Morton's Neuroma

The Problem

  • Discomfort caused by a neuroma can present as a burning pain in the forefoot, or as an ache or shooting pain. There may be some numbness or tenderness under the ball of the foot. The pain can radiate to the toes or back towards the ankle. Pain is usually relieved by the removal of footwear.
    Morton's Neuroma describes the presence of thickened fibrous tissue surrounding nerve tissue, (also called perineural fibroma). The affected nerves run between the long metatarsal bones of the foot. Most commonly between the 3rd and 4th and 2nd and 3rd metatarsals.
  • The thickening of tissue around the nerve generally results from compression and irritation of the nerve by the metatarsal bones either side.
  • Pressure from footwear, particularly narrow and high heeled shoes, can bring on the pain, but most often poor foot mechanics inside the shoe is the underlying problem.
  • Unstable foot mechanics will allow the metatarsal joints to drop down, encourage excessive movement between the bones, increasing friction and compression and facilitating the growth of the neuroma.

Diagnosis

  • Squeezing the foot from both sides or putting direct pressure between the metatarsal heads will recreate the pain for a positive diagnosis.
  • Ultrasound or an MRI will usually confirm this.
  • X-rays may be useful to rule out any other causes of pain.

Morton's Neuroma

Treatment

Treatment options will be relative to severity of pain and length of time the symptoms have been present. For mild to moderate pain the options are:

  • Padding can be added to the innersole of the shoe to lift and separate the metatarsal bones, reducing compression of the neuroma.
  • Modification of footwear style, to increase foot support and reduce forefoot compression.
  • Correction of poor foot mechanics with the prescription of appropriate foot orthoses. These will be designed to reduce foot instability and optimise support. The type of orthotic will depend on your activity level and footwear.
  • Local anti-inflammatory gels may be useful, applied directly to the painful area. Extreme, stubborn cases may require antinflammatory/ Anesthetic injections by your Doctor.
  • Acupuncture and Trigger Point Therapy may be helpful in reducing symptoms and pain relief.

Surgery may be required for more severe cases; where conservative therapy hasn't had adequate results. Surgery will result in a loss of feeling on one side of both toes distal to the neuroma.
Post surgical management should involve long-term measures to help keep the symptoms from returning. These should include appropriate footwear, orthotics when required and modification of activities that cause overloading pressure on the forefoot.

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