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Morton’s Neuroma

MORTON’S NEUROMA

What is a Morton’s Neuroma?

Morton’s neuroma, or Morton’s metatarsalgia, is a condition commonly seen by podiatrists.

At each of the gaps between the bones that make up the ball of the foot (the metatarsal heads) lies a nerve which is responsible for innervating the toes. If this gap becomes too tight, it can irritate the nerve and cause it to swell and become painful.

The terminology ‘neuroma’ is misleading as traditionally, a neuroma would refer to a benign (non-cancerous) tumour comprised of nerve tissue. A true Morton’s Neuroma however, is a perineural fibrosis; as the sheath protecting the digital nerve becomes inflamed and irritated forming a thick scar tissue.

What are the Signs and Symptoms of Morton’s Neuroma?

Morton’s Neuroma usually occurs between the third and fourth toes (65%) and, less often, between the second and third toes. Symptoms are quite clear and can indicated the severity or progression of the neuroma.

  • The most common symptom is the sensation of standing on a pebble, marble or fold in your sock.
  • Burning pain (sharp or dull) in the midfoot, ball of the foot and toes which will increase with activity and wearing shoes.
  • ‘Electric’, sharp, shooting pain in the foot.
  • Pins and needles, numbness, uncomfortable or unpleasant feeling in the ball of the foot and toes.
  • Clicking sensation between the toes.
  • Pain in the ‘toe-off’ phase of gait or when wearing high heel shoes which mimic this position.

What Causes Morton’s Neuroma?

A Morton’s Neuroma is caused by repetitive trauma to the nerve and surrounding soft tissue. Mechanisms can include:

  • Compression of the nerve between the metatarsal bones (base of the toe).
  • Imbalance within the foot causing changes in the motion.
  • Sustained irritation or pressure of the nerve (i.e. tight shoes or foot position).
  • Foot injury or poor arch control changing the biomechanics of the foot.

These mechanisms cause the body to lay down scar tissue to protect the overloaded structures. This triggers the inflammation and swelling of the nerve and hence the formation of the neuroma.

Risk Factors for Morton’s Neuroma?

There are some notable factors which can increase your risk of getting a Morton’s Neuroma:

  • Sex: females, especially middle-aged women, are 8-10 times more likely to develop Morton’s Neuroma.
  • Improper Footwear: unsupportive or excessively tight footwear can place increased pressure through the feet and squeeze the bones together.
  • High Heels: can place extra on toes and the ball of your foot increasing risk.
  • Certain Sports: high impact sports and activity can place increased force through the foot and those requiring tight fitting shoes place further pressure on the toes and bones.
  • Foot Deformities: can place increased pressure on the skeletal structures of the feet and increase likelihood of Neuroma. Examples include flat or high arches, hammer toes or bunions.

How is a Morton’s Neuroma Treated?

Diagnosis:

To diagnose the injury, a doctor or podiatrist may palpate the foot to examine whether there is an obvious lump or click between the toes. They will place pressure through the foot to reproduce the pain and obtain an accurate diagnosis.

Medical imaging may be used to get a confirmation of diagnosis and to rule out other injuries. An X-Ray will examine whether any stress fractures are present whilst an MRI or, preferably, an Ultrasound will be used to inspect the soft-tissues and reveal whether a neuroma is present.

Conservative Treatment:

Initially, most neuromas are treated conservatively and will involve a treatment plan constructed by our Pivotal Motion Podiatrist to best remedy your symptoms and individual requirements.

Treatment will depend on the severity of your symptoms and involve simple steps to change and remedy the issue which caused the neuroma.

  • Pain and Inflammation Management: In the initial stages, neuromas may respond well to ice and rest which will reduce inflammation and pressure on the nerve. Use of anti-inflammatory pain medication may help relieve symptoms.
  • Assessing footwear: tight footwear will apply lateral pressure to the foot, squeezing the bones together and increasing irritation of the nerve. Changing footwear or the use of small practice aids (i.e. metatarsal domes) can help remedy the issue and relieve pain.
  • Address biomechanics: by finding and addressing the cause of foot instability we can prescribe exercises or custom orthoses to stabilise the foot and decrease pressure on the neural structures.
  • Foot Mobilisation: in addition to strengthening the arch, mobilisation exercises have been shown to improve or relieve symptoms.

Surgical Intervention:

If the above conservative measures are unable to relieve symptoms, surgical intervention may be required and is possible from doctors or podiatrists.

  • Corticosteroid or anaesthetic injection: will provide good pain relief as it decreases the swelling and inflammation of the nerve. There are some risks however which should be discussed with the doctor or podiatrist.
  • Surgical Removal: the last and most permanent form of treatment, surgical removal involves excision of the affected nerve. With this treatment, there are some possible side effects which need to be discussed with your doctor or podiatrist.

Do I Need a Referral to See a Podiatrist?

For a general appointment, you do not need a referral to see our Pivotal Motion Podiatrist, though referral may occur via a physiotherapist or GP when podiatry issues are reported.

Referrals are required for Enhanced Primary Care treatment plan or bill through WorkCover, DVA or Third Party. These cases can be discussed when booking an appointment and our reception staff will be able to advise you of the materials/paperwork required.

How Do I Book a Podiatry Appointment for Morton’s Neuroma?

It is important to get a Morton’s Neuroma addressed quickly to relieve symptoms and improve recovery. If you think you are suffering a Morton’s Neuroma or have other issues with your feet, book using our online booking gateway or call 07 3352 5116.