A neuroma is often a benign tumour of a nerve, but can be just a thickening of the tissue that surrounds the digital nerve and leads to the toes. It usually occurs between the third and fourth toes, in response to irritation, trauma or excessive pressure.
The incidence of Morton’s neuroma is 8 to 10 times greater in women than in men.
Symptoms of Morton’s Neuroma
- You are “walking on a marble,” and have persistent pain in the ball of your foot
- Burning pain in the ball of the foot may radiate into the toes
- Pain intensifies with activity or wearing shoes
- Night pain is rare
- There may also be numbness or an unpleasant feeling in the toes
- High-heeled shoes place more pressure on the forefoot
- Tight, narrow shoes compress the toe bones and pinching the nerve
- Excess walking in poor fitting shoes leads to stress on the tissues
- Age may increase the collapse of the front foot arch
Diagnosis of Morton’s Neuroma
Your physiotherapist will feel for a palpable mass or a “click” between the bones. Local finger pressure on the space between the toe bones replicates the pain.
- Calluses on the sides and under your imply uneven foot stress.
- Your calf muscles may also be tight while your deep intrinsic muscles, which normally support the front foot arch, will be weak and lengthened.
- You may progress to a diagnostic ultrasound if you are thinking of having a steroid injection or surgery.
Treatment of Morton’s Neuroma
Initial therapies are nonsurgical unless your pain is severe and unloading the painful tissues does not help you walk more easil. Severe numbness may also encourage early surgery. A podiatrist or orthopaedic surgeon can resect a small portion of the nerve or release the tissue around the nerve,
About eighty percent of people with Morton’s Neuroma recover with a combined approach to treatment.
- Avoid high heels or tight shoes as reducing pressure may allow the nerve to heal
- Wear wider shoes with lower heels
- Choose a soft sole.
- Mobilisation of any foot restrictions by your physiotherapist can help
- Retraining the intrinsic muscles under the foot to help support your front foot arch are effective.
- Orthoses, off the shelf or from your podiatrist, may help relieve irritation by lifting and separating the bones, reducing the pressure on the nerve.
- Injection of corticosteroid can reduce the swelling and inflammation of the nerve.
Helen Potter FACP Specialist Physiotherapist
Reviewed March 2017