Hi, I'm Dr. Andrew Cohen, and today we're going to be talking about a foot problem that causes
intense pain but is oftentimes misdiagnosed and poorly treated. It's called Morton's neuroma.
So Morton's neuroma is caused by a squeezing of the foot, whether it's a result of a biking
or a climbing shoe that puts a lot of pressure in the forefoot, or even a high heel that puts a lot
of pressure on the toes, wow look at that toe box, or just wearing a shoe that does not fit
your foot. By the end of this video we're going to make sure you understand what caused the problem,
how to fix it, and make sure it never comes back again. Let's dig into Morton's neuroma.
I got really good at Morton's neuromas after working with runners. And we work with all
types of runners, whether you're doing a 5k, or you're an Olympian. Now the thing that is true
across the board with all runners is typically they try to power through whatever the issue is.
They put on the blinders, and keep repeating to themselves "no pain, no gain, no pain, no gain",
and that does not work with Morton's Neuroma. So it progressively gets worse and worse and worse,
to the point where simply putting a step down on a hardwood floor feels like there's a giant
boulder inside of your shoe. So if you have that going on, any kind of pebble in your shoe, or
experiencing some issues around the toes where you have numbness or burning, that's Morton's neuroma.
So if I had a foot, (TWO CLAPS) FOOT! Then we could really understand this, so,
the top third of the foot is where we see Morton's neuroma symptoms, if your issues are on the bottom
two-thirds of the foot, it's not Morton's neuroma, most likely. That might be plantar fasciitis or a
heel spur. But typically, if the issue is on the top third of the foot, it's most likely Morton's
neuroma. It could also be a stress fracture or a condition called metatarsalgia, which we won't dig
in today, we'll just dig into Morton's neuroma, because if you have these symptoms, that's most
likely what it is. So if this arch right here gets irritated, it squeezes the nerves that go out to
all of the toes. That's why you feel that burning or numbness sensation. That boulder type sensation
is a result of the 26 bones of the foot collapsing onto that nerve because there's so
much inflammation and irritation. So, let's talk about a simple at-home test that you can do right
now that will let you know whether or not your footwear is the right fit for you. Let's dig in.
A simple test you can do at home with a box and a marker is called the trace test. It's an easy one,
just stand on a cardboard box or a piece of paper and trace the outline of your foot.
This will give you an understanding of how wide your toe box should be.
Then, you simply grab a shoe you're considering, for example, this dress shoe.
This is going to be a really uncomfortable day. Trying to imagine this big foot, inside of this
tiny toe box, it just doesn't make any sense. I don't know why they design shoes like this.
Compared to my trail running shoe, and these are Altras. Altras make sure that they provide what's
called a natural toe box. So, you can tell this would fit in there very easily. You can also pull
out the inside of your shoes insole, for example on the dress shoe, and compare that if the shoe
itself is a little obtrusive and difficult for you to understand whether or not it would fit.
Compared to my custom orthotic, which is made for my foot, lifts up my arches in the right way,
and make sure that I have enough space for my toe box. So that's the trace test, try it at home,
that'll give us a lot of insight, and next let's talk about normal foot biomechanics and mobility,
and how you can improve that both at home and with your health provider. Let's dig into biomechanics.
Now i'd like to give you some tricks and tips on how to relieve the pain
that you have going on right now. So previously we talked about how to make sure you get in the right
footwear for you and what a normal toe box should look like, and I really like Altras, both their
trail running shoes and their street running shoes are fantastic for me. I'll put a link below, but
if you have a pair of shoes that seem to alleviate your pain, please share that information with us.
We're going to look at this as a group learning effort, and we love hearing about what actually is
successful for each and every one of you. So, in your home, most people have some type of a ball,
that's where I would start. So whether it's a golf ball, a lacrosse ball, or a tennis ball,
just start off by sitting and gently starting to put a little bit of pressure around that area
where you feel the marble or the stone inside of your foot, where you feel like it's putting
pressure on the nerve. Now I wouldn't start by directly putting all of your pressure on that
sort of very center of the marble, because we don't want to irritate it, so start by going
around in concentric circles around that area to loosen up the tissue. That should provide you some
level of relief. Sometimes if the ball is too big and the tissue is too, too specific, it's
very difficult for you to target that section. So what I would suggest next is to use that same
sharpie used for the trace test, and use it as a massage tool. The back of a sharpie is really nice
for getting in there and working around, freeing up that marble, if you think of it as a marble
that's putting the pressure on the nerve. And just gently go around, and none of these should cause
really sharp pain going out to the pain, or to the toes, it should feel like a massage of tissue that
needs to be massaged, no nerve pain. So do that, you can simply do it for one to three minutes,
and it should also give you some relief when you go to stand up. When you stand up after that,
kind of move it around and if it feels like you're getting close, that's where you want
to jump into right away. Now the other thing that I found is useful for at-home approach is
an a bite extraction kit. Now this is a random one, in our office we use fancy cupping tools,
but these for only 15 bucks or so, maybe 20 bucks, you can use a bite extractor kit to create suction
to create a little bit more space in that area. So, you put it on, it starts to push open
the tissue and separate out all the different layers of the tissue, so you could do that again
around that section, I wouldn't start off right in the most irritated section, but once you have it
there you can gently move it around a little bit, which moves that tissue and can provide a lot of
relief. If you've tried all these and they don't seem like they are creating the relief that you're
needing to be able to get back to your sport, do not, and I repeat, do not just try to plow through
and just keep running on it, playing on it, climbing on it, it will slow down this whole
process. This is where it's really important for you to find the right provider, and next
we're going to talk about what that provider should be doing with you at each and every visit
to make sure they're not just wasting your time duplicating what you've already tried but they're
going at this with precision level care to avoid surgery, which is our last case scenario.
