What Is a Morton’s Neuroma?
A Morton’s Neuroma is a thickening or enlargement of the digital nerve that runs between the metatarsals. It most commonly occurs on the digital nerve that runs between the 3rd and 4th metatarsals, but may occur on any of the digital nerves, or any nerve where there is friction or compression.
Stages of Progression
There are three stages that occur:
This is swelling or inflammation of the digital nerve. The patient may have mild symptoms, which are brought on by various shoes or activities. Avoid ill-fitting footwear and activities that aggravate the nerve as well. Massage to the area may provide relief.
Continual swelling or inflammation, aggravated by activity and footwear, which does not resolve completely after the cause is removed. The patient will continue feel generalised ache and may have some swelling present. The patient may achieve relief by avoiding footwear and activities that aggravate the nerve. Massage may assist to relieve symptoms.
This occurs when the cause has not yet been removed and the nerve tissue is significantly changed. Symptoms for the patient at this stage will be continual pain without relief.
Symptoms of a Morton’s Neuroma
One or more of these symptoms may be present. Normally there are no outward signs of a neuroma.
- Tingling, Burning, Numbness
- General Pain, Shooting Pain, Stabbing Pain
- Burning Pain on the ball of the foot may radiate into the toes
- Pain generally increases when wearing footwear or doing the activity that is causing it
- Numbness or an unpleasant feeling in the toes
- A feeling of a marble or pebble in your shoe
- A feeling that there is a bump in the ball of the foot
- A feeling that the sock / stocking is bunched up
Causes of Morton’s Neuroma
Any footwear or activity that causes a compression of the nerve, typically footwear that is thin soled, leather soled or has a shallow toe box or narrow width.
- Other Foot Conditions
People with foot conditions such as bunions, hammer toes, flat feet and hypermobile feet are at great risk of developing a neuroma.
Repetitive activities and sports that involve the ball of the foot can also increase the likelihood of developing a neuroma.
Poor foot biomechanics may cause the forefoot to be unstable and lead to a collapse of the metatarsal arch. This can also lead to an increased susceptibility.
- Injury or Trauma
Injury or trauma to the metatarsal area can lead to a secondary Morton’s Neuroma.
Conservative Treatment of Morton’s Neuroma
It is important to consider the time and symptoms present. Treatment may vary according to the stage of progression.
It is important to support the metatarsal arch and decrease pressure on the nerve. There are various methods; this can be discussed with the podiatrist.
Cold is used to minimise swelling and inflammation.
These address biomechanical causes which result in the Morton’s Neuroma occurring.
- Activity Modification
Any activities that worsen symptoms should be limited.
- Changes to Footwear
Footwear should have a wide, deep toe-box to allow room around the forefoot (i.e. reducing pressure).
NSAID’s (Ibuprofen, Diclofenac) may help reduce the swelling and inflammation but in later stages may not provide 100% pain relief. *please check with your doctor if you are suitable for these*
- Injection Therapy
Corticosteroid injections under ultrasound may provide temporary relief by decreasing the inflammation. For more information ask your podiatrist.
Surgical Treatment of Morton’s Neuroma
For patients that have not received relief from other treatments there are two main procedures:
- Removal of the Neuroma
- Release of the Neuroma
Time of recovery may vary from patient to patient and according to the procedure, as well as the initial severity of the neuroma. Following surgery conservative treatments such as orthotics are often advised.