All About Morton’s Neuroma

Perhaps your third and fourth toes are going a little numb, particularly when you’re wearing tight shoes. Maybe you’ve started experiencing little tingles and shocks when doing burpees or ballroom dancing (or anytime the ball of your foot is bearing your weight).  Or perhaps things have progressed, and it feels like you’re always standing on a pebble, or the ball of your foot feels like it’s burning. If this is you, you might be suffering from Morton’s Neuroma.

Also known as Morton’s Interdigital Neuroma, Morton’s Metatarsalgia, Intermetatarsal Neuroma, Plantar Neuroma and Morton’s Neuralgia. You’ve probably guessed that the condition is named after someone called Morton. And you’re right – Dr. Morton first described the condition in 1876 and it’s been diagnosed pretty frequently ever since. It’s more common among women than men (more on why later) and usually only happens in one foot at a time.

What is it and why have I got it?

One of the nerves in your foot that runs between the metatarsal bones and the toes (a common plantar digital nerve to be precise) has thickened. There are a few theories as to why this happens: micro-traumas causing lasting damage over time or just the nerve being excessively squeezed between the bones. Once enlarged, there’s just not enough space for it between the metatarsals so the nerve gets caught in a cycle of continuous irritation and enlargement. It makes sense then that the condition most commonly affects the nerve between the third and fourth metatarsal bones, causing pain and numbness in the third and fourth toes because there’s less space between these metatarsals than the others.

Morton’s Neuroma is, in fact, not a neuroma at all. A neuroma is a benign tumour and there’s nothing tumorous about what you’re experiencing, instead, it’s an irritated and entrapped nerve.

So, What Do I do About It?

The right footwear is essential. Give your feet a complete break from shoes that pinch the toes together, and heels that put excessive weight onto the ball of the foot for a time. It’s thought that women’s footwear fashions with heels and narrow, pointed-toe boxes are the reason this condition is more common among women than men. Since the very definition of Morton’s Neuroma is a nerve being pinched between bones, it makes sense that further pinching the toes together can only make it worse.

Comfy flat shoes with plenty of room for your toes to spread out are a must. If you have flat feet you may need to add some orthotics or ensure your shoes have great arch support, to begin with. You can purchase these at most pharmacies. This is a priority, as flattened feet put excessive pressure on the outer ball of the foot and toes. It’s important to remember that it’s the nerve between the third and fourth toe that is statistically most likely to be affected – ground zero for the extra pressure of flat feet. Metatarsal support can also be added. But these will require care in their placement. Your physiotherapist or podiatrist can help you determine the right placement for you and your neuroma.

Most people will recover well simply by making these adjustments to their footwear. But for others the condition is persistent. And, of course, some people must wear heels (female ballroom dancers and some flight attendants for example). What then?

Exercises for Foot Fitness

Your physiotherapist can advise you on a range of exercises to stretch, strengthen and stabilise your feet, ankles, and calves. We outline a few of the commonly prescribed exercises below. But if you find that numbness and pain in your toes are persistent, we recommend that you make an appointment at the clinic. Your physiotherapist can assist with massage and manipulation to relieve overworked muscles around the nerve and advise on the right exercises for you.

·        Plantar fascia stretch

Hold your toes on the affected side and stretch them toward your shin bone. You should feel a mild stretch across the bottom of your foot. Do this frequently particularly after sleeping or sitting for a long time.

·        Intrinsic muscle strengthening

Put a towel down on the floor and then gather it up with your foot and toes.

·        Calf Stretches

Lean against a wall with one leg in front of the other. Bend the front knee keeping the back leg straight to get a stretch through the back of the leg. Now bend the back knee also to get a different calf stretch.

An inability to fully bend the ankle joint (exacerbated once again by those high heels) is linked to Morton’s Neuroma and stretching out tight calves is essential to getting that mobility back.

·        Point and Flex

Warm up for the day as you might for the ballet. Point and flex your feet several times, strengthening all the muscles of the feet and legs involved in dorsiflexion (bringing your foot up towards your body). The aim here is to improve your gait so that walking and other activities stop putting such excessive strain on your poor common plantar digital nerve.

What About Surgery?

If nothing else is working, there are more invasive treatment options available. Some patients find relief (at least temporarily) through steroid injections into the affected site (guided by ultrasound). Radiotherapy ablation is a promising new treatment option, and some find the pain so debilitating that doctors recommend the surgical excision of the neuroma. You and your physician must consider if any of these are right for you. But, if the initial causes of the condition aren’t dealt with, problems are likely to recur. Exercises to improve your foot fitness and well-fitted shoes are therefore a must whether you think surgery is for you or not. The physiotherapists at Next Generation Physiotherapy hope we can help you avoid the inconvenience, cost, and pain of invasive treatment so please call (08) 9203 7771 to make an appointment sooner rather than later. Remember, we’re here to help.

References:

Demetrious, T. (2022, March 4). Morton’s Neuroma.[Online] Available at https://physioadvisor.com.au/injuries/foot/mortons-neuroma#. Accessed on 21/12/2022.

Hauser, R., Feister, W. & Brinker, D. (2012, June). Dextrose Prolotherapy Treatment for Unresolved “Morton’s Neuroma” Pain. [Online] Available athttp://faoj.org/wp-content/uploads/2012/06/prolotherapy.pdf. Accessed on 21/12/2022.

Knott, L. (2021, March 9). Morton’s Neuroma. [Online] Available at https://patient.info/foot-care/heel-and-foot-pain-plantar-fasciitis/mortons-neuroma#:~:text=Morton%27s%20neuroma%20is%20named%20after%20Dr%20Morton%20who,of%20taste%20and%20smell%20a%20symptom%20of%20coronavirus%3F. Accessed on 21/12/2022/

Munir, U., Dawood, T., & Morgan, S. (2022, October 25). [Online] Available at https://www.ncbi.nlm.nih.gov/books/NBK470249/. Accessed on 21/12/2022.

The Physical Therapist Advisor. Morton’s Neuroma Rehabilitation Exercises. [Online] Available at https://www.thephysicaltherapyadvisor.com/wp-content/uploads/2017/06/Mortons-Neuroma-Rehabilitation-Exercises.pdf#:~:text=1%20Morton%E2%80%99s%20Neuroma%20Rehabilitation%20Exercises.%202%20Plantar%20Fascia,of%20your%20foot%29.%206%20…%20%28more%20items%29%20. Accessed on 21/12/2022.