What is a Morton’s neuroma?
Morton’s neuroma also known as Morton’s metatarsalgia is a medical term for what is thought to be a fibrous tissue formation around the intermetatarsal plantar nerve or a benign neuroma of the intermetatarsal plantar nerve. The intermetatarsal plantar nerve runs between the metatarsal bones in the foot and causes pain, numbness and pins & needles in the ball of the foot and toes when the nerve and its surrounding soft tissue become inflamed and swollen. The Foot itself is made of three sections of different bones. The bones at the back of the foot under the ankle joint are known as the Tarsal bones, which include the calcaneus (which forms your heel), the talus (which forms part of the ankle), Navicular, Cuboid, and the lateral, intermediate and medial cuneiforms. The next section is the mid foot consisting of the five long metatarsal bones, numbered in the sense that your big toe is first and your little toe is your fifth. The metatarsals connect at the back to the cuneiforms and cuboid bones and at the front to the toes. The toes are the last section consisting of five bones called phalanges which like the fingers are individually divided into three parts (distal, middle and proximal) and the big toe is referred to as the hallux. The metatarsals play an important role in the biomechanics of the foot. They contribute to and support the structure of the foot arch thus affecting balance and they also act like a lever in the push off movement of the foot. It is possible to develop Morton’s neuroma in between any of the metatarsals but it is most commonly seen between the spaces of the third, fourth and fifth metatarsals.
Why and when does Morton’s neuroma happen?
Morton’s neuroma can happen to anyone at any age and can be the result of many different causes although the exact reason for onset is not always known. The condition is commonly seen in those who are athletic and play sports as a lot of time is spent jumping from or landing on the tips of toes. Tight shoes that squeeze the front of your feet are also a major factor in the development of further irritation of the condition. High heeled shoes, in particular those over three inches and pointed at the front, not only squeeze the metatarsals but due to the size of the heel most of the body weight is transferred to ball of the foot. This greatly increases the weight–bearing stress through the metatarsals and the pressure through the soft structures and plantar nerve in between them. Due to this there are considerably more cases of Morton’s neuroma recorded in females than in males. Poor foot posture such as flat feet when the arch of the foot falls or high arches when the arch is raised higher than normal and certain toe disfigurement like bunions which change the biomechanics and the weight distribution through the foot have the ability to irritate and put pressure on the plantar nerve increasing your risk of developing Morton’s neuroma.
What does Morton’s neuroma feel like?
Morton’s neuroma normally starts as discomfort, numbness and mild pins & needles around the ball of the foot and into the two toes either side of the affected nerve, most commonly between the third and fourth toe. In more severe cases, the numbness and pins and needles is accompanied by an intense, immediate, sharp, burning pain in the ball of the foot. The pain normally lasts as long as the aggravating factor is present whether that is wearing ill-fitting tight or high heeled shoes or playing sports. Unfortunately, if the cause is related to poor foot posture then the condition may aggravate when walking or running and will only be relieved with rest or with correction of the foot posture. Occasionally there is a small amount of swelling present and the area is most likely to be tender to the touch.
How will Morton’s neuroma be diagnosed?
Your GP or Therapist will be able to diagnose you by both listening to your history and examining you. A full examination of the foot will be done to rule out any additional injuries or complications. On occasion the doctor may want to order an X-ray of the foot to confirm the diagnosis and identify any underlying reasons for the development of Morton’s neuroma. Occasionally an MRI or a CT scan will be ordered as this will give a more detailed view but this is rarely necessary.
What treatment options are available for a Morton’s neuroma?
Most cases of Morton’s neuroma find that the majority of symptoms heal with rest and avoiding the aggravating causative factors. Conservative treatment is normally sufficient to ensure full recovery; however surgical intervention or the use of steroidal injections is occasionally necessary in stubborn cases. The first step is to change your footwear to one that is slightly looser and less restrictive over the toes, females should try to avoid wearing heels initially and once the condition has healed, should either opt for smaller heels or try to find small cushion pads for the ball of the foot to try and relieve some pressure and avoid recurring episodes. The doctor will most likely prescribe anti-inflammatory medication to reduce any swelling and painkillers for pain relief. Stretching exercises and massage for the foot are advised to decrease any muscle tightness or joint stiffness. Many people find manipulative therapies like osteopathy, physiotherapy or chiropractic helpful in restoring any lost mobility and flexibility to the foot.
It is very important for those individuals with poor foot posture that they see a podiatrist who can fully examine their feet and determine whether they need orthotics for your shoes. The podiatrist should also be able to give advice on more appropriate and supportive training shoes. The failure to remedy these problems may result in a prolonged recovery or recurring injuries.