Do you ever feel like you’re walking on a rock in your shoes? Or do you have that constant feeling of your socks being scrunched up when they aren’t?In between the spaces of the metatarsals in the foot, there are a series of nerves that innervate the toes. Each nerve is surrounded by a sheath which provides protection to the nerve. When the area is overloaded due to an increase of pressure, this sheath becomes irritated and thickened in an attempt to protect the nerve. It occurs most commonly in middle-aged females, particularly in those who often wear high heels and constrictive footwear. The most common space it affects is in between metatarsals three and four.
Risk factorsThe likelihood of developing a neuroma depends on a range of factors. These include:
- Foot mechanics – can lead to a pressure overload
- High heels – increase the amount of pressure on the forefoot
- Tight footwear – compress the area
- There are a few indicators that you may be suffering from Morton’s neuroma. These include:
- Pain under the ball of the foot
- Feelings of a pebble in your shoe or sock scrunched up
- Pain and/or numbness in the lesser toes
- Pain on direct palpation of the area
- Pain on side-to-side compression of the forefoot
DiagnosisUsually, a diagnosis can be made following a clinical assessment. However sometimes ultrasound or MRI imaging can be used to confirm the diagnosis.
- Ice massage: pain associated with Morton’s neuroma may be reduced with icing of the forefoot. The inflammatory response when the nerve is irritated results in pain. Therefore by addressing the inflammation with ice therapy, symptom reduction should occur.
- Non-steroidal anti-inflammatory drugs (NSAID’s): anti-inflammatory medication can help reduce the inflammation and pain associated with Morton’s neuroma. Before consuming these medications, it is important to consult your doctor.
- Footwear: Morton’s neuroma respond poorly to being compressed, such as what occurs when wearing tight footwear. High heels are a definite no-go zone when suffering Morton’s neuroma. A well-fitted walking shoe with a wide toe-box area is highly recommended. A podiatrist or a trained footwear fitted technician can recommend a specific shoe suitable for you.
Professional treatmentFollowing an assessment by one of our Podiatrist’s a suitable treatment plan will be made. This aims to address the cause of the issue and therefore reduce the pain symptoms that you have been experiencing.
- Footwear recommendations/modifications: footwear is an important aspect of the treatment process of a neuroma. This is because forefoot compression due to tight footwear may aggravate Morton’s neuroma and increase the symptoms. In all cases it is necessary to ensure that there is adequate width across the forefoot area of footwear, to minimise the risk of this happening.
- Physical therapies: treating any muscular restrictions which may increase abnormal pressures of the forefoot, such as tight calfs, is also an important process.
- Orthotic therapy: it may be necessary to use custom orthotic therapy in the treatment of a neuroma to improve foot mechanics and distribute the pressure more evenly throughout the foot.
- Injection therapy: in cases that are persistent, injection therapy can be effective in minimising symptoms in the short-term, whilst allowing other treatment modalities to take effect. Our podiatrists are trained and qualified to perform these injection therapies.
- Surgery: in cases that are non-responsive to conservative management, our team can provide the guidance you need in taking the nex step towards gaining relief.