What is a Morton’s Neuroma?
Neuromas in the foot are a benign enlargement of the digital nerves. Pressure or trauma to the nerve causes swelling and thickening of tissue around the nerve. This commonly occurs along the bottom of the foot, between third and fourth metatarsal bones in the feet. The thickening of the tissue around the nerve is the cause of the compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage. This is what makes Morton’s Neuroma an extremely painful condition which requires immediate podiatric attention.
Signs and Symptoms of Morton’s Neuroma
The most common symptom of a neuroma is localized pain where the nerve damage is occurring. The symptoms felt by patients who have Morton’s Neuroma are caused by the compression of the nerve between the ends of the metatarsal bones at the base of the toes. If you have Morton’s neuroma, the pain will occur in the space between the third and fourth toes.
Some other signs and symptoms include:
- Burning pain in the ball of the foot.
- Increase in pain with activity or wearing tight shoes.
- Foot pain that radiates into the toes.
- Tingling or numbness in your toes.
- Sharp stabbing pain in your forefoot or toes.
- Runners may feel pain more as they place more pressure on the area.
- Pain on compression of the metatarsal bones from the side. This will compress the nerve and cause symptoms.
Causes of Morton’s Neuroma
The symptoms felt by patients who have Morton’s Neuroma are caused by the compression of the nerve between the ends of the metatarsal bones at the base of the toes. Studies have shown that there are several risk factors that may contribute to the formation of Morton’s Neuroma:
- Foot type: excessively flat feet (pronated) or high arch (supinated) feet can increase the likelihood of developing Morton’s Neuroma due to the instability around the toe joints.
- Hyper-mobility in the forefoot results in the bones rubbing on the nerves and this frictional force causes the nerves to get thicker. As the friction persists, the nerve continues to enlarge and symptoms get worse and occur more frequently.
- Injury or trauma to the area can cause damage to the nerve, resulting in inflammation or swelling of the nerve.
- Tight or poorly fitting footwear that causes the toes to be squeezed together can cause damage to the nerve, resulting in swelling and inflammation.
- High heels. Neuromas are more common in women than men, primarily because one of the most common causes of neuromas is poorly fitting shoes. Wearing high-heeled shoes or any type of shoe that places more force on the forefoot can increase the risk of nerve compression.
- Repeated stress, often seen in certain hazardous occupations, can cause formation or aggravation of Morton’s Neuroma.
Conservative Treatment for Morton’s Neuroma
We can provide various treatment options for Morton’s Neuroma, but selecting the right options for you depends on the severity. Identifying and diagnosing the neuroma early often results in the best treatment outcomes. If left untreated, neuroma’s progress and get worse and conservative treatment options become less effective. Early treatment focuses on relieving pressure on the area affected by the neuroma. Some of the treatment options for Morton’s Neuroma include:
- Padding: Supporting the bottom of the foot with additional padding can correct the abnormal foot function and relieve the symptoms caused by the neuroma.
- Wearing adequate footwear: avoid tight shoes with a narrow toe-box. These increase the risk of symptoms by compressing your forefoot. Avoid high heels as these also place increasing pressure on your forefoot.
- Orthotic therapy: A custom orthotic device placed in your shoe can help address possible causative factors such as flat feet or high arched feet.
- Activity modification: modifying activity that places increasing pressure on your forefoot provide time for healing and increase the effectiveness of other treatments.
- Medication: Anti-inflammatory medications can be prescribed via your GP to relieve pain and reduce inflammation caused by the neuroma.
- Muscle therapy. It is important to address any restrictions or weaknesses within muscles that influence the injury. Strengthening weaknesses and lengthening muscular restrictions is important to offload the area of injury.
- Injection therapy: specialised injection techniques can be used to relieve pain and reduce inflammation associated with a neuroma if other conservative treatments have not resolved symptoms.
Surgery for Morton’s Neuroma
If conservative treatment does not relieve symptoms, surgery may be necessary.