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  • Writer's pictureDaniel Selin

Morton's Neuroma

Morton's metatarsalgia, Morton's foot, Morton's syndrome, ball of the foot pain, numbness in toes, electric shock-like pain, painful toe walking, heaviness, high heels, intermetatarsal neuroma, benign neuroma or perineural neuroma, Helsinki, OMT physiotherapy.

In Morton's neuroma, the interdigital nerve of the foot becomes compressed and irritated as it rubs against the deep transverse metatarsal ligament. Over time, this friction and compression can lead to excessive fibrous growth around the nerve, which further narrows the space between the interdigital nerve and the surrounding structures. This constriction exacerbates the pinching and rubbing sensation between the nerve and the adjacent ligaments.


Morton's neuroma is also known as Morton's metatarsalgia, intermetatarsal neuroma, intermetatarsal space neuroma, benign neuroma, or perineural neuroma. It typically causes pain, numbness, and characteristic nerve damage symptoms, such as electric shock-like pain, altered sensation, tingling, or burning pain in the second, third, or fourth toes and in the central part of the forefoot.

 

Etiology

The initial symptoms of Morton's neuroma usually start between the ages of 40-50, and the condition is considerably more common in women than in men.

This increased prevalence is often attributed to excessive loading of the forefoot, repetitive flexion of the toes, and widening of the front of the foot. Additionally, high-heeled, narrow-toed, and tight-fitting shoes can increase loading on the forefoot, which in turn increases pressure on the nerve. Professions that involve prolonged squatting with the ball of the foot planted to the ground, such as installing carpets or floors, can also create increased pressure on the forefoot and compress the nerve.

Engaging in high-impact physical activities such as running or jumping can also contribute to the development of nerve compression. Other potential underlying causes may include foot injuries that alter the structure of the foot or pinched nerves resulting from surgical scars. Biomechanical challenges in the lower extremities can also shift the load towards the middle of the forefoot, initially causing micro-traumas that can eventually become more severe over time.

 

Symptoms

Symptoms in the foot and toes often start insidiously, gradually worsening over time. At first, the symptoms are mainly a feeling of numbness in the toes or a feeling as if there was a stone under the ball of the foot. Typically, the symptoms are felt in the second, third or fourth toe as well as the middle of the forefoot, where the neuroma change is most commonly located.

Over time, the symptoms worsen, causing burning and sharp pain in the ball of the foot, electric shock-like radiating pain in the toes, as well as tingling, prickling or numbness in the toes and foot. The symptoms often worsen with walking or other exertion and ease when a tight shoe or sock is removed. Gentle massage of the foot and toes can also help alleviate symptoms. In advanced cases, there is also pain while resting that does not ease when the load is lifted or when the shoe is removed.

A neuroma is a benign tumor of the nerve tissue that develops in the interdigital nerve, which can be palpable by by hand between the bones of the foot. The neuroma is typically very sensitive to touch, and there is often enlarged swelling around it.

 

Risk factors

  • Overuse or under-recovery: Continuous foot loading and insufficient rest increases nerve irritation and can lead to the formation of a neuroma.

  • Ill-fitting footwear: Tight shoes or excessive use of high heels can contribute to the development of Morton's neuroma.

  • Obesity: Excess weight increases the load on the feet and can lead to inadequate muscle recovery.

  • Pregnancy: During pregnancy, weight gain and the growing belly shifts the center of mass forward towards the ball of the foot.

  • Biomechanical challenges: Biomechanical challenges in the lower limbs can shift the load towards the center of the ball of the foot, resulting in overloading the area.

  • Joint laxity: Lack of support from ligaments and weakened arch support can increase loading on the center of the ball of the foot, irritating the interdigital nerve.

  • Other factors that can exacerbate Morton's neuroma include foot type, high heels, and foot joint laxity, which can transfer the load to the middle of the ball of the foot, resulting in overload.

 

Treatment

The primary treatment for Morton's neuroma is conservative care. Treatment involves reducing painful physical activity, discontinuing the use of tight or unsuitable footwear, and utilizing pharmacological and non-pharmacological pain management techniques.

Physiotherapy is also an essential component of Morton's neuroma treatment.

Pharmacological treatment commonly involves a combination of pain relievers and anti-inflammatory drugs, which is usually sufficient. However, if the pain is severe, medications suitable for neuropathic pain or local anesthetics may also be considered. Cold therapy may also be attempted to alleviate symptoms. The goal of conservative treatment is to alleviate pain and improve function and work capacity.

Surgical procedures should only be considered when desired results are not achieved with conservative treatment or when the patient experiences severe pain that clearly impairs function. The neuroma can be surgically removed, but a change in sensation and numbness between the toes is often observed as a consequence. Scar tissue formation from surgery can also lead to the problem recurring after surgery. These complications are still relatively rare and in most cases, surgery achieves good results.

 

Physical therapy

Physiotherapy begins with a detailed assessment of the underlying factors, based on which an individualized plan is created to overcome the problem. The treatment is aimed at reducing painful movements and improving functionality. The physiotherapist can also design an exercise program that aims to improve lower limb biomechanics and foot stability. Through exercise, the muscles that support the foot can be strengthened so that the load on the foot does not shift excessively to the forefoot. However, these exercises should be started cautiously to avoid worsened pain and dysfunction.

Joint restrictions, muscle stiffness and pain can be treated through manual therapy, taping techniques or orthotics that may be beneficial if the pain is severe. Orthotics can support the transverse arch structures of the foot, which maintain the firmness of the forefoot and reduce the load on the ball of the foot. The support provided by orthotics is always tailored to the individual, to achieve maximum effect.

Shoe advice may also be part of physiotherapy. For example, a person with Morton's neuroma may benefit from shoes with slightly curved soles, which reduce the extension movement of the toes during walking and other activities. This reduces the load on the foot and ball of the foot, giving the irritated tissues time to recover.

 

Self care


  1. Wear appropriate footwear: Make sure you wear shoes with a wide toe box, low heels, and good arch support. Avoid high heels, tight shoes, and shoes with a pointed toe.

  2. Use cold therapy: Apply a cold pack for 15-20 minutes, three or four times a day, to reduce pain and inflammation.

  3. Massage: Gently massage your foot with your hands or a massage ball to reduce muscle tension and improve circulation.

  4. Take breaks: Avoid activities that worsen your symptoms and take regular breaks.

  5. Stretching: Try gentle and dynamic stretches to improve circulation and reduce pressure in your foot.

  6. Pain medication: Ibuprofen and paracetamol can relieve pain and inflammation.

  7. Orthotics: Use orthotics that help distribute the load on your feet evenly and support the transverse arch of your foot.

Remember, if your pain persists or worsens, it's important to consult a healthcare professional for further assessment and treatment. To get an individualized program, I recommend those who suffer from Morton's neuroma to contact a physiotherapist who specializes in lower extremities.







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