Morton’s neuroma is a painful condition that affects the ball of your foot, most commonly the area between the 3rd and 4th toes (about 65% of cases). It is less commonly found in the 2nd web space, and rarely at all in the 1st or 4th web spaces.
A Morton’s Neuroma is actually incorrectly termed, with the name suggesting it is a tumour or growth. Rather than a true neuroma it is actually what is called a peri neural fibrosis, which means that over time the sheath surrounding the nerve becomes irritated, inflamed, and forms a thickened scar tissue.
There are several other structures in this area that can be irritated in combination with the interdigital nerves. These include plantar plates, joint capsules and bursas. Identifying the appropriate injury is important for improving treatment, although treatment for all are very similar.
This can cause a sharp, burning pain, numbness in the ball of your foot and radiating into your toes. It may also present as if you are standing on a pebble in your shoe or on a fold in your sock.
A Morton’s Neuroma is a result of complex biomechanical changes that occur in your feet. There are a number of theories as to the exact cause of the scarring and thickening, but it basically boils down to an overload of the tissue structure. Constant trauma from the surrounding bones damages the nerve branches and therefore the body will try and protect the nerve by increasing the thickness of the nerves insulating sheath.
This constant abuse to the nerve branch is present when the foot is unstable. This means that there is an imbalance in the structure of the foot causing abnormal motion. This abnormal motion is the primary factor associated with the formation of a neuroma. Other contributing factors include high heels, certain sports, foot deformities, muscle imbalances and tight footwear.
Diagnosis of this condition is usually done via patient history and physical examination by the podiatrist but ultrasound and MRI can also be used to verify diagnosis or severity of condition.
Treatment
Identifying correct problem
Rest/Modify Activity – Minimise excessive weight bearing and appropriate fitting footwear
Ice/Heat – Packs, gels, creams, ice, frozen water in bottle
Massage – Combine with heat/ice gels/creams
Stretching – Calf stretches/raises will reduce pressure on forefoot
Strengthening – Toe swaps and toe spreading can strengthen intrinsic forefoot muscles
Strapping – low dye strapping can reduce any foot imbalances
Footwear – Firm heel counter, Firm midsole, plenty of room and low heel height
Footwear padding – metatarsal dome is critical in treatment of this complaint
Orthotics – improve any biomechanical issues
Acupuncture/dry needling, Prolotherapy or cortisone injections
Surgery is occasionally required when the conservative treatment is not able to relieve your symptoms, particularly if you have had pain for more than 6 months and the neuroma is large. They may use Decompression surgery which can relieve the pressure on the nerve by cutting nearby structures, such as the ligament that binds together some of the bones in the front of the foot or removal of the neuroma
