Forefoot pain is a very common injury within athletes. The structures that are usually involved are the nerves, the bones, ligaments, tendons, and the sesamoids. In this video, we’ll be focusing on a very misdiagnosed condition, or conditions, known as intermetatarsal bursitis and neuromas. These structures run between the toes, and are very, very commonly affected in athletes.
The two most common causes of intermetatarsal bursitis and Morton’s neuromas are usually caused from tight calf muscles and ill-fitting footwear. So shoes that are too narrow for the foot lead to too much compression of the metatarsal heads together, which then compresses the bursae and the nerves in between the toes. With the tight calf muscles, you increase forefoot loading, and that leads to excess pressure
through the forefoot, and also increases the amount of pressure you’re putting on those structures between the toes.
Common signs and symptoms that you may experience with intermetatarsal bursitis and Morton’s neuromas will usually involve neurological symptoms. So usually your tingling, shooting, burning and numbness sensations. This is usually reproduced upon lateral compression of the metatarsals where you push the toes together and compress the structures between the toes. This usually reproduces your symptoms.
Another thing that can cause it is tight-fitting socks or footwear. So if you’re going for a walk in these particular items, you can reproduce the symptoms. Patients will usually describe a burning sensation at nighttime, and this is usually the pain that people will get most of the time.
When it gets quite extreme, you will experience burning where you have to put feet outside of blankets to try and cool them down, and any sort of pressure on the foot can cause or reproduce the symptoms.
Early-stage treatments of intermetatarsal bursitis and Morton’s neuromas usually involves addressing the risk factors. These risk factors are tight calf muscles and the footwear being too tight for the foot. So with tight calf muscles we usually issue stretches to try and stretch the calf out, and take away forefoot pressures. These forefoot pressures are usually one of big things that causes the problem. We also look at trying to address the footwear to make sure that it’s not too narrow for the foot. If it’s too narrow, it can lead to too much pressure between the toes. If the pressure between the toes is higher, it damages the structures between the toes.
So the next treatment if these things fail is we usually look at putting an orthotic in the shoes. These orthotics helps reduce planar pressures at the forefoot by neutralizing these high areas of pressure. The more invasive treatment that can be involved with this treatment path is injections. So we can inject with local anesthetic to try and help with these structures. If that’s not enough, a steroid can be used. The steroid is probably the last resort before we refer on for a surgical opinion.
If this condition goes untreated, it can progress to be a lot worse, and patients can experience restless sleep at night, which can lead to a lot of other health issues. So usually what that involves is being referred on to a surgeon who will have to remove the nerve, and with this the nerve can potentially grow back and be problematic again. So the best course of action is usually to treat it earlier to prevent it from getting worse.
This information is general, and if you’re experiencing any foot pain, you should definitely see a professional. If you’d like to book an appointment with one of us, visit us at our website, or give us a call at one of our offices.