Injuries: Morton’s Neuroma

A comment on my foot pain post reminded me that I had missed Morton’s Neuroma. How could I forget something so painful? Must have blocked it out.

A neuroma is technically a tumor. Morton’s Neuroma is NOT a tumor, but the name has been used for so long that it is here to stay. The true technical term is Morton’s metatarsalgia. This is a thickening of the sheath that surrounds the nerves that converge between the 3rd and 4th toes (usual place) or the 2nd and 3rd toes (less common). This thickening is caused by irritation caused by pressure or trauma. The pain associated is often described as burning and shooting and happens when the foot bears weight, meaning when you stand, walk, run…and dance.
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The picture above is from a website run by a podiatrist in Southern California: Dr. Daniel Bank. Clicking on that link takes you to his page on common foot problems.

In college, I dealt with this as well as sesamoiditis. When this pain hit me, I thought it was sesamoiditis again, so I self-treated this one by doing what my PT had done for the sesamoiditis: my PT made a pad from thick moleskin to cover the ball of my foot, but there was a hole cut in it over the area of the inflammation. This prevented me from putting weight on that area. We put a similar pad without the hole on my other foot so that my alignment was not affected. I wore dance shoes in all of my modern classes until it was healed. This healed, too.

Now, very often the cause of the Morton’s pain is attributed to shoes that are too tight or to tight high heels. The toes are squeezed together which irritates the nerves between the toes. This eventually causes a thickening of the sheath that surrounds the nerves which adds more pressure on the nerves…and now we have pain. Apparently this pain occurs mainly between the 3rd and 4th toes because 2 nerves converge here, but it can also happen between the 2nd and 3rd toes as well.

So what to do about those tight shoes in Irish dance? I am a proponent of the close-fitting dance shoe. In general, a loose shoe does not help the foot look its best. In ID, if the hard shoe in particular is loose it not only looks bad, but it can then offer NO support for the dancer in toe stands. Hmmm…back to that thought that someone needs to design the perfect ID hard shoe…

But there is perhaps another reason that MN happens. It occurred to me as I was thinking about this post that I dealt with MN when I was in college as a MODERN DANCER…I did not wear shoes. I had a suspicion. So, I went surfing the net to see what I could find…

“Pronation of the foot can cause the metatarsal heads to rotate slightly and pinch the nerve running between the metatarsal heads. This chronic pinching can make the nerve sheath enlarge. As it enlarges it than becomes more squeezed and increasingly troublesome.

Tight shoes, shoes with little room for the forefoot, pointy toeboxes can all make this problem more painful.

Walking barefoot may also be painful, since the foot may be functioning in an over-pronated position. “

There it was! That nasty problem, OVER-PRONATION!!! It always comes back to mis-use of the leg and foot! Here is what over-pronation looks like:

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Why is this a problem? Some pronation happens when we walk, run, jump, etc, because it is part of the landing mechanism of the foot. Over-pronation because of weakness, incorrect alignment, and/or faulty movement technique weakens the structure of the foot by putting stress on the bones and soft tissues of the foot which will eventually cause pain not only in the foot but also the knees, hips and even the back.

So, what to do about MN? Making sure the toes are not squeezed by excessively tight shoes will help alleviate the pressure on the nerve. A pad as I described above might also help alleviate some pain. And if over-pronation is part of your problem, arch supports can help because they can prevent the arch from rolling in. Better yet, having orthotics made specially for you might be even better.

And then learn how to use your legs right. Most over-pronation in dancers is caused by not understanding how to rotate the leg in the hip socket. Dancers hear, “Turn your feet out” so that is what they do, turn their feet out. Yes, the knees and thighs follow, but turn-out happens more effectively and safely if the hips turn out first so that the thighs, knees and feet follow them! And if the hips are correctly rotating, then the leg stays in alignment which means the foot will most likely not over-pronate (there are always exceptions to the rule!).

To learn about the hips and find a simple exercise to train the hips to turn out correctly, go here: Hips and Turning out

Click for more kinesiology info: Dance Kinesiology

To start educating yourself, try here.

1 Comment (+add yours?)

  1. Trackback: Dance Kinesiology posts « Taoknitter

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