Morton's Toe and location for the insert

Your chronic pain is real and does have an explanation.


(Did you know that you can hold down the control key and spin the wheel on your mouse and it will enlarge or shrink the image on your computer screen? Use this "trick" to make the image to the left larger.)

This is a picture of a typical foot (mine) with a long second metatarsal (The long bone that the toe attaches to). Notice that  the notch between the big toe and the second toe is much deeper than the notch between the second and third toes. This genetic condition is called Morton’s toe, after the medical doctor Dudley Morton. Lots of people, doctors, chiropractors, podiatrists and other health care professionals have heard of Morton’s neuroma. It is a completely different condition named after another Dr. Morton. Interestingly, the first condition (Morton’s Toe) may actually be the cause of the second condition, (Morton’s neuroma). Morton’s neuroma refers to an inflamed nerve between the distal ends of two adjacent metatarsals. Morton’s toe refers to a first metatarsal that is shorter than the second metatarsal. Most often, the second toe is also longer than the first (big) toe.

Dr. Dudley Morton described Morton’s toe and the associated chronic pain conditions back in 1927. He noticed that most people with this condition walk with their toes pointed out (duck feet); some percentage (20% ?) walk  with their toes pointed in (pigeon toed). In both cases, male and female, the pelvis tilts abnormally which causes the rest of the spinal curves to become abnormal, which causes the head to be carried well forward on the shoulders and the shoulders to also round forward. All of this causes Myofascial pain throughout the body. If you have unexplained pain in your knees, hips, base of the neck, upper back, low back, shoulders … (any of this sound familiar?) your feet may well be the source.

It took five years, but Dr Dudley Morton eventually got a corrective device patented. You can make your own in less than 5 minutes for less than $5.00. Yep, all that money you (or your health insurance company)spent on your chronic pain could possibly have been saved by making and wearing an inexpensive shim under the ball of the foot just behind the big toe (see the white arrow).

Janet Travell was the personal physician for both Presidents Johnson and Kennedy while they were in office. She, now deceased, was the leading authority on Myofascial pain. She researched, mapped trigger points and co-authored the text book on trigger point therapy. Dr Travell fully understood the relationship between a long second metatarsal and chronic pain. She published over 100 medical articles. Isn’t it strange that so few people know about Morton’s toe and its’ relationship to unexplained chronic pain.

I  first learned about Morton’s toe and using a "mole foam" shim from the “Trigger Point Therapy Workbook” written by Clair Davies, a massage therapist.  The drawback to mole foam shims is that they crush flat pretty quickly and have to be replaced. I tried cutting and gluing 3-4 layers of inner tube together with Elmer’s rubber cement to create shims. That works pretty well, but is a little work intensive. I recently discovered heavy duty felt strips, sold in the hardware section of stores like Fred Meyers, to be used underneath furniture. Like mole foam, it has a sticky back, is easy to cut and place and lasts much longer than the mole foam shims. Use inner tube for durability; felt strips for convenience. Cut your shim so that it is only as wide as the ball of the foot directly behind the big toe. I like to make it between one and a half to two inches long so I  am certain to get the support needed under the ball of the first metatarsal. If your shoes have removable inserts, pull them out and put the shim underneath the insert. If shoes do not have removable inserts, you of course have to put the shim on top of the insole. If using the ¼ wide felt strips, most people will need 2 strips, side by side. Remember, if your insole is removable, the shim will be more comfortable if you put the strips underneath, but placed so the same area is supported..

Sad story, close to home. Chronic pain's "End Game"

I just got off the telephone with my 62 year old brother. He has been a self employed handyman all of his adult life. He just got MRI results that show that he has severe spondylolisthesis. This is a guy that makes his living climbing ladders, lifting heavy tools, sheet rock, plywood, 5 gallon buckets of paint... you know fit, trim, hard working, strong.

His Sciatica has slowly been getting worse. His doctor now tells him, "do not climb ladders, don't lift anything heavier than half a gallon of milk, no running, jumping, golf, .... don't keep working as a handyman". Well, what about the bills? Doctor replies, "there is a very real chance that you will become a paraplegic if you don't follow the advice.

Spondylolisthesis is a condition where the (usually lumbar) curve and damage to vertebra and disks has become so sever that two vertebrae may slide one off the other severing or severely damaging the spinal cord.  Picture a stack of childrens' blocks. Drill a hole down through the stack and put a strand of cooked spaghetti inside.  As long as the stack is vertical, there is no stress on the noodle. Now tilt, wiggle and shake the stack a little bit. Pretty soon one block will start to slide off the one below it. Visualize the spaghetti noodle (spinal cord). Increase the tilt, jump a little, bend over just a little off balance. OOPS, that long noodle (spinal cord) is cut and the legs don't work anymore. This is pretty simplified. The spine is designed with normal curves. The curves help with shock absorption and flexibility. The spine is also wrapped with muscle and connective tissue which helps keep its' integrity. However, when damage and increasing lumbar curve occurs it can become a real problem. The traditional solution is to fuse the  vertebrae.

In my brothers advanced case it is probably the only viable solution. Any alternative seems pretty risky. Does he take a chance that therapy and exercise are able to reverse or lessen the spondylolisthesis? What if he stumbles and takes a fall before his spine improves?

Is there anything he could have done to prevent what has happened? I am not a doctor. My background is personal training, massage therapy and my personal experience. My brother has a significant anterior pelvic tilt, hence the spondylolisthesis. He also walks with his feet turned out (duck feet) which is a common thread shared with almost all persons with chronic fatigue syndrome, and Fibromyalgia victims. Abnormal pelvic tilt is usually the result of tight psoas muscles and lax abdominal muscles (again simplified). I am convinced that if a person realizes what is going on, there is a simple, inexpensive treatment and a very inexpensive self made orthotic . Treatment involves stretching short tight psoas muscles, strengthening flaccid abdominal muscles and massage which speeds recovery and helps teach the body that a new posture is "safe" and achievable.

