Mortons Neuroma

Mortons Neuroma is defined as an inflammatory foot problem characterized by pain and swelling at the ball-of-the-foot. The condition occurs mostly between the 3rd and 4th toes.

It is named after Dr. Morton, a Viennese physician who first described the term in 1876.

The pain associated with Morton’s Neuroma is most commonly felt between the third and fourth toes, but can also occur in the area between the second and third toes.

A neuroma is a condition that occurs from repetitive injury to the nerve that is running under and between the metatarsal heads. The primary cause of such injury is from a twisting of the forefoot while walking, often associated with flattening of the foot or pronation.

Key Symptoms

The key symptoms include:

• Aching or a shooting pain in the forefoot
• Patients’ urge to frequently take off the shoes and rub their foot
• Pain that aggravates when the person spends time on the feet, particularly in high heels
• Pain that might occur in the middle or end of the run
• Pain while walking (if the neuroma is very large)
• Sensation of numbness, even before the onset of pain
• Tingling or cramping in forefoot
• Pain that diminishes with massage
• Pain while walking barefoot
• A snapping sensation or electrical shock sensation (Muldier’s Sign)

Causative Factors

In other words, it is a foot condition caused from an abnormal function of the foot, causing the bones to squeeze a nerve, normally between the 3rd and 4th metatarsal heads.

Mortons Neuroma is known to occur during or after the individual has been placing significant pressure on the forefoot area, while walking, standing, jumping or sprinting.

Pronation of the foot is considered to be the main contributing factor. It causes the metatarsal heads to rotate slightly and pinch the nerve running between the metatarsal heads. This chronic pinching causes the nerve sheath to enlarge.

Tight shoes, with little room for the forefoot and pointy toe boxes can also lead to the condition. A higher heel also puts the common intermetatarsal nerve under tension, making it further prone to injury. In addition, constricting shoes can pinch the nerve between the toes, causing discomfort and extreme pain.

Activities such as squatting will increase the ground reactive force applied to the plantar foot and is likely to aggravate the condition. Lastly, the hypermobility of the forefoot can contribute to the formation of Mortons Neuroma.

Prevention and Self Care

Foremost, it is important to ensure that you wear wide toe box shoes. Moreover, you should never lace the forefoot part of the shoe too tight. Overall, the footwear should be well fitting and supporting enough so that it does not squeeze your forefoot.

Experts also recommend usage of an orthotic designed with a metatarsal pad. This pad is located behind the ball-of-the-foot to unload pressure and relieve pain caused by the neuroma.

Patients also have the option of using prefabricated arch supports that come with a metatarsal pad, which is already seated in the correct position. Some patients also prefer to use inserts with metatarsal pads because of the ease with which it can be removed from shoe to shoe.

In fact, research suggests that 70% or more of the cases of Mortons Neuroma respond positively to conservative forms of treatment.

Treatment Options

• Rest to the foot
• Better fitting footwear
• Anti-inflammation medication
• Ice packs

Cortisone injections can also be administered, if required. Surgical intervention is sought for cases with persistent symptoms. The procedure normally involves removal of the swollen nerve tissue for permanent relief.

In addition, cyrogenic neuroablation is one of the more modern forms of treatment for the Mortons Neuroma.

An MRI scan is normally extremely helpful in the correct diagnosis of the condition.