Morton’s neuroma is the thickening of the sheath that surrounds the digital nerve that innovates your toes, causing entrapment of the nerves. Tissue around the nerve then causes irritation to the nerve, leading to inflammation and pain. We most commonly find Morton’s neuroma between the third and fourth toes, due to a narrower gap between these toes.
Symptoms of Morton’s Neuroma
Patients suffering from a Morton’s neuroma often describe the sensation of having a rock underneath their forefoot. Other symptoms include:
- a burning sensation underneath the forefoot
- numbness in the toes
- pins and needles
- an occasional click when squeezing the forefoot together
Extended periods of walking and wearing tight-fitting or high-heeled footwear can aggravate your pain.
Causes
Morton’s neuromas can often develop under an increase in pressure and irritation being placed on the forefoot and the toes. Repetitive trauma to the area causes damage to the nerve and increases the thickness of the sheath. Some of the risk factors that increase the pressure on the forefoot include:
- Wearing high-heeled or narrow toe box footwear that puts greater stress on the balls of the feet.
- High impact sports.
- Wearing tight-fitting sports shoes, such as footy boots or rock climbing shoes.
- Certain foot deformities cause restriction in the forefoot, such as bunions and hammertoes.
- Having a pronated (flatter) foot or a rigid high arched foot posture may increase pressure on the forefoot.
Diagnosis of Morton’s neuroma
In order to diagnose Morton’s neuroma, we conduct a physical examination alongside referring to your medical history. Often a diagnosis can be made based on your history and physical examination during a consult. X-rays may help rule out any other potential causes of pain, such as stress fractures. An ultrasound or MRI may be utilised to confirm a diagnosis and identify any other potential injuries.
Treatment
When treating Morton’s neuroma we look at eliminating the risk factors associated with it. Treatment often involves the following:
Reassess footwear choices. A really easy improvement in symptoms can be seen by eliminating any potential ill-fitting footwear that has previously been worn. Avoiding tighter fitting shoes and high heels as well as potentially changing your lacing technique should provide a considerable amount of relief.
Address biomechanical deficiencies within the foot and lower leg. A podiatrist is able to identify certain risk factors in your biomechanics after conducting a biomechanical assessment and gait analysis. Treatment of such deficiencies may include dry needling, shockwave therapy, massage, an exercise program, taping, padding, and orthotics to reduce plantar pressures going through the forefoot.
Local anaesthetic/cortisone injection. Although this is often not used as a first response, local injections of anaesthetic or cortisone may help in pain relief and reduction in swelling.
Surgery. Surgery of a Morton’s neuroma is seen as a last resort if all other conservative alternatives have failed to provide relief. A podiatric surgeon will perform a resection of the neuroma.
If you believe you are experiencing symptoms similar to a Morton’s neuroma and would like a professional opinion, feel free to book in with us at our Point Cook or Yarraville clinic.
