What is a Morton’s Neuroma?
A Morton’s neuroma is a painful condition within the ball of the foot. It is a thickening or swelling of of a nerve usually between the third and fourth metatarsals, though a neuroma can also occur between the second and third metatarsals and less commonly between the first and second or the fourth and fifth metatarsals. Morton’s neuroma is caused by compression and irritation of the nerve.
A Morton’s neuroma can occur at any age, however it is more common in middle aged people, particularly women. It is usually worse after walking and at the end of the day, and can often be relieved by removing your footwear.
If left untreated, a Morton’s neuroma can lead to plantar fasciopathy, Achilles tendinopathy, ankle, knee, hip and lower back pain due to your altered gait.
What Causes A Morton’s Neuroma?
There are many causes of a Morton’s neuroma, however the most popular cause is footwear.
A tight shoe or a high heeled shoe puts added pressure on the forefoot compressing and irritating a nerve causing it to thicken and exacerbating a neuroma
Likewise an unsupportive shoes with memory foam will encourage the muscles in your feet to weaken overtime and alter gait patterns, which eventually put pressure on the nerves in your feet causing them to become inflamed.
Bunions and bunionettes (tailors bunions) increase the width of your forefoot, often making your existing footwear too tight and increasing pressure across your foot. This increased pressure squeezes your intermetatarsal nerve causing it to become thickened.
Court sports such as tennis/squash or netball which involve a lot of stopping, starting, twisting on your toes and high impact can cause a neuroma.
Likewise sports requiring tight shoes such as football, ballet, ice skating and cycling can increase pressure across the forefoot and exacerbate a neuroma.
Overpronation and Flat Feet:
Gait abnormalities (such as overpronation) and pes planus (flat feet) can also cause Morton’s neuromas due to the forefoot twisting (adductory twist) as your foot leaves the ground. It is the abnormal twisting of the forefoot that inflames the nerve causing your neuroma.
Sometimes an injury to your foot is enough to trigger a Morton’s neuroma.
What are the Symptoms of a Morton’s Neuroma?
A Morton’s Neuroma can present in many ways. Commonly numbness and tingling in the toes or burning in the forefoot are familiar symptoms of a Morton’s neuroma. Quite often your pain is relieved by removing your shoes at night.
Your pain may feel as though you are having a you are having a sharp needle or “hot poker”pushed either through or along your foot. While others describe the sensation of a neuroma as continually walking on a screwed up sock or crumpled paper, and others say “it feels like I’m walking on a pebble”. Chronic neuroma sufferers often complain of pain radiating up their legs.
When you look at your foot there does not appear to be anything wrong, no swelling or redness, however there is excruciating pain.
How Do You Treat a Morton’s Neuroma?
The very first thing you need to do to treat a Morton’s Neuroma is to check your footwear. Is it wide enough? Is it deep enough? Is it suited to your activity? If the answer to any of these questions is “no”, then first and foremost address your footwear, it may be very simple to remove your symptoms. If the answer to all of these questions is “yes” then it will be necessary for you to make an appointment to see one of the podiatrists at Erica Dash Podiatry as there is a wide range of treatment options for you to explore.
Your podiatrist will take detailed notes and perform a thorough biomechanical assessment to enable you to choose the correct treatment for you and your activity level.
You may require the addition of a metatarsal dome to your shoes. The correct placement of a dome to your shoes will separate your metatarsal heads and release the inflamed nerve.
If you require more control than a metatarsal dome, your podiatrist may suggest an orthotic. At Erica Dash Podiatry we have off the shelf inserts available. Or for those who require the extra support, we use Sidas European Custom Orthotics made in our rooms within the hour by your podiatrist. Your podiatrist usually couples your orthotics with stretching and strengthening exercises for you to perform at home if necessary.
Depending on the results of your biomechanical assessment your podiatrist may suggest you do a course of mobilisation. Joint mobilisation is a series of corrective forces applied to your feet, coupled with stretching and strengthening exercises, to strengthen the tiny intrinsic muscles within your feet that have become weak over time due to the wearing of shoes and walking on hard, flat man made surfaces.
If your Morton’s neuroma has been caused by the tightening of your muscles, then your podiatrist may suggest some dry needling. Dry Needling is performed to lengthen shortened muscles and correct muscle imbalances.
If you have a chronic Morton’s neuroma, your podiatrist may suggest a course of shockwave therapy. Shockwave therapy is the release of a soundwave through the foot to stimulate blood flow and the body’s natural healing properties. It is often chosen instead of dry needling if you are needle phobic.
Ideal Footwear for Morton’s Neuroma Sufferers
If you have a Morton’s neuroma the best shoes to wear are lace up shoes with enough room in the toe box to be able to wiggle your toes. They need to fit comfortably across your forefoot and not be too tight.
Footwear to Avoid when suffering from Morton’s Neuroma.
- High heels – as these throw your weight onto the ball of your feet and compress the intermetatarsal nerves.
- Tight Fitting Shoes – as these compress the foot and consequently inflame the nerve
- Non supportive footwear with memory foam – over flexible shoes with memory foam cause your foot muscles to become weak and collapse compressing the intermetatarsal nerve.
- Thongs – As you claw your toes to hold a thong on your foot, your transverse metatarsal arch collapses and compresses your intermetatarsal nerve.