What is a Morton’s Neuroma?
A Morton’s Neuroma is a perineural fibrosis, which means that over time the sheath surrounding the nerve between the toes becomes irritated, inflamed, and forms a thickened scar tissue.
Morton’s Neuroma Symptoms
It usually occurs in between the 3rd and 4th toes (about 65% of cases) as is pictured to the right. It is less commonly found in the 2nd web space, and rarely at all in the 1st or 4th web spaces. You can also experience pins and needles and/or numbness as a result of the nerve being affected. The condition tends to occur predominantly in middle aged females.
What Causes a Morton’s Neuroma?
A Morton’s Neuroma are a result of complex biomechanical changes that occur in your feet. There are a number of theories as to the exact cause of the scarring and thickening, but it basically boils down to overload of the tissue structure. The body lays down scar tissue to try to protect the overloaded structure.
Tight-fitting shoes may exacerbate a Morton’s Neuroma. Shoes such as high heels and shoes with tight toe boxes like high heels are particularly damaging to the toes. These shoes have a sloping foot bed and a narrow toe box. The slope causes the front of the foot to bear your weight. The angle of the toe box then squeezes your toes together.
Footwear is not the only cause of a Morton’s Neuroma. Injuries to the foot can also be a factor in developing the condition by changing your foot biomechanics. Poor foot arch control leading to flat feet or foot over pronation does make you biomechanically susceptible to a neuroma.
Morton’s Neuroma Treatment
PHASE I – Pain Relief. Minimise Swelling & Injury Protection
Pain is the main reason that you seek treatment for a neuroma. Analgesics may help. Inflammation it best eased via ice therapy and techniques or exercises that deload the inflammed structures. Anti-inflammatory medications may help.
Your Podiatrist will use an array of treatment tools to reduce your pain and inflammation. These include: ice, EWST Shockwave therapy, deloading taping techniques, and orthotics to offload the irritated nerve.
One of the biggest factors in relieving pain may be changing or modifying your footwear. This may mean adding felt, foam or gel products to your shoe to help offload the area, or looking at avoiding tight fitting heels or shoes.
Metatarsal domes are often very useful.
Sometimes a corticosteroid injection is required to help settle the inflammation surrounding the nerve but there are risks with this therapy technique.
PHASE II – Restoring Normal ROM & Posture
As your pain and inflammation settles, your podiatrist will turn their attention to restoring your normal toe and foot joint range of motion and muscle length.
Treatment may include joint mobilisation and alignment techniques, muscle and joint stretches, EWST Shockwave therapy, taping, or orthotic.
PHASE III – Restore Normal Muscle Control & Strength
Your foot posture muscles are vital to correct the biomechanics that led to the overload injury. Your podiatrist will assess your foot posture muscles and prescribe the best exercises for you specific to your needs.
PHASE IV – Restoring Full Function
During this stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their feet that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block. Others may wish to run a marathon or return to a labour-intensive activity. Your podiatrist will tailor your rehabilitation to help you achieve your own functional goals.
PHASE V – Preventing a Recurrence
A Morton’s Neuroma may recur with repeated overload. The main reason is biomechanical. In addition to your muscle control, your physiotherapist will assess your foot biomechanics and may recommend custom made orthotics. You should avoid wearing high heel shoes and shoes with tight or angular toe boxes.
Morton’s Neuroma Surgery
Surgery is occasionally required when the conservative treatment is not able to relieve your symptoms, particularly if you have had pain for more than 6 months. 80% of patients who require surgery report good results, with 71% of people becoming pain-free.