What is Morton's Neuroma?
A Morton’s Neuroma is a thickening of tissue around a nerve (nerve sheath) .
It usually occurs between the third and fourth metatarsals, but is possible to occur between other metatarsal spaces (refer to figure 1).
Who is likely to get a Morton’s Neuroma?
Anyone at any age can develop a Morton’s Neuroma. However the condition commonly effects middle aged women.
What are the Symptoms of a Morton’s Neuroma?
A Morton’s Neuroma presents itself in a number of ways.
It can often feel like a pain in the ball of the foot, or a numbness or tingling sensation in the toes.
It may even feel as though your sock is slipping down your foot in your shoe and forming a crease in the arch in your foot.
Some Morton’s neuroma sufferers can report a sharp shooting pain like a hot needle is being driven through their foot...
... and the pain intermittently radiates through the foot, around the ankle and up the leg.
What causes Morton’s Neuromas?
Tight footwear is one of the leading causes of a Morton’s Neuroma (refer to figure 2).
This is because it squeezes the metatarsal heads together particularly at the toe off phase of gait, when the unrestricted foot would normally spread.
Also, tight shoes with a heel will exacerbate the condition.
This is due to the shift of body weight onto the forefoot and generally a tight toe box squeezing the foot together (Refer to Figure 3)
Footwear is not the only cause of a Morton’s Neuroma.
Injury to the foot or other conditions such as Plantar Fasciitis and tight calf muscles can cause a neuroma.
This is due to a shift in our usual gait patterns (ie. To remove the pain from a certain area in our body, we alter the way we walk).
Over pronation can cause a Morton’s Neuroma as we tend to twist or screw our foot into the ground to toe off.
How is a Morton’s Neuroma Treated?
Treatment of a Morton’s Neuroma can usually be handled conservatively without the need for surgery.
Our podiatrist will do a biomechanical assessment to determine the cause of your neuroma and recommend the best treatment options for you.
Some options include:
- Correct Footwear. A shoe with a toe box deep and wide enough to accommodate your foot is always the first step. Also a low heel so your weight does not shift forward onto the ball of your foot will help.
- Pressure Relief by means of a metatarsal dome. A metatarsal dome is a cushion which sits under the metatarsal heads, restoring your metatarsal arch thereby relieving pressure on the inflamed nerve sheath.
- Stretching and Strengthening Exercises. To allow the muscles of your foot to strengthen and maintain the metatarsal arch.
- Other Treatments can involve ice, deep tissue massage, mobilisation and acupuncture.
- Orthotic Therapy To stabilise your foot and prevent over pronation, sometimes a customised orthotic is necessary; this is determined by a thorough podiatric biomechanical assessment.
- After trying all these options, if your neuroma is still a problem, then it may be necessary to seek a surgical opinion.
Article by Erica Dash
Erica started Erica Dash Podiatry in 1993 due to the need of a family friendly podiatry business on the Central Coast, NSW.
Erica is focus driven with a great interest in children and biomechanics.
She also welcomes patients of any age into her (state of the art) practice with an emphasis on family footcare.