably wouldn't know what you were talking about if you asked). Why would they tell me to try cutting up an old mouse pad, when they can get me to spend $200+ for orthotics for each pair of shoes, and get my insurance company to spend $700 for a knee brace? Actually, you can add a very excellent LMT to the list, too - obviously she's just not familiar with this condition, since she was well aware that I need to be doing something with my feet to keep my ankles in neutral and help with all the muscle imbalances. I'm sure she will notice the difference next time I see her though!


PS - ask the LMT for help putting your ankles into neutral, standing barefoot. They should be happy to help. Easier to do with a pair of eyes that's (1) not yours trying to look down at your ankles and (2) trained at recognizing a neutral ankle. That'll make it easier for you to figure how tall your pads need to be.

[nscrbug]

I've been using these metatarsal pads in my running shoes, with fairly good success -


http://www.hapad.com/hapadonline/pro...roductid=16155

[OakLeaf]

Under your first metatarsal?

If somewhere else, could they be cut down to fit under the first metatarsal only?

[NbyNW]

I've got this problem, too -- except it's more a case of my first metatarsal being really short, which also leads to the same callusing under the second. I've been using custom orthotics for years, but they don't do a lot for my forefoot mechanics.

Thanks for starting this thread, zia! I think I might experiment a bit with metatarsal pads, too.

[OakLeaf]

I'm curious... are your third metacarpals longer than your second?

Mine are. I wonder if there's a correlation.

[zia]

I'm curious... are your third metacarpals longer than your second?

What's the difference between a metacarpal and a metatarsal? My third is longer than my first... (but not my second).

[Owlie]

What's the difference between a metacarpal and a metatarsal? My third is longer than my first... (but not my second).

Metacarpals are the hand's equivalent of metatarsals.

http://en.wikipedia.org/wiki/Metacarpal

[kmehrzad]

I've got Morton's foot, actually feet, and have had surgeries on both feet to remove the neuromas (enlarged nerves). I've gone the orthotics route, had the cortisone shots (several times) then finally begged for surgery. All THREE surgeries helped get rid of the pain; however, had to have scar tissue removed from one foot which had a neuroma 10 yrs. prior.

My dr. told me to stop running and switch to exercises that do not involve pounding the pavement. On my bicycles I don't use clipless pedals; I'm concerned that the pressing of my foot against the pedal in a localized spot would cause pain again, so I use toe clips on my bikes. This works best in my case.

[OakLeaf]

Morton's foot and Morton's neuroma are two different things. Just named after the same doctor.