Morton's Neuroma:

Hello and welcome back yet again to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy and health related. In this physiotherapy blog I thought we would continue looking at problems of the lower limbs and examine a potential cause of metatarsalgia (pain in the front part of the foot): Morton's Neuroma. This is a tricky condition that can take a while to diagnose as it may initially have many similarities with other lower limb problems. Just to remind any readers: we are a home visit physiotherapy service based in Lichfield and offering services in Sutton Coldfield, Tamworth, Cannock, Rugeley and Walsall.

What is Morton's Neuroma?

Morton's Neuroma is a a problem of one of the nerves of the forefoot, usually in between the 2nd and 3rd or 3rd and 4th metatarsal heads. This usually gives pain and pins and needles in the 2nd, 3rd or possibly 4th toes. A neuroma is a fibrous growth or tumour (in this case benign) of a nerve. In Morton's Neuroma there is a benign neuroma (growth) on one of the plantar nerves of the foot that supply the toes, this causes the nerve to be compressed. To better understand what Morton's Neuroma actually is, it is probably worth having a brief look at the anatomy of the foot, so that we can have a clear idea of the terminology being used and understand how this relates to the symptoms and causes of Morton's Neuroma.

Firstly the foot is pretty complex and podiatrists spend 3 years studying it, so this is really just a cursory look at the bones! In the first part of the foot (nearest the ankle) we have the tarsal bones and then leading away from them towards the toes are 5 metatarsals (5 because we have 5 toes!). The first metatarsal bone leads onto become the big toe and the 5th metatarsal the little toe etc... At the end of the metatarsals we have the metatarsal heads (knuckles of the foot) and then we have the toes themselves (these bones are called phalanges). The metatarsal heads are a key part of the anatomy of the foot because on the underneath (plantar) part of the foot at this point is the "ball" of the foot. In between each of the metatarsal bones is a nerve (the plantar nerve) which provides signal and sensation to the muscles and joints of the toes. It is one of these plantar nerves that gets compressed and irritated in Morton's Neuroma and then causes the pain and pins and needles associated.

What are the Symptoms of Morton's Neuroma?

In general Morton's Neuroma causes pain or pins and needles in one or sometimes several of the toes of the of the foot. Sometimes these symptoms are there all the time but in most patients they are triggered when walking or running. Wearing tight fitting shoes especally around the ball of the foot tends to irritate things in anyone with Morton's Neuroma, as this compresses the nerve in between the bones of the foot.

Who Does Morton's Neuroma Affect?

It can affect anyone at any age but it seems to affect more commonly middle aged women and runners (possibly due to the extra pressure on the toes from wearing heels and running). Certainly Morton's Neuroma is more prevalent in people that spend a lot of time on their feet.

What Causes Morton's Neuroma?

As with many problems in the world of physiotherapy the exact causes of Morton's Neuroma are not fully understood. It is likely that putting a large amount of pressure on the forefoot  and therefore compressing the plantar nerve in between the metattarsal bones by wearing ill fitted or too tight shoes could be a cause. Certainly it seems reasonable that wearing large heels will put more pressure in this area and this increase in pressure vauses one of the plantar nerves to become irritated. This slowly develops into Morton's Neuroma.

Treatment for Morton's Neuroma

There are a few treatment options for Morton's Neuroma which depending upon severity of symptoms will intially aim to conservatively manage the symptoms. Below is a rough guide to how a typical patient may want to consider managing their Morton's Neuroma.

1. Assessment and Diagnosis of Morton's Neuroma: although it seems obvious the starting point for any discussion about treatment for Morton's Neuroma is actually getting it assessed and diagnosed because there are several conditions that may have similar symptoms that will need ruling out. Being certain that you have Morton's Neuroma is the first part of the treatment process.

2. Footwear: the usual start point for treament of Morton's Neuroma once the diagnosis has been made is to adjust footwear to relieve pressure on the nerve . This can be done simply by not wearing tight shoes or in particular shoes that cause increased pressure around the ball of the foot. Commonly for mild symptoms where the patient has had their Morton's Neuroma diagnosed early on this can work well. Often in discussion with patients they will actually be aware that a particular type or pair of shoes irritate their Morton's Neuroma. 

3. Shoe Insert/Orthotics: using a shoe insert to again relieve pressure on the nerves in the ball of the foot can also help with relieving the symptoms of Morton's Neuroma and can be especially effective in those whose symptoms are still mild. These inserts are widely available on the internet and aim to offload the area where the plantar nerve is being compressed and causing the symptoms of Morton's Neuroma.

4. Rest: simply staying off your feet or at least doing a bit less can sometimes ease the symptoms of Morton's Neuroma dramatically and then make it possible to slowly build up the activity levels again. This sounds like a pretty obvious solution and it is! However, commonly patients will have just been hoping that the problem will go away and it takes an assessment with a physio to make them understand that they need to do things differently. 

5. Steroid Injections: if these conservative options don't work in relieving the pain and problems from Morton's Neuroma a steroid injection would likely be the next option. This would be injected at the site of the neuroma in the foot and would attempt to reduce inflammation of the nerve. 

6. Surgery: finally if all of the other treatment options for Morton's Neuroma have been exhausted then surgery to remove the neuroma would be considered. This would occur following a referral from your GP to a consultant and then a consultation to discuss the options. 

Okay, I hope that you have enjoyed reading this article about Morton's Neuroma and have found it useful. For anyone reading: we are a home visit physiotherapy service, based in Lichfield but serving anywhere within a 20 minute drive including areas such as Sutton Coldfield, Tamworth, Cannock, Burton and Rugeley. We offer a wide range of services including paediatric physiotherapy, post-operative rehabilitation, neurological physiotherapy and neck and back pain relief. If you need further information or would like to book an appointment we can be contacted on 0788 428 1623 or via enquiries@threespiresphysiotherapy.co.uk