Mortons Neuroma (or Interdigital Perineurial Fibrosis) is a common painful condition involving compression of nerves between the long bones of the forefoot just before they enter the toes. Commonly this involves the 3rd and 4th toes, however may affect the 2nd and 3rd toes. Repeated trauma or compression of these nerves causes the nerves to swell and thicken causing a Morton’s neuroma to develop.
Patients will often experience a clicking feeling in the forefoot followed by a sharp shooting pain or a sensation of numbness or pins and needles extending into ends of their toes. Tight narrow fitting shoes may often exacerbate these feelings which become worse after long periods of standing or walking. Once the Mortons Neuroma progresses symptoms will become more frequent and often more intense.
What does the pain feel like?
People with a Morton’s Neuroma often feel a combination of nerve pain type symptoms ranging from mild tingling and numbness in the toes to severe shooting or searing pain between the toes and the area just behind the base of the toes. At first this pain is worse with tight fitting footwear and athletic activity and progresses to pain all the time even without tight fitting shoes.
Who gets Morton’s Neuroma?
Some studies suggest that women aged 30+ are more likely to develop this problem due to high heeled, narrow and poor-fitting shoes with a tight or pointed toe box. These footwear types tend to compress the nerve between the metatarsals causing damage, inflammation and thickening of the nerve. The condition is also prevalent in athletes, runners, footballers and dancers where activity and footwear compresses the nerve.
How we treat Morton’s Neuroma?
The exact cause of Mortons neuroma can often vary between patients. An accurate diagnosis must be carefully made by the podiatrist through thorough history taking and direct questioning to ensure all possible causes are addressed. The podiatrist will also gather further information about the cause through a hands on assessment where they will try to reproduce your symptoms. A biomechanical and gait analysis will also be performed to assess whether poor foot alignment and function has contributed to your neuroma. Your podiatrist is best placed to assess and identify what footwear and/or biomechanical problems are causing nerve compression. The first step is identifying whether footwear changes will assist with pain reduction. In addition, our podiatrists will assess your foot type and provide a video gait (walking) assessment. Extremely hypermobile (very flexible) feet certainly play a large part in the development of Morton’s Neuroma.
Relief of symptoms can often start by having a good pair of well fitting shoes fitted to your feet ensuring that the shoes don’t squeeze your foot together. Once footwear is addressed, if the patients foot structure and mechanics is found to be a contributing cause, a custom made orthotic is usually the most convenient and effective way to manage the problem. The orthotic will include a large dome pad at the forefoot area of the device directly behind the knuckles of the metatarsal bones (long bones). This works nicely to splay the knuckles reducing the compression on the nerve. Sometimes an injection of local anaesthetic and steroid is recommended to assist in settling acute symptoms.
If pain persists with conservative care, surgery may be an appropriate option. The common digital nerve is cut and the Mortons neuroma removed. This will result is numbness along the inside of the toes affected, and there is a small chance the end of the nerve will form a Stump Neuroma.
Approximately 75% of people receive symptom resolution for Mortons Neuroma with conservative care.