Fellowship of the Morton's Toe

Discussion in 'Health, Nutrition, Injuries & Medical Conditions' started by Nyal, Sep 30, 2010.

  1. Barefoot TJ Administrator
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    Here is a copy of a post I shared in a Ask the Docs thread where Kozz is having to deal with this condition...

    This sounds exactly like a Morton's Toe discussion! Yikes! So much of us are affected by MT!

    I hope you are able to manage this thing, Kozz. Good luck to you!



    Freiberg's Disease


    - Discussion:
    - anterior metatarsalgia that involves head of second metatarsal;
    - occurs during the growth spurt at puberty - most are female;
    - caused by avascular necrosis of the metatarsal head;
    - from repetitive stress with microfractures at the junction of the metaphysis and the growth plate
    - these fractures deprive the epiphysis of adequate circulation;
    - disease is more common in pts whose 1st metatarsal is shorter than 2nd metatarsal, which increases wt on 2nd metatarsal head;
    - in adulthood, DJD may develop in MTP joint;
    - Clinical Manifestations:
    - pain in the forefoot, usually localized to head of the second metatarsal;
    - wearing of high heeled shoes makes condition worse;
    - localized swelling and limitation of motion in MP joint;
    - Radiologic Findings:
    - initially the epiphysis becomes sclerotic;
    - early in disease, joint space is widened, much later, it narrows & irregular bony surfaces, sclerosis, & bone spurs at margins give the
    appearance of osteoarthritis;
    - epiphysis becomes fragmented followed by osteolysis & reconstitution of bony archetecture;
    - fragmentation and osteolytic phases:
    - metatarsal head becomes irregular, widened, and flattened at articular surface;
    - Diff Dx:
    - Ewing's Sarcoma
    - Stress Fracture
    - Osteosarcoma
    - Treatment:
    - initial management includes proper foot wear w/ metatarsal bar or pad placed beneath the involved bone;
    - limit activity for four to six weeks;
    - w/ severe symptoms consider immobilizing foot in short leg walking cast until symptoms subside, usually in 3-4 weeks;
    - surgical indications: rare:
    - failure of conservative treatment;
    - surgery may be warrented to remove metatarsal heads


    Freiberg Disease Complicating Unrelated Trauma.

    Surgical Treatment of Freiberg's Infraction in Athletes.

    Frieberg's disease: A suggested pattern of management.


    Original Text by Clifford R. Wheeless, III, MD.

    Last updated by Data Trace Staff on Thursday, April 12, 2012 10:05 am

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  2. Sid Barefooters

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    It all makes sense now!

    - Used to have a callous under 2nd met.
    - Used to have TOFP across 2-5 mets.
    - 2nd met used to be tender after running.
    - Footfalls previously favored 2-5 mets on left foot, even when trying to land on 1st met.
    - Left 1st met didn't reach the ground with the foot flat, even when 2-5 did.
    - Positive knuckle test on both feet.

    Again, I'm no foot expert, but here's my personal story:

    Somehow I learned to run barefoot, landing on mets 5-2 first, so I didn't really notice all of the signs. However, after aggravating the lateral plantar nerve under the 5th mets of both feet and reading Saxby and Stoxen's recommendations, I tried switching to landing on 1-2 first. However, I had problems doing so, as noted above. I even tried stretching my 2-5 mets by manually extending them, but of course that didn't work.

    While doing my bunion straightening, I noticed that my left 1st met didn't seem to reach the ground, when the foot was flat. I thought it was due to the bunion, but apparently the 1st met was elevated.

    I hadn't read about engaging the first met or flexor hallucis brevis, but I did notice that I could easily stand demi-pointe on mets 1-2 on my right (good) foot, but not my left (bunion). So, that's what I've been practicing for months, getting to the point where I could do 25 minutes on a stairmaster holding that position.

    I thought it was due to straightening my bunions, but I managed to strengthen my flexor hallucis brevis in the process. It's seemed to help a lot. All mets now touch the ground evenly. No more 2nd met pain, despite doing some sprints this morning. I'm all good now, without orthotics or met pads.

