Mortons Neuroma
When two bones repeatedly rub together, it will usually cause the outer coating of a nerve in your foot to swell which is called a neuroma or a Morton’s neuroma. If repeated trauma occurs in the area the nerve will scar. It is most commonly affected between the metatarsal heads of the third and fourth toe. If caught early conservative treatment can be successful however if the Morton’s neuroma gets too large the only option is surgical removal.
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This photo depicts the 3rd and 4th metatarsals in the foot as well as the phalanx of the toes. It is between the 3rd and 4th metatarsals that a Morton’s neuroma is most often found. |
The Deep Transverse Intermetatarsal ligament between the 3rd and 4th metatarsal heads. |
The Common Digital Nerve as it courses between the 3rd and 4th metatarsals and branches to the 3rd and 4th toes. |
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The development of a neuroma between the 3rd and 4th metatarsal heads. |
This photo demonstrates a neuroma in its relationship just beneath the Deep Transverse Intermetatarsal ligament. |
Symptoms
The pain from the Morton’s neuroma may start gradually but may become a severe and persistent pain. It is described as a burning, cramping, or aching sensation but may cause tingling or numbness. It usually occurs after walking or standing on your feet for a long period of time and is commonly found in people who wear tight-fitting shoes. The pain is usually relieved by removing the shoe and massaging the affected area.
When examined, the clinician may feel a “click” which is known as Mulder’s sign. There may be tenderness in the interspace. The metatarsal bones will also be examined both clinically (and often with an x-ray). Tenderness at one of the metatarsal bones can suggest an overstress reaction (pre-stress fracture or stress fracture) in the bone.
Contributing Factors
Pronation of the foot can cause the metatarsal heads to rotate slightly and pinch the nerve running between the metatarsal heads. This chronic pinching can make the nerve sheath enlarge. As it enlarges it than becomes more swollen and increasingly troublesome causing Morton’s neuroma symptoms.
Tight shoes, shoes with little room for the forefoot, pointy toe boxes can all make Morton’s neuroma more painful.
Walking barefoot may also make the Morton’s neuroma more painful, since the foot may be functioning in an over-pronated position.
Treatment
self treatment for Morton’s neuroma
Wear wide toe box shoes
Don’t lace the forefoot part of your shoe too tight
Make sure your feet are in supportive shoes that do not squeeze your forefoot.
Remember virtually all Morton’s neuroma problems occur during the contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point. It is therefore vital to improve your biomechanics with orthotics designed for your chosen sport.
Golden rule- Don’t ignore the problem, it won’t go away!
The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family). The way you function is set and cannot be cured. What you can do however, is control lower limb biomechanics by altering foot position during the contact phase of gait (when the foot is in contact with the ground). This can only be done by wearing a good shoe (see our shoe guide) and with orthotics (foot beds).
This is the cheapest and most cost effective way for any athlete to reduce the risks of injury from occurring and from helping to prevent re-injury. Overall costs for the average athlete will run into pennies per mile/hour of sport.
Orthotics are designed to alter the biomechanics during the time the foot is on the ground. They are also used to provide increased shock absorbency working in harmony with the sport shoe worn.
If Morton’s neuroma pain persists seek treatment as soon as possible. The earlier conservative treatment of this condition takes place the less likely surgical excision will be required.
Morton’s neuroma –
returning to sporting activity
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your Morton’s neuroma injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your Morton’s neuroma recovers, not by how many days or weeks it has been since your injury occurred.
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
You have full range of motion in the injured leg compared to the uninjured leg.
You have full strength of the injured leg compared to the uninjured leg.
You can jog straight ahead without pain or limping.
You can sprint straight ahead without pain or limping.
You can do 45-degree cuts, first at half-speed, then at full-speed.
You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
You can do 90-degree cuts, first at half-speed, then at full-speed.
You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
You can jump on both legs without pain and you can jump on the injured leg without pain.
Morton’s neuroma
surgery
Below is a video showing Morton’s neuroma surgery. If the conditions does not respond to conservative treatment then often the only option is a surgical approach