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What Is Morton's Neuroma?

Does it feel like you’re walking on a pebble, maybe even a hot stone? Do you experience shooting, burning sensations in the ball of your foot? Then it is likely to be Morton’s neuroma. Continue reading to find out more about this painful condition and what to do about it.

What is it? 

Morton's neuroma is a swelling and thickening of tissue around nerves in the ball of the foot, which carries sensations from the toes. This can lead to a sharp, burning pain, which feels like walking on a stone, a hot pebble, or wearing a bunched up sock in your shoe. People can also develop numbness and tingling, which can radiate to the toes. 

Morton’s neuroma occurs between the third and fourth metatarsals (long bones connected to the toes) and accounts for 80-85% of neuromas in the feet. It is up to ten times more common among women compared to men, likely due to footwear choice and is most common when middle aged. 

How is it caused? 

Footwear is the most common cause, be that high heels, tight, tapered or poorly fitted shoes. These types of footwear cause too much pressure on the ball of the foot, leading to nerve pain and a trapped nerve sensation. High impact activities such as running, particularly when wearing runners which have lost their shock absorption properties is another cause. Conditions such as bunions, hammer toes, high arches, “flat feet” and being overweight all increase the likelihood of developing a neuroma. 

What you can do to help

  • Change your footwear!  Avoid high heels and tapered, tight shoes. Choose wide and round shaped shoes, that allow plenty of space across the ball of the foot and extra depth for more comfort. ASICS are a well known brand that manufacture athletic runners and they advise to change your runners around 450-550 miles.

  • Reduce activity level - this is advised for a few weeks. Reduce high impact activities such as running and dancing which subject the feet to excessive pressure.  

What are the professional treatment options? 

The symptoms may come and go according to footwear. Healthcare workers usually advise trying conservative treatment options first. Your doctor/GP may prescribe anti-inflammatories to reduce the swelling and pain. They may refer you for an X-ray to rule out a stress fracture, or refer for an ultrasound/MRI to diagnose a neuroma. Your doctor may also refer you to a podiatrist, who is a lower limb specialist. A podiatrist can examine and advise on footwear as well as assess, diagnose and provide treatment options for this condition. 

What a podiatrist can do for you

  • Assessment - at your appointment, a podiatrist will examine your footwear, take a detailed history and perform a squeeze test called a “mulder’s click” which can elicit a click sensation and trigger the pain, which indicates the presence of a neuroma. 

  • Short term - padding and strapping taped to the feet or footbeds in shoes offloads pressure from the nerve. It is a temporary measure used as a trial for insoles, but only last a few days. 

  • Long term - orthotics/insoles. These can be purchased off-the-shelf, or you may be prescribed a custom-made manufactured just for your feet. Insoles correct lower limb malalignment and distribute weight more evenly throughout the foot. A metatarsal dome is a tear drop shaped pad placed near the ball of the foot which can alleviate pressure from the neuroma as you walk. Customised insoles are a very successful treatment option for most patients.  

How successful is the treatment? 

Over 80% of people will respond to conservative treatments. However, for the minority who continue to have symptoms, steroid injections may be suggested. Some people obtain pain relief through the injection of steroids, others find it unsuccessful, as it treats the symptom, not the cause. The pain relief is usually temporary, especially if the cause of the condition remains the same e.g. continuing to wear tight shoes. 

In some cases, surgery may be required but may result in side effects such as permanent numbness in the affected toes.  

References