    Podiatrists, eat your hearts out! :p
  3. Sid Barefooters

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    This is a very neat video!

    My left foot is still weaker than my right foot. Hopefully, I can work up to the full range of motion that he demonstrates.
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  4. Bare Lee Chapter Presidents
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    Very Interesting Sid.

    In karate training we stretched that joint by getting into kneeling position but with the bottoms of the toes flat on the floor and the sole perpendicular to it, like Allen does at 2:40, rather than with the top of the foot and shins touching the ground. You then rock back and forth a bit, with hands on the floor to stabilize. We would also sit cross-legged and pull the toes back and forward to stretch them out. You can also do this at a desk chair with just one leg up on the opposite thigh.

    I should probably get back to doing this as part of my stretching routine. Looks like it might make me a better runner. Thanks for the video Sid, and congratulations on eliminating your 2nd met pain.

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  5. Sid Barefooters

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  6. dutchie53 Barefooters
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    Great info Sid, good find.
  7. Sid Barefooters

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    Was there a reason for stretching that particular joint in karate? Or was it part of some general flexibility regimen?
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  8. peter.robinson Barefooters
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    We did it in Tae Kwon Do so probably similar to Karate...
    There are certain kicks where you pull your toes back and strike with front part of the ball of the foot, just near the base of the toes. The area is quite hard with the toes pulled back. Striking with the toes just breaks them - ouch
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  9. Bare Lee Chapter Presidents
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    Yah, what Peter said. I was never able to pull back the toes all the way on my high kicks, but high kicks are best left to the movies or as a coup de grâce in a real street fight in any case. What you really want to do is low kicks--hard to telegraph, hard to see coming, and they don't leave you so vulnerable if they're successfully blocked. My strategy was to kick just above the knee, with my shin, get their guard down, then move in and go for the mid-section, with either shins to the ribs or knee to the gut, and then finish them off.

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  10. Barefoot TJ Administrator
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    My strategy would be to kick "where it counts," then run like hell!

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  11. Bare Lee Chapter Presidents
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    Wow, I just realized I've contributed to a four-year-old thread.

    In the dojo of course, you don't get any sparing points for running away. And etiquette prevents kicking where it counts.

    But yeah, in a real fight, running away is always a good option, with or without the preliminaries. As my Sensei used to say, all fights are potentially lethal--best avoided if possible. I once kept from getting mugged by two guys with a good knee to the stomach of one of the guys who was grabbing me, throwing that guy into the other guy, and then quickly fleeing in the opposite direction. Very Scary. My style, Ashihara, is a street-fighting style, so we practiced techniques against two or more attackers. The basic idea is to neutralize the nearest guy fast, and then put him in between you and the others, if possible, to collapse the attacking angles.

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  12. Barefoot TJ Administrator
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    Well, it does happen, at least in our dojang the other night when my son was sparring with a red belt for his green belt test. I guess he was tired and didn't bring his kick up high enough. Worked like a charm though. Poor kid.

    I will keep your strategy in mind should I have to take down a bunch of "nuts."

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  13. Bare Lee Chapter Presidents
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    Yes, it does happen, and has happened to me, but it's not supposed to be intentional! In my case I misjudged my opponent's next move and moved right into his low kick. I almost puked. I never made that mistake again.

    But in the street, given women's relatively strong lower body, and men's low-hanging fruit, you'd be remiss not to target them if you're attacked or threatened by a male. The other extremely vulnerable bits--throat, nose, and eyes--are higher and much harder to hit.

    I think as you learn more about martial arts, you'll find most action films comical. They often fight like they're sparing, not defending their lives.

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  14. Barefoot TJ Administrator
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    It was purely accidental. My son doesn't have an ugly bone in his body.

    And, I knew before we got into MMA that the movies are for show, not real life.

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  15. Bare Lee Chapter Presidents
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    Yah, high kicks are very cinematic, but knees and elbows win the day. And most fights end the minute someone gains an advantage.

    Now back to Morton's Toe . . .