You can estimate your pelvic tilt easily and with reasonable accuracy. Put your jeans on. Stand sideways to a full length mirror. Look at the belt line. It usually follows pelvic tilt. This method is not 100 percent accurate, but is usually pretty close. It is probably accurate enough for our purpose. My research indicates that men should have 0 to 10 degrees of anterior tilt and women should have 10 to 20 degrees of anterior tilt. If your tilt is significantly different or if tilt is posterior, I would predict that you have a head forward posture, hold pain / tension in your neck and shoulders, probably have or will develop knee /  hip pain, and may also  have plantar fasciatis (bottom of feet hurt) and may be diagnosed with Fibromyalgia or Chronic Fatigue Syndrome.

It seems that about 80 % of the people with chronic pain have an anterior pelvic tilt while about 20 % have a posterior tilt. Both situations cause similar fatigue, and pain. Look at the posture chart from my previous post and see if you recognize your posture.

Dr Janet Travell researched chronic pain and trigger points several decades ago. She was not some unknown "quack". She was the personal physician for both presidents Kennedy and Johnson.  She recognized and published peer reviewed articles describing the relationship between chronic pain and turned out / in foot position while walking. Read my next blog to learn more the condition and how to inexpensively treat it.

Fibromyalgia / chronic pain / chronic fatigue: is there an explanation.

Fibromyalgia is a label used to describe unexplained chronic pain. My opinion of the source of fibromyalgia and chronic pain has been formed by more than 2 decades of experience as a personal trainer and aerobics instructor and over 3 years experience as a massage practitioner focused on medical massage rather than "spa" or "relaxation" massage.

The overall posture of every person I have treated for chronic pain can be found in the fair or poor columns in the chart to the left. I have very rarely had people on my table whose posture was described in the "good" column. They rarely seem to suffer chronic pain. I think that it is "interesting" that people from the "fair" and "poor" columns also frequently complain of chronic fatigue. Is there a link? Here is my paradigm for both chronic fatigue and chronic pain / fibromyalgia:

When your posture is reflected in the "good" column, opposing muscles are in balance. These people do not have chronic pain or chronic fatigue in my experience.  None of their muscles are working "extra". The operative here is "working". A muscle is working if it is contracting. When it is contracting, it is using energy. If it is using energy, it is producing metabolic by-products (lactic acid among others). When your posture is reflected in the fair or poor columns, several muscles are "working" (contracting) nearly 24/7. They are using glycogen (sugar) & oxygen and producing metabolic by-products. Even though you are not actively running, lifting weights, sitting at your computer, pounding nails or doing anything else you think of as work, your body is using unusual amounts of energy. YOUR MUSCLES are "working".

Try holding a tooth brush out at arms length. In less than a minute your arm muscles will fatigue and your arm will start hurting. Now imagine holding a 20 pound bowling ball 1 inch out from the side of your body. How long before your arm starts hurting? Your head is like that bowling ball. Look at the top picture in the middle column. Look familiar? Is it any wonder that those neck and shoulder muscles are hurting? Look at any of the other pictures in the fair or poor columns. In each case, muscles are working extra hard, using extra energy, holding up extra weight. No wonder they are tired and in pain.

Years ago, I had a supervisor that stated in a staff meeting, "don't complain about a problem, unless you can bring a solution to the table". Well, I am pretty sure that I have a solution that works in 90 to 95 percent of the cases.

Part  of the solution is to do specific exercises designed to re-achieve balance between opposing muscles. You may need to work with a knowledgeable personal trainer for a few weeks. I am not talking about the "gung ho" trainer that demands you "go for the burn". The  no pain, no gain mentality is great (maybe) if you are an 18 year old foot ball player. I am talking about the trainer that  truly understands fitness. Long supple, cat like muscles are much healthier than bunched up, short, tight, professional body builders muscles. I know the trainer is expensive. How much are you currently paying in medical bills treating your chronic condition?

Another part of the solution can be regular massage. There are generally two types of massage practitioners. Those focused on "spa" or relaxation massage, and those focused on "medical" or therapeutic massage. Yes, I agree that almost all massage can be therapeutic and giving someone an hour of relaxation is beneficial, but...  I suggest getting massage from someone focused on therapy who has pursued the knowledge necessary for real medical massage.  In general, spa or relaxation massage feels really good. That's because rubbing on any muscle for more than 10 or 15 seconds causes the body to  produce an endorphin response. Endorphins are the bodies natural pain killers. It doesn't take very long for them to start to wear off.

The Therapeutic or Medical massage practitioner uses several techniques that actually cause a change in muscle length. PNF (proprioceptive facilitated) stretching, reciprocal inhibition, strain -counter strain, manual ligament therapy and others. The effects last much longer, because it is more than a temporary shot of endorphins. The stress on the short, tight muscle is lessened, just like de-tuning a guitar string. Short, tight muscles learn that it is safe to be a little softer and longer.

When  I have a client who complains of tension or stress at the back of the neck and upper shoulders, I work on their pectoralis (chest) and SCM (anterior neck) muscles. Once the chest and anterior neck loosen up, the tension leaves the upper traps and back of the neck. It is just like  taking the string off of a hunters bow. The big curve (rounded shoulders) relaxes and the pain and tension are gone.

Stay tuned for the most important part aspect of "curing" chronic pain / fatigue