u/stefpix

My “Morton’s neuroma” story: ultrasound also showed plantar-plate tears, and a second opinion changed my treatment
Post
Will it ever heal? I asked Herstik directly: “Will the plantar-plate tear ever heal?” His answer was basically: maybe not completely. Then I asked: “Can I run again without pain?” He said: likely yes.

I wanted to put my whole experience in one post because I think it may help somebody else who has been diagnosed with Morton’s neuroma but whose symptoms don’t quite fit.
For months I thought my main problem was two Morton’s neuromas. It turns out the neuromas are real, but they may not be what is causing most of my current pain.
My pain has mostly been under the ball of my right foot, around the 2nd and 3rd toes. More soreness, pressure and stiffness than electrical nerve pain. At times I described it as feeling like I was “walking on bone.” I have had very little of the classic burning/zapping pain usually associated with a neuroma.
At my first visit with Dr. Levenson at Curalta, before I knew anything about plantar plates, I specifically said that the cushioning under the ball of my foot felt thinner and it felt like I was walking on bone. He examined it and told me I had plenty of cushioning.
An ultrasound was eventually ordered. It showed:
2nd webspace Morton’s neuroma: about 14 mm
3rd webspace Morton’s neuroma: about 15 mm
High-grade plantar-plate tear at the 2nd MTP
Intermediate-grade plantar-plate tear at the 3rd MTP
The problem was that my treatment and the conversations I remember having focused on the neuromas. I don’t remember the plantar-plate tears being discussed with me at all.
I didn’t discover their significance until months later when I went through the ultrasound report and my medical records myself.
What happened during those 3½ months
Because I thought I understood my diagnosis, I started making decisions based on a neuroma being the main problem.
I researched cryoablation and other neuroma procedures and seriously considered spending around $5,000 out of pocket. I bought shoes with neuroma relief in mind. I paid around $650 for custom orthotics, which were very thick and needed to be modified twice.
I also kept walking normally. Had I understood that I had a high-grade plantar-plate tear, I could at least have asked whether I should limit long walks, change footwear, offload the area, start PT, etc.
I actually asked Levenson if there were exercises I could do. He said he would give me some, but I never received them.
This is what frustrates me most:
I was making treatment decisions based on the diagnostic picture I had been given.
The second opinion
I finally went to Dr. Barry Herstik at NYU Langone.
I really liked him. He was communicative, competent, clear and to the point. Honestly, it was a stark contrast with my previous experience, where the visits often felt rushed and I felt I had to know the right questions to ask to get information.
Herstik did a much more thorough mechanical evaluation. He took several X-rays in different positions, weight-bearing and non-weight-bearing, and showed them to me while explaining what he was seeing. I also brought several of my shoes and he actually examined them and explained what was good or bad about them for my particular problem.
His assessment was that my current pain is primarily coming from the plantar-plate tears, not the Morton’s neuromas.
But there is an interesting connection.
He didn’t say the neuromas were irrelevant or that the original diagnosis was false. He said the neuromas may actually have contributed to the development of the plantar-plate tears by increasing the space between the metatarsal bones.
He also thinks my hallux valgus/bunion is part of the mechanical picture. Mine developed after an old bicycle fall, and the altered mechanics around the big toe may have put more stress on the adjacent toes and ligaments.
Suddenly the location and character of my pain made much more sense.
Treatment is now quite different
For now the approach is conservative:
Physical therapy
More rigid-soled shoes with less forefoot flex
Meloxicam
Ice/cold treatment
Possibly PRP
MRI to better assess the plantar plate
Herstik also told me that a steroid injection would be detrimental to the plantar-plate tears.
He explained that an older plantar-plate tear can scar and may never completely heal structurally. That doesn’t mean the pain can’t improve. The goal is to strengthen the supporting structures, manage the injury and hopefully get me back to activities like running.
PRP, MRI and surgery
I asked about PRP because I had already been researching it.
What I liked about Herstik was that he didn’t try to sell me on it. He was very straightforward: it may work or it may not, particularly if the tear is old and has already scarred.
I asked whether an MRI could help us understand the condition of the plantar plate before I spend money on PRP. He agreed and ordered one.
He mentioned image-guided PRP at NYU at roughly $1,500 plus an initial consultation, but also told me I could probably find it elsewhere for around $500. His main point was that if I do PRP, it should be image-guided.
He was similarly realistic about surgery: it doesn’t always work. So I would rather exhaust conservative options first.
Shoes were another eye-opener
I had previously brought Topos, New Balance and other shoes to Levenson. They were looked at pretty quickly and I basically got “they’re good.”
Herstik looked at the Topos and gave me a very specific answer: he likes the shoes, but they flex too much through the forefoot for my plantar-plate problem. He wants something more rigid.
That is exactly the kind of practical information I had been looking for.
What I learned
I don’t think my story is “I was misdiagnosed with Morton’s neuroma.”
The neuromas are there. They are large enough to show clearly on ultrasound, and according to Herstik they may even have played a role in creating the mechanical conditions that contributed to the plantar-plate tears.
The bigger lesson for me is:
Just because an abnormality appears on imaging doesn’t necessarily mean it is the thing causing your pain.
The imaging has to be correlated with where you hurt, what the pain feels like, your foot mechanics and the other findings on the same imaging.
If somebody tells you that you have Morton’s neuroma but what you mostly feel is pressure, soreness or a “walking on bone” sensation under the MTP joints, especially without much electrical/zapping pain, I would ask:
What else is on my imaging?
What does the plantar plate look like?
Does the diagnosis actually match where and how I hurt?
One last observation about access to care
I originally went to Curalta partly because it was incredibly convenient. Through Zocdoc I could usually get an appointment with Levenson within a day or two.
I later learned that Curalta is a much larger, investor-backed organization that has grown by acquiring/partnering with podiatry practices. I’m not saying that ownership structure caused my experience. I can’t know that.
But my experience there did feel much faster and more high-volume than the evaluation I received at NYU.
An NYU appointment might mean waiting about a week instead of a day or two.
In my case, saving a few days ended up costing me about 3½ months.
I now have PT starting September 23 and an MRI coming. After that I’ll have a better idea whether PRP makes sense.
Hopefully this helps somebody else avoid spending months treating the finding on the ultrasound rather than figuring out what is actually causing the pain.