My goal is to keep you out of the doctor's office, including my own, but sometimes there are
some stubborn cases that won't get the magical relief that others get from all of these steps
that you've taken so far. And in that case, it is critical that you find the right provider for you,
so I'm going to talk you through what to look for in a provider,
what they should be doing with you at their visits so that they aren't wasting your time and you can
get the quickest results possible. So, I've found that for athletes who are dealing with Morton's
neuroma for a little while, they've tried all of the home care tips that we previously discussed,
Graston is incredibly useful. And what Graston is, is basically using a metal instrument to get
in there and do what we were pointing at with the sharpie, but the thing about the metal instrument,
is it creates a higher vibration, you can feel it in the tool when you're getting close to the
areas where you have more adhesions. So we can get in there and we have specific sized tools
to work all around where that nerve is entrapped. It works really well. The other thing we can do is
what's called Gua sha, and Gua sha is a similar idea, where we're using an instrument or a tool
to get in there and there's all different types of shapes, which allow us to work that area to
free up that nerve. Sometimes we'll add in some movement as we're working the muscle, to try to
what's called "active release therapy" or "active release technique" to get even more flexibility
in there to recreate the irritation which happens when you're under load, because sometimes people
can get some relief with these home exercises, and they can walk around in their house barefoot
on hardwood floor, but then when they lace up their shoes, even if it's the right shoe,
when they start pounding on it, the irritation is too great for them to be able to run and play and
do the things that they love. So that leads us to orthotics, and orthotics
is a little bit of a controversial topic, many people have very strong opinions about orthotics,
and let me talk to you about what my vision is on orthotics. Orthotics are not for everyone,
but if your arches are collapsed and they're not supporting the bones of the foot, all 26 bones,
then that puts a lot of pressure onto the nerves. Now as I mentioned before,
we could do some type of movements with the ball, if you see a specialist, a chiropractor can get in
there and do specific chiropractic adjustments to free up that area, but if it feels like the
pain is coming back again and again and again then that means your feet are not supported when you're
under load. So that's where the orthotic comes in. So, like I mentioned before, in a custom orthotic,
its goal is to support your foot the way your foot is. So, this one supports all three arches
of the foot. Most shoes just support this medial arch. But in Morton's, it's this arch up top that
is really the one that's collapsing and irritating that nerve. So, getting you in a custom orthotic
that allows the foot to move, and I love that these are flexible and allow the foot to move the
way they should, versus being a hard rigid piece of plastic that kind of locks you in place. So
orthotics, not for everyone, but if your feet are not supporting your arches, it is a game changer.
And the thing I would say on custom orthotics or any orthotics, even over-the-counter orthotics,
the trick is make sure that they are returnable. So even our custom orthotics, you're allowed to
return them for the first few months. We want to make sure they're right for you and we do
not want to waste your money. I've seen people buy four or five over the counter orthotics that did
not work for them, and they just sit in their closets, and especially you don't want to deal
with that when you spend a few hundred bucks on a custom orthotic. Thanks so much for joining us,
I really hope that this helps get you out of some of the pain that you're experiencing right now. I
know how hard it is to be away from the thing that you love, and boy, oh boy does your stress level
raise right through the roof. If you're still looking for some at-home tricks and tips, we have
two other Morton's neuroma videos which covers a slightly different angle and approach than what
this video covered, so definitely feel free to dig into those, we'll have a link to that
above, and the goal there is to avoid invasive surgeries which can take you out of doing your
sport for extended periods of time. Let us know what worked for you in the comment section below.
Our goal is really to nurture the community, YouTube has really helped me with lots of
different projects and conundrums that I've had, so it's been an honor to try to provide
some resources to all of you. We look forward to seeing you in the next video, we try to put
out content regularly. If you have questions it and you write those in the comments below,
it does help sculpt what we put out next, and if you're ever in California, we do see people from
out of state and we sculpt a specific care plan that revolves around them just being in town for
two to three days. So if you're ever interested in that we'll put a link below as well,
for you to dig into understanding what it would be like to see us if you ever decided to do
that. But until the next video, thank you all for watching and we look forward to seeing you again.