Morton’s neuroma is a condition that affects one of the nerves between the toes. It’s also known as Morton’s metatarsalgia or interdigital neuroma. In Morton’s neuroma, fibrous tissue develops around the nerve, which becomes irritated and compressed. This causes severe pain on the ball of the foot and at the base of the toes. Morton’s neuroma can occur on one foot or both feet. It usually affects the nerve between the third and fourth toes, but sometimes the second and third toes are affected.
The exact cause of Morton?s neuroma is not known, but the choice of footwear seems be a factor. Wearing high heels (shoes with heels over 2 inches) can put extra pressure on the balls of the feet. Wearing tight or pointed toed shoes may squeeze the toes together or otherwise constrict their movement. For that reason, women are about 8 to 10 times more likely to develop Morton?s neuroma compared with men. People who are born with flat feet, high arches, or an abnormal position of the toes are more prone to developing Morton?s neuroma. This may be due to instability around the toe joints. Certain conditions that develop over time, such as bunions or hammer toes, are also associated with Morton?s neuroma. Some sports that involve running, including tennis and other racquet sports, can also increase the chance of developing Morton?s neuroma due to trauma or injury to the foot.
Pain is usually increased by forefoot weight bearing activities (such as running), with narrow-fitting footwear, or with high heeled shoes. It is usually painful to firmly touch the affected region and, in chronic cases, pain and sometimes an audible click, may be heard when squeezing the foot and toes together with the hand. Often a localized area of swelling may be evident at the site of injury.
The physician will make the diagnosis of Morton’s neuroma based upon the patient’s symptoms as described above in an interview, or history, and a physical examination. The physical examination will reveal exceptional tenderness in the involved interspace when the nerve area is pressed on the bottom of the foot. As the interspace is palpated, and pressure is applied from the top to the bottom of the foot, a click can sometimes be felt which reproduces the patient’s pain. This is known as a Mulder’s sign. Because of inconsistent results, imaging studies such as MRI or ultrasound scanning are not useful diagnostic tools for Morton’s neuroma. Thus the physician must rely exclusively on the patient’s history and physical examination in order to make a diagnosis.
Non Surgical Treatment
The good news is that the pain can often be relieved fairly easily with the right softer styled orthotic (even in those cases where there is concurrent plantar plate tears and capsulitis!), but its important to remeber that even if your no longer in pain, there is no magic cure to speeding up the healing process so one must take care of their feet for 6-12 weeks. As a rule of thumb a neuroma should always be treated conservatively where possible. This means icing and resting the area, trying to remove the causative factors, and providing postural control and support via metatarsal domes or, if needed, specialised pre-made or custom made orthotics.
Surgical treatment has provided relief in some cases while poor results and surgical complications have resulted in other cases. It is believed that ligament weakness, as opposed to the pinching of nerves in the foot, may be to blame for recurrent pain in these situations. For reasons which are not fully understood, the incidence of Morton?s Neuroma is 8 to 10 times greater in women than in men.