What is a Mortons Neuroma?
Morton's neuroma is a painful condition that can be felt at the ball of the foot and affects one of the common plantar digital nerves that run between the long bones (metatarsals) in the foot. It is common to find this discomfort in-between the third and fourth metatarsal bones, causing pain and numbness in the third and fourth toes. It may also affect the nerve between the second and third metatarsals impacting the second and third toes.
It involves thickening or a change to the tissue around one of the nerves and can cause a sharp, burning pain in the ball of your foot. You may also have stinging, burning or numbness in the affected toes. It should be understood that Morton’s neuroma is a common finding and is prevalent in many of the general population but they have no symptoms. It is observed that about three out of four people who have Morton's neuroma are women. It commonly affects people between the ages of 40 and 50 but can occur at any age.
What causes a Mortons Neuroma?
The exact cause of Morton's neuroma is not known but it is thought to develop as a result of long-standing stress and overload causing irritation of a plantar digital nerve. The nerve may be compressed, rubbed, or stretched causing thickening (fibrosis) and swelling around a part of the nerve. This can look like a neuroma and can lead to compression of the nerve. The reason a Mortons Neuroma becomes painful can be related to an overload of the forefoot. There are multiple reasons why someone puts too much pressure through the forefoot and trying to reduce that can impact greatly. Poorly fitting or restrictive shoes may contribute as it is more common in women who wear high-heeled shoes or in men who wear tight (constrictive) footwear. In sport can also be more prevelant in ballet dancers and runners.
What Treatments can I do? will I need Surgery?
Treatment for Mortons Neuroma can include multiple interventions. These are all trying to help offload the nerve or provide pain relief. These may involve orthotics, rehabilitation, injections or surgery if all other interventions have failed.
Footwear: Choosing suitable footwear is very important. If you have Morton's neuroma you should avoid narrow, pointed-toe and high heel shoes. Shoes with a thin thin sole can also cause more pressure and pain. Aim for wide-fitting shoes that don't squash your feet and footwear that has some support under the ball of the foot.
Orthotics: Shoe inserts (orthotics) can be of great assistance and can help offload the Mortons Neuroma. These can be made bespoke by a Podiatrist or purchased over the counter. An insert known as a metatarsal pad can also be used that is a soft pad that sits under the ball of the foot.
Rehabilitation. Specific rehabilitation for the foot muscle can assist greatly. Increasing the strength and control of the foot can help offload the forefoot giving you the natural support you require. Physiotherapy can aid greatly for this.
Steroid or local anaesthetic injections into the area may be needed if the other interventions above have not aided. This can help in reducing pain and symptoms and can work well combined with the other treatments
Surgery may be required if nothing has improved our condition. Surgery to remove Morton’s neuroma involves removing the nerve through an incision on the top of the forefoot, between the corresponding metatarsal heads (‘knuckles’) but this is only undertaken if all other interventions have proved unsuccessful.