Morton's Toe and Step Therapy for Fibromyalgia

Before many pain sufferers can get approved painkillers through California's Medicaid called Medi-Cal, they are required to undergo what is commonly referred to as prescription "step therapy," which means a patient must try weaker or cheaper (generic) drugs over a period of sometimes up to two weeks or even months before they can move on to something that is known to be more effective for their condition.

Take for example, the drug Lyrica, which is known to be an effective pain medication for people suffering from Fibromyalgia (www.lyrica.com). Instead of the condition being immediately treated with Lyrica, patients in "step therapy" are told they must try Tylenol, or Vicodin to see if these drugs effectively deal with the problem.

What is Morton's Toe?

Photograph of a foot illustrating Morton's Toe, where the 2nd toe is longer than the big toe.

Morton's toe is a type of brachymetatarsia, and is the condition of a shortened first metatarsal in relation to the second metatarsal. Other names for Morton's toe include: Morton's syndrome, long toe, boss toe, Morton's foot, LaMay toe, hallicusbradymetatarsalgia, Greek foot, Royal toe, Turkey toe, Sheppard's toe, and Viking toe.

Morton's neuroma is a painful condition that affects the ball of your foot, most commonly the area between your 3rd and 4th toes. Morton's neuroma can feel as if you have a pebble in your shoe or a fold in your sock. Other symptoms may include a burning pain in the ball of your foot that may radiate into your toes or a tingling feeling or numbness in your toes.

Among the issues associated with Morton's toe is that weight distribution causes the front of the foot to widen as weight shifts from the first shortened toe to the other toes. Regular shoes can often cause metatarsalgia and neuromas as your shoe pushes your toes together - hence the case of Morton's neuroma. Wider shoes are often recommended for people who have Morton's Toe problems.

While Fibromyalgia patients wait for their appropriate pain meds to be approved, there's another form of "step therapy" they can consider - Have their feet checked by a foot doctor for a first short metatarsal bone - also known as Morton's Toe. Morton's Toe is a common foot condition, but it is less common to link it to Fibromyalgia.

In Why You Really Hurt: It All Starts in the Foot, the author Dr. Burton S. Schuler, a Northwest Florida podiatrist, makes a causal link between how your foot steps and Fibromyalgia (whyyoureallyhurt.com/mortons-toe/fibromyalgia/)

A short first metatarsal bone causes the foot to over pronate, which leads to pain throughout the body.

Schuler's recommended treatment, in consultation with a podiatrist, is a toe pad under the first toe bone, which re-balances the weight of the foot and reduces pain throughout the body.

A new bill, AB 369, introduced by Assemblyman Jared Huffman, D-San Rafael, makes it easier for pain sufferers to access medication their doctors think will work best for them.

"Step therapy costs the state because of unplanned emergency visits and additional doctor visits because the patient is not getting relief in a timely manner (www.sanfrancisco.networkofcare.org/mh/legislate/detail.cfmbill=AB%20369). It costs the state when there are additional complications from that pain," Huffman said. ''And it costs us indirectly in terms of the tremendous productivity costs. If someone is suffering chronic pain, they can't work."

Schuler's version of "step therapy", diagnosing and treating Morton's Toe, (whyyoureallyhurt.com/mortons-toe/what-is-a-mortons-toe/) as it is related to Fibromyalgia, is worth consideration even if your pain is alleviated by accessible painkillers.

Many people do not want to be on painkillers for life, and a chronic condition like Fibromyalgia could be caused by a common condition that is not commonly understood.

Dr. Burton S. Schuler is a foot doctor, foot specialist (Podiatrist), of Panama City, Fl and the director of the Ambulatory Foot Clinics Podiatric Pain Management Center.