I wanted to share this because it may be relevant to people who have been diagnosed with Morton’s neuroma but whose symptoms don't completely sound like classic nerve pain.

I had an ultrasound of my right foot because of persistent forefoot pain. It showed two fairly large Morton’s neuromas — 14 mm in the 2nd webspace and 15 mm in the 3rd — with a positive Mulder sign.

For most of the summer, I therefore understood my problem to be essentially two Morton’s neuromas. I was researching treatments including cryoablation.

I only discovered that there was another potentially important part of the diagnosis when I recently uploaded the complete ultrasound report and my podiatrist's visit notes to ChatGPT and asked it to analyze them together.

ChatGPT pointed out something that I had somehow never understood from my appointments: the ultrasound didn't just show two neuromas. It explicitly diagnosed:

• a high-grade plantar-plate tear at the 2nd MTP
• an intermediate-grade plantar-plate tear at the 3rd MTP

I then went back and read the original radiology report myself. The tears are clearly stated in both the findings and the impression. Even more surprisingly, my podiatrist's own subsequent notes acknowledge “plantar plate pathology” at the 2nd and 3rd MTP joints.

So this wasn't a diagnosis ChatGPT invented or inferred. The information was already in my ultrasound and medical record. ChatGPT simply helped me understand and connect what was written there.

That realization was upsetting because I don't remember my podiatrist ever saying to me in plain language:

“You have two plantar-plate tears, including one described by the radiologist as high-grade.”

My experience during the visits was that the doctor often seemed in a hurry and not particularly communicative. The discussion centered on the neuromas and orthotics. I don't remember receiving an explanation of what the plantar-plate findings meant, whether the MTP joints were unstable, what activities I should avoid, or what type of footwear might protect the injured area.

This matters because I was actively asking for guidance.

I actually brought 3–4 different pairs of shoes to appointments and specifically asked whether they were appropriate. My recollection is that he looked at them quite quickly without really explaining what characteristics I should be looking for.