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  16. Sid Barefooters

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    I thought this was interesting. This doc suggests that the first met should be shorter, to allow for better engagement with the ground.
    http://www.footdoc.ca/www.FootDoc.ca/Website Stiff Big Toe Joint.htm
    The Gait Guys also indicate that it's possible to perform exercises to "descend the 1st ray".
    http://thegaitguys.tumblr.com/post/20226254854/bunions
    So, maybe some of the problems with Morton's toe is due to specific weaknesses and imbalances?
    Why wasn't Morton's toe to be "discovered" until after the widespread use of shoes ?
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  17. Barefoot TJ Administrator
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    Good point, Sid. And good find once again.

    But now I am confused. I will have to practice this later, since I am at the doctor's office.

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  18. Sid Barefooters

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    Maybe we should call this what it is, Interdigital Perineural Fibrosis. Oftentimes, having the correct name for a problem will promote finding better solutions. We are now in the 21st century after all. Time for an update.
    http://www.wheelessonline.com/ortho/mortons_neuroma_interdigital_perineural_fibrosis
    Perhaps, then podiatrists would feel more inclined to save the nerve.
    https://www.podiatry.com/etalk/Neuroma-Should-we-save-the-t1741.html
    It also seems that there are much more sophisticated techniques for treating perineural fibrosis in the upper extremities.

    MRI manifestations of bowler’s thumb
    http://radiology.casereports.net/index.php/rcr/article/viewarticle/458/797

    Surgical options for recalcitrant carpal tunnel syndrome with perineural fibrosis
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280361/
  19. Barefoot TJ Administrator
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    This is what I actually have shared time and time again, here and at MN Talk. From Wiki: Despite the name, the condition was first correctly described by a chiropodist named Durlacher,[1] and although it is labeled a "neuroma", many sources do not consider it a true tumor, but rather a perineural fibroma (fibrous tissue formation around nerve tissue).

    It would be nice if everyone can not only get on the same page, but the same paragraph. The problem is so deep-rooted and long lived though that it's going to take a long, long time until we can start to fade away the incorrect naming of the condition.

    Dellon wrote an article about this very problem, which I previously shared in our Studies & Articles About Studies forum at MN Talk.

    J Am Podiatr Med Assoc. 2005 May-Jun;95(3):298-306. (http://www.ncbi.nlm.nih.gov/pubmed/?ter ... n+neuroma#)
    Accurate nomenclature for forefoot nerve entrapment: a historical perspective.
    Larson EE, Barrett SL, Battiston B, Maloney CT Jr, Dellon AL.
    Author information
    Abstract
    Current medical nomenclature is often based on the early history of the condition, when the true etiology of the disease or condition was not known. Sadly, this incorrect terminology can become inextricably woven into the lexicon of mainstream medicine. More important, when this is the case, the terminology itself can become integrated into current clinical decision making and ultimately into surgical intervention for the condition. "Morton's neuroma" is perhaps the most striking example of this nomenclature problem in foot and ankle surgery. We aimed to delineate the historical impetus for the terminology still being used today for this condition and to suggest appropriate terminology based on our current understanding of its pathogenesis. We concluded that this symptom complex should be given the diagnosis of nerve compression and be further distinguished by naming the involved nerve, such as compression of the interdigital nerve to the third web space or compression of the third common plantar digital nerve. Although the nomenclature becomes longer, the pathogenesis is correct, and treatment decisions can be made accordingly.

    This is the description I was compelled to use for our main forum at MN Talk: Your Story
    ****Tell us what brought you here. Share your experiences with us. Let us know the negatives as well as the positives you've encountered while battling Interdigital Nerve Compression, a.k.a., Morton's Neuroma.

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  20. Sid Barefooters

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    What will it take, an act of Congress?!
    http://www.nola.com/politics/index.ssf/2010/09/congress_eliminates_term_menta.html

    But seriously, people should advocate for their needs. It's called patient care for a reason, because healthcare exists to serve patients.

    A.K.A. seems a bit inaccurate, as that puts MN on the same level as the new name. Maybe "formerly or previously known as" would be more appropriate.

    I like the term nerve compression, not only for accuracy, but it serves as a reminder that something might be causing the nerve to be compressed.

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