What is a Morton’s neuroma and what treatment is available?

 
A Morton’s Neuroma occurs when a small nerve lying between the bones of the forefoot becomes irritated. It is often associated with wearing shoes that are either too tight or not supportive enough. High heels can also cause a Morton’s neuroma due to a shift in weight-bearing over the forefoot. A Morton’s neuroma is also more prevalent in women than men. The condition can however occur in anyone at any age.
 
When you have Morton’s neuroma, the nerve between the bones of your toes may become swollen and inflamed. You usually feel it on the bottom of your foot, between your toes. The neuroma can feel painful and make it hard to walk.
 
Getting treatment for Morton’s neuroma is important. The neuroma can become larger without treatment. The nerve damage may become permanent.

Symptoms of a Morton’s neuroma?

 
The symptoms of a Morton’s neuroma include:
 
Sharp pain felt between the bones of the forefoot (often between the 3rd and 4th toes).
 
Sharp pain during walking and running or exercising. Especially on cobbled and uneven surfaces.
 
A sensation that you are standing on a small pebble or stone.
 
Pins and needles in the sole of the foot radiating down to the toes.
 

What other conditions can present like a Morton’s neuroma?

 
Osteoarthritis of the ankle
 
Sinus tarsi syndrome
 
Midfoot osteoarthritis
 
Osteoarthritis of the big toe
 

Morton’s neuroma vs osteoarthritis of the midfoot

 
Osteoarthritis of the midfoot and Morton’s neuroma are two very different conditions.
 
Symptoms of a Morton’s Neuroma are felt under the sole of the foot and can spread towards the ball of the foot.
 
Pain is often sharp and sometimes accompanied by pins and needles.
 
A Morton’s neuroma does not affect the joints of the foot. It is not associated with foot stiffness or with a change of shape of the foot like osteoarthritis. A Morton’s neuroma is more common in younger people. Generally, osteoarthritis is more common in an older population. Symptoms of osteoarthritis include pain and stiffness over the top of the midfoot. It does not give pain into the sole of the foot or pins and needles as a Morton’s neuroma does.
 

where is morton's neuroma pain felt on foot

What is Morton’s neuroma, and how do we treat it?

 
A Morton’s neuroma is irritation and swelling of a small nerve between the bones at the front of the foot. It is usually felt between the 3rd and 4th toe. Often being associated with poor foot biomechanics and wearing the wrong footwear. Morton’s neuroma can cause a lot of pain. Patients often describe the pain as feeling like there is a ‘stone in their shoe’.
 
There are different ways to treat Morton’s neuroma. This will often include correcting the biomechanics of the foot. Possibly reviewing footwear and addressing any muscle tightness and weakness.
 

Here are a few top tips you can try yourself:

 
Avoid wearing tight slip-on shoes especially if you have quite wide feet
 
Leather lace-up shoes are normally more comfortable
 
Ensure your shoes are not too small for you.
 
Here is a quick test: there should be a thumb width from the end of the shoe to your big toe. If there is not, you need to go up a size! (In one study, up to 90% of people wore shoes too small for them)
 
Stretch your calf muscles regularly
 
Strengthen the intrinsic muscles of your foot. Core Physio will be able to provide you with a bespoke rehabilitation plan
 
Use an off-the-shelf orthotic to support the arches of your feet or a ‘metatarsal pad’. Available from most chemists
 
If you come to see one of our highly specialised physiotherapists we will be able to confirm the correct diagnosis.
 
This may involve an ultrasound scan. This differentiates between other problems which can present similarly to Morton’s neuroma. Such as bursitis, plantar plate injuries, and stress fractures of the foot.  Assess the way you walk and test your muscle strength.
 
It can cause pain for prolonged periods if left untreated. If the nerve becomes very irritated and enlarged, it may not respond to these simple conservative treatments. It may require intervention such as an injection and, rarely, may even require surgical removal.
 

How long does it take for it to settle?

 
Unfortunately, Morton’s neuroma pain can stay for a very long time. Mainly when there are significant biomechanical issues. Or if the person does a lot of impact activity and wears sub-optimal footwear.
 

How do we treat it?

 
We would start by correcting the mechanics of walking and running. We would look at muscle length and strength relationship, and consider orthotics. Depending on how thickened the nerve has become, it may require an injection.
 
At Core Physio, we can perform a full assessment of the foot. This includes an ultrasound scan to ascertain the correct diagnosis. If the symptoms are failing to improve we may offer an injection. Using ultrasound guidance and a combination of steroid and local anaesthetic. This helps to reduce the pain and inflammation around the nerve.
 
If you would like further information or would like to book an assessment of your foot pain, please contact us on 01698 540380. Or alternatively, email referrals@core-physio.org
 
Other foot and ankle conditions:
 
Ankle Osteoarthritis (OA)
 
1stMTP
 
Chronic ankle sprain
 
Plantar Fasciitis
 
Sinus Tarsi Syndrome
 
Midfoot Osteoarthritis (OA)
 
Calf Tear
 
Gout
 
Retrocalcaneal and pre-Achilles bursitis
 
Mid-potion Achilles tendinopathy
 
Baxter’s nerve
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