Morton’s Neuroma

Morton’s Neuroma is a painful condition that affects the ball of the foot, most commonly between the third and fourth toes. It occurs when the tissue around one of the nerves leading to the toes thickens, causing sharp pain, burning sensations, or numbness in the affected area. This article will explore the causes, symptoms, and treatment options for Morton’s Neuroma, drawing on respected sources in podiatry and orthopaedics.

What Is Morton’s Neuroma?

Morton’s Neuroma, also known as intermetatarsal neuroma, is a non-cancerous growth of nerve tissue, often associated with pain, numbness, and a tingling sensation in the ball of the foot. It typically occurs between the third and fourth toes, though it can develop between other toes as well. According to the American Academy of Orthopaedic Surgeons (AAOS), Morton’s Neuroma is most prevalent in middle-aged women, but it can affect anyone, particularly those who wear high-heeled or tight shoes.

Causes of Morton’s Neuroma

The exact cause of Morton’s Neuroma is not entirely understood, but several factors are believed to contribute to its development:

• Foot Structure: People with certain foot types, such as flat feet, high arches, or those with bunions or hammertoes, are more likely to develop Morton’s Neuroma. These structural abnormalities can cause instability around the metatarsal bones, leading to increased pressure on the nerve.
• Footwear with Poor Insoles: Wearing tight or ill-fitting shoes, especially those with a narrow toe box or high heels, can compress the toes and increase pressure on the nerves in the foot. The constant squeezing and pressure can irritate the nerve, leading to inflammation and the formation of a neuroma.
• Repetitive Stress: Activities that involve repetitive stress on the foot, such as running, dancing, or certain sports, can increase the risk of developing Morton’s Neuroma. These activities can lead to repeated trauma to the nerve, resulting in thickening of the tissue around it.
• Injury: A previous foot injury or trauma can damage the nerve or surrounding tissues, making it more susceptible to developing a neuroma.

Symptoms of Morton’s Neuroma

Morton’s Neuroma often presents with the following symptoms, which can vary in severity:

• Sharp, Burning Pain: The most common symptom is a sharp, burning pain in the ball of the foot, often extending into the toes. This pain may worsen with activity or when wearing tight shoes and may improve when the shoes are removed or when massaging the foot.
• Numbness or Tingling: Some people experience numbness, tingling, or a "pins and needles" sensation in the toes, particularly in the third and fourth toes.
• Feeling of a Lump or Pebble: Many people with Morton’s Neuroma describe the sensation of having a small lump or pebble under the ball of the foot, even though no visible lump is present.
• Pain When Walking: The pain associated with Morton’s Neuroma is often aggravated by walking, especially when wearing shoes that compress the forefoot. The pain may cause the person to alter their gait to relieve pressure on the affected area.

Diagnosis of Morton’s Neuroma

Diagnosing Morton’s Neuroma typically begins with a physical examination, during which a healthcare provider will press on the foot to identify the source of pain. According to the Mayo Clinic, imaging tests such as X-rays, ultrasound, or MRI may be used to rule out other conditions, such as fractures or arthritis, and to confirm the presence of a neuroma.

Treatment Options for Morton’s Neuroma

Treatment for Morton’s Neuroma focuses on relieving pain and reducing pressure on the affected nerve. The treatment approach can vary depending on the severity of the symptoms and may include the following options:

Footwear Modifications

One of the first steps in treating Morton’s Neuroma is to modify footwear. Wearing shoes with a wide toe box, low heels, and good arch support can help reduce pressure on the nerves and alleviate symptoms. 

Orthotic Insoles

Orthotic insoles or custom-made insoles can also provide additional support and cushioning to relieve pressure on the neuroma. Insoles with soft, cushioning top covers and arch support are recommended. The materials of choice for these insoles is either Poron, Plastazote or low density (soft) EVA foam.

Padding and Taping

Padding the affected area and taping the foot can help distribute weight more evenly across the foot, reducing pressure on the neuroma. This can be particularly effective in combination with footwear modifications.

Activity Modification

Reducing or modifying activities that exacerbate symptoms, such as high-impact sports or prolonged standing, can help manage Morton’s Neuroma. Low-impact activities like swimming or cycling may be recommended as alternatives.

Medications

Over-the-counter pain relievers, such as ibuprofen or naproxen, can help reduce pain and inflammation associated with Morton’s Neuroma. In some cases, corticosteroid injections may be used to reduce severe inflammation and provide longer-lasting pain relief.

Physical Therapy

Physical therapy can help strengthen the muscles around the foot and improve flexibility, which may alleviate pressure on the affected nerve. Exercises that focus on stretching and strengthening the foot and calf muscles can be particularly beneficial.

Surgery

If conservative treatments fail to relieve symptoms, surgery may be considered. Surgical options include removing the neuroma (neurectomy) or releasing the tight ligaments that are compressing the nerve. According to the Cleveland Clinic, surgery for Morton’s Neuroma has a high success rate, but as with any surgery, there are risks, including the possibility of persistent pain or numbness.

Prevention of Morton’s Neuroma

Preventing Morton’s Neuroma largely involves reducing the factors that contribute to its development:

• Wear Proper Footwear: Choose shoes that fit well and provide ample space for the toes. Avoid high heels and narrow shoes that compress the toes.
• Use Morton's Neuroma Orthotic Insoles: If you have a foot structure that predisposes you to Morton’s Neuroma, consider using orthotic inserts to provide support and reduce pressure on the nerves.
• Take Breaks During High-Impact Activities: If you engage in activities that put stress on your feet, make sure to take breaks and wear appropriate footwear that provides cushioning and support.
• Maintain a Healthy Weight: Keeping your weight in check can reduce the overall pressure on your feet, lowering the risk of developing Morton’s Neuroma.

Conclusion

Morton’s Neuroma is a painful foot condition that can significantly impact your quality of life if left untreated. By understanding the causes, symptoms, and treatment options, you can take steps to manage and alleviate the condition. If you experience persistent foot pain or symptoms of Morton’s Neuroma, it’s important to seek medical advice from a podiatrist or orthopaedic specialist to receive an accurate diagnosis and appropriate treatment plan.

References

• "Morton’s Neuroma: Symptoms, Causes, and Treatment." American Academy of Orthopaedic Surgeons.
• "Footwear and Morton’s Neuroma." American Podiatric Medical Association.
• "Diagnosis and Imaging of Morton’s Neuroma." Mayo Clinic.
• "Conservative Treatments for Morton’s Neuroma." Cleveland Clinic.
• "Surgical Outcomes for Morton’s Neuroma." Journal of Foot and Ankle Surgery.
• "Role of Orthotics in Morton’s Neuroma." National Institute for Health and Care Excellence (NICE).
• "Physical Therapy for Morton’s Neuroma." Journal of Podiatric Medicine.
• "Foot Structure and Morton’s Neuroma Risk." British Journal of Sports Medicine.
• "Impact of High Heels on Foot Health." American Orthopaedic Foot & Ankle Society.
• "Preventing Morton’s Neuroma." American Academy of Podiatric Sports Medicine