What Is It?
Morton’s Neuroma is an entrapment of one of the small nerves in the foot as it passes between the toes and is also known as a compressive neuropathy of the common plantar digital nerve. It occurs most often in the third web space and can cause significant pain which limits footwear choices and weight bearing activities.
What Causes It?
Morton’s Neuroma can be caused by compression or irritation of the nerve usually from wearing high heeled shoes, narrow tapered shoes or shoes that force the toes into the toe box. Patients with foot deformities like bunions, hammer toes or flat feet are at higher risk of developing this condition. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or court sports injuries or other type of trauma to the area may also lead to a neuroma.
What Does It feel like?
Symptoms are usually described by patients as abnormal forefoot sensations such as burning, numbness or tingling. Pain is localised most often in the plantar aspect of the forefoot, followed by the toes and also in the dorsal web space at the base of the third, fourth or second toes. Patients sometimes describe a sensation of a lump, a fold of sock or a “hot pebble” between the toes. Pain is produced in the ball of the foot when weight bearing.
How Are they Diagnosed?
Your physiotherapist will do a full assessment and examination with palpation which includes testing for Morton’s neuroma by squeezing the metatarsals from the sides of the foot with one hand, while pressing the thumb of the other hand on the bottom of the foot, between the third and fourth metatarsal bones and is called Mulder’s sign. Diagnosis can be reliably made based on clinical presentation though in some cases may require Ultrasound testing.
What can Back in Action do to help?
Your physiotherapist will advise you on appropriate footwear and how to reduce load on your foot to settle your symptoms. This may include the addition of a small piece of foam called a metatarsal dome in the shoe to support the transverse arch of the foot. This is different to the large longitudinal arch of the foot and using orthotics or foam supports on this may further aggravate symptoms of Morton’s neuroma. We may also tape the foot to relieve pressure on the nerve and this taping technique is very simple and can be taught to the patient.
You may also require local massage, gentle mobilisations and other techniques to help reduce inflammation to the sole of the foot, at the site of the nerve entrapment. We will also make a rehabilitation plan with you to optimise healing which may include exercises and biomechanical assessment and advice to get you back to functioning normally again and to help return to sports with a reduced chance of recurrence.