Have you ever had the sensation that you are walking on a pebble, or even a rock under the ball of your foot? If you have then keep reading, you may just find some information that relates to you.
What is a Morton’s neuroma?
A Morton’s neuroma is a painful foot condition that typically occurs in response to irritation, pressure or traumatic injury to one of the digital nerves just before they enter the toes. As a result of the compression between the metatarsal bones in the ball of the foot, the nerve becomes inflamed/swollen. The most common location for this to occur is between the 3rd and 4th toes, however it can also occur between the 2nd and 3rd toes.
What causes a Morton’s neuroma?
Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. Abnormal foot posture/movement to compensate for bunions, hammertoes, flatfeet are just a few of the more common conditions that can lead to irritation and development of a Morton’s neuroma. Pronation of the foot, or rolling in of the foot, may cause the heads of the metatarsal bones to rotate slightly. In doing so, they pinch the nerve running between the metatarsal heads. Chronic pressure or pinching causes the nerve sheath to enlarge, becoming increasingly squeezed and worsening pain over time, if not addressed.
Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running, dancing or court sports.
Tight fitting shoes may exacerbate a Morton’s neuroma. Shoes with tight toe boxes like high heels are particularly damaging to the toes. These shoes have a sloping sole and a narrow toe box. The slope causes the front of the foot to bear your weight. The angle of the toe box then squeezes your toes together.
Patient will often experience sharp shooting pain or a sensation of numbness or pins and needles in the forefoot which may extend into the ends of their toes. Occasionally patients will describe a clicking sensation in their forefoot. Tight narrow fitting shoes may often exacerbate these feelings which become worse after long periods of standing or walking. As the Morton’s neuroma progresses, symptoms will become more frequent and often more intense.
In developing a treatment plan, your Podiatrist will first determine how long you’ve had the neuroma and evaluate its stage of development. Treatment approaches vary according to the severity of the problem.
For mild to moderate neuromas, treatment options may include:
- Padding: padding techniques provide support for the metatarsal arch, thereby lessening the pressure of the nerve and decreasing the compression when walking.
- Icing: placing an icepack on the affected area helps reduce swelling.
- Orthotic devices: custom or pre-fabricated orthotic devices prescribed by your Podiatrist provides the support needed to reduce pressure/compression or the nerve, and to correct any biomechanical abnormalities.
- Foot mobilisation: current research is showing very positive results with a course of foot mobilisation.
- Activity modifications: activities that put repetitive stress on the neuroma should be avoided until the condition improves.
- Shoe modifications: avoid narrow toed shoes or shoes with high heels.
- Medications: oral nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. These should only be taken under the guidance of your GP.
- Injection therapy: treatment may include injections of cortisone, local anaesthetics or other agents.