Mortons neuroma is a condition in which the nerve that runs between the metatarsal bones is entrapped. It is one of the most common causes of metatarsalgia (pain in the ball of the foot). The nerve in the third webspace of the foot is most frequently affected, causing pain and numbness in the third and/or fourth toes. This less commonly occurs in the second webspace, and even rarer in the first and fourth. Women are around five times more likely to suffer with this condition, with the 40-50 age group most affected.
The common digital plantar nerve runs between the metatarsal bones and under the transverse intermetatarsal ligament. The anatomical location of the nerve makes it particularly vulnerable to trauma, stretching and compression. Overtime, the tissue surrounding the nerve may become thickened and inflamed. Improper footwear (ie: tight shoes and high heels), high impact activity, abnormal foot biomechanics and joint hypermobility can increase pressure in the ball of the foot and contribute to the development of a Mortons neuroma.
Morton’s Neuroma symptoms
People with this condition may experience:
– Burning sensation in the ball of the foot
– A sudden pain that comes and goes as quickly as it appears, like a spasm
– Numbness and shooting pain in the toes
– The feeling of walking on a pebble
At Erko Podiatry we can often diagnose a Morton’s neuroma through a thorough history in combination with clinical assessment. Your podiatrist may assess the web spaces and compress the toes to reproduce the symptoms. Sometimes, you can hear an audible click of the nerve as your podiatrist squeezes the ball of your foot. Morton’s neuroma is often demonstrated on ultrasound well so we may refer you for scans to confirm our diagnosis or rule out other conditions.
How to treat Morton's neuroma
In the majority of cases, Mortons neuroma can be treated non operatively. The podiatrists at Erko Podiatry will manage the condition with the aim of reducing the load and compressive forces at the intermetatarsal nerve. This may involve:
– Rest, ice, anti-inflammatories
– Activity modification, especially a reduction in activities which increase forefoot load
– Footwear modifications (eg. wider fitting shoes, flatter sole)
– Metatarsal devices to open up the space between the metatarsal heads and offload the neuroma
– Orthotics to address any biomechanical issues that may be contributing to abnormal forefoot compensation
– Injection therapy with local anaesthetic and/or cortisone for more severe or chronic cases not responding to the above treatment
Generally, Morton’s neuroma will not resolve on its own. However with effective management symptoms can be managed and in the majority of cases resolved. The symptoms can seemingly appear spontaneously, and can come and go sporadically. Although this may not initially cause too much bother, the onset of pain can increase in frequency and intensity over time, so it is advisable to seek diagnosis and treatment as soon as you start experiencing symptoms.
Morton’s neuroma can progressively worsen if left untreated and can make daily activities such as walking unbearable. Repetitive long term damage to the nerve can lead to permanent loss of sensation, affecting balance and mobility.
Reducing weight bearing activity is recommended initially to allow inflammation around the nerve to settle. High impact activities such as running and walking on uneven terrain should be avoided. We recommend more gentle activities such as swimming, cycling (provided tight fitting shoes are not worn) and careful strength / resistance training. THis allows the sufferer to maintain physical fitness and mental well0being without further aggravating the Morton’s neuroma.