Had I been told that I had a high-grade plantar-plate tear and another intermediate-grade tear, I would have researched footwear specifically for plantar-plate/MTP injuries and asked much more specific questions about walking distances, running, jumping, forefoot loading, metatarsal pads and shoe stiffness.

Instead, because I thought my main problem was Morton’s neuroma, I bought several pairs of Birkenstocks and walked long distances in them. Some have also been painful for me during the break-in period. After prolonged walking I sometimes notice increasing stiffness through the right metatarsal/foot/ankle area and what feels like reduced comfortable dorsiflexion.

I'm not claiming that the Birkenstocks caused or worsened the tears. I can't know that. What bothers me is that I wasn't given the information that would have allowed me to make informed choices about footwear and activity.

My symptoms are now also making me question whether the neuromas are actually the main source of my pain.

My characteristic sensation is often that I'm “walking directly on the metatarsal bones,” together with pain and stiffness across the ball of the foot, rather than predominantly burning/electric/tingling nerve pain.

Years ago another podiatrist told me that my lesser toes sit somewhat elevated and increase pressure on the metatarsal area. I've also noticed that consciously lowering my toes toward the floor while walking can sometimes make the foot feel better.

I also have significant hallux valgus, so I'm now wondering whether there is a broader mechanical problem involving the bunion, transfer loading onto the 2nd/3rd metatarsals, elevated toes and the two damaged plantar plates — with the neuromas potentially being only part of the picture.

Obviously I can't diagnose which structure is causing the pain myself, and neither can an AI from an ultrasound report alone. That's why I'm getting a second opinion on September 10 at NYU Langone with Barry G. Herstik, DPM. I want a proper clinical assessment of 2nd/3rd MTP stability, toe purchase/elevation, plantar-plate tenderness and forefoot loading, and to determine how much of my familiar pain can actually be reproduced from the neuromas.

I'm also interested in discussing ultrasound-guided PRP for the plantar-plate injuries. There is emerging research, including work from NYU, suggesting that PRP may improve pain and function in plantar-plate injuries, although the evidence is still limited and it has NOT been proven to regenerate a chronic high-grade tear.

The frustrating part for me is that I spent the summer thinking I understood my diagnosis when I didn't.

It took uploading my own ultrasound and medical notes to ChatGPT for me to realize that an important part of the diagnosis had never been clearly communicated to me.

I don't know whether different footwear or activity modification would have changed the outcome of the tears, and I'm not claiming that the lack of explanation caused them to worsen. But I do think that when imaging shows a high-grade structural injury, a patient should be told in understandable language what was found, whether the doctor considers it clinically important, and what implications it has for activity and footwear.

I'll update after the NYU evaluation.

Just tested the GoPro Mission 1 Pro.
Took some photos. The skyline and the pole with the reflector on the jetty look out of focus. It seems the focus is somewhere halfway.
Is it normal and acceptable? in the second photo, the sign is in focus, and the homes in the background are not. Not so sure. I include the 2 full-res files and 2 zoomed screenshots.
Any opinions?

I understand the depth of field is shallower with the larger sensor, but this makes the M1 a bit not good for landscapes or distant subjects.

(Reposting with picture.
I could not add the screenshot to the first post).

SOXL down 8%, MUU down 10% after the US strikes Iran.

Another TACO Tuesday next week?

If MUU goes down to $700 I will buy a couple of shares or more.
Sell some non leveraged.

This Iran quagmire is to save face, at the cost of inflation, gas/oil prices, inflation and the stock market. And some random Iranian lives lost in collateral damage bombings.

Pride more than common sense.
I want to make some $$$ but always a bitter aftertaste when it’s because of unnecessary war.

But the case for semis and memory is still here.
Some people who missed the boat can dip their toes and get some SOXL.
Usually on red days the bottom is between 11 and noon. But it’s not always the case.

Reply from previous post.
On Robinhood SOXL is available on the 24 hour market.

I put an order for MUU at 700. My average is around 200. May scalp some soxl or roll a couple of covered call higher.

But generally with geopolitical turbulence, Friday tends to be worse than any other day of the week.