What is a Morton’s neuroma?
A Morton’s neuroma occurs when a small nerve lying between the bones of the forefoot becomes irritated. A Morton’s neuroma is often associated with wearing poorly fitting shoes that are either too tight or not supportive enough. High heels can also cause a Morton’s neuroma due to a shift in weight bearing over the forefoot. A Morton’s neuroma is more prevalent in women than men, however, this condition can occur in anyone at any age. In some cases, a Morton’s Neuroma can also be accompanied by an intermetatarsal bursitis (irritation of a small fluid filled sac that sits next to the site of the neuroma).
What are the symptoms of a Morton’s neuroma?
The symptoms of a Morton’s neuroma include:
- A sharp pain felt between the bones of the forefoot (often between the 3rd and 4th toes).
- Sharp pain during walking and running or exercising (especially on cobbled and uneven surfaces).
- A sensation that you are standing on a small pebble or stone.
- Pins and needles in the sole of the foot radiating down to the toes.
What other conditions can present like a Morton’s neuroma?
- Osteoarthritis of the ankle
- Sinus tarsi syndrome
- Midfoot osteoarthritis
- Osteoarthritis of the big toe
Morton’s neuroma vs osteoarthritis of the midfoot
Osteoarthritis of the midfoot and Morton’s neuroma are two very different conditions.
Symptoms of a Morton’s Neuroma are felt under the sole of the foot and can spread towards the ball of the foot. Pain is often sharp and sometimes accompanied by pins and needles. Many people report a Morton’s neuroma to feel like they are standing on a pebble! A Morton’s neuroma does not affect the joints of the foot and is not associated with foot stiffness or with a change of shape of the foot like osteoarthritis. A Morton’s neuroma is more common in younger people whereas osteoarthritis is more common in an older population. Symptoms of osteoarthritis include pain and stiffness over the top of midfoot (the instep of the foot). It does not give pain into the sole of the foot or pins and needles as a Morton’s neuroma does.
What is Morton’s neuroma, and how do we treat it?
A Morton’s neuroma is irritation and swelling of a small nerve between the bones at the front of the foot. It is usually felt between the 3rd and 4th toe and is often associated with poor foot biomechanics and wearing the wrong footwear. Morton’s neuroma can cause a lot of pain. Patients often describe the pain as feeling like there is a ‘stone in their shoe’.
There are different ways to treat Morton’s neuroma. This will often include correcting the biomechanics of the foot, reviewing footwear and addressing any muscle tightness and weakness. Here are a few top tips you can try yourself:
- Avoid wearing tight slip-on shoes especially if you have quite wide feet
- Leather lace-up shoes are normally more comfortable
- Ensure your shoes are not too small for you. Here is a quick test: there should be a thumb width from the end of the shoe to your big toe. If there is not, you need to go up a size! (In one study, up to 90% of people wore shoes too small for them)
- Stretch your calf muscles regularly
- Strengthen the intrinsic muscles of your foot. One of our expert physiotherapists will be able to provide you with a bespoke rehabilitation plan
- Use an off the shelf orthotic to support the arches of your feet or a ‘metatarsal pad’. These can be purchased from most pharmacists
If you come to see one of our highly specialised physiotherapists we will be able to confirm the correct diagnosis. This may involve a diagnostic ultrasound scan to differentiate between other problems which can present similarly to Morton’s neuroma, such as bursitis, plantar plate injuries and stress fractures of the foot. We will also examine your foot biomechanics, assess the way you walk and assess your muscle strength.
Morton’s neuroma can cause pain for prolonged periods if left untreated. If the nerve becomes very irritated and enlarged, it may not respond to these simple conservative treatments and may require intervention such as an injection and, rarely, may even require surgical removal.
What is Morton’s neuroma pain?
As the nerve becomes irritated between the bones in the forefoot, it will begin to thicken. Unfortunately, this causes the nerve to become even more pinched and impinged, and often the pain becomes worse. Patients often feel pain when they are walking for prolonged periods. As the nerve becomes more irritated, the pain can become quite constant and can shoot into the toes.
Symptoms include a sharp pain felt at the front of the foot. Again, often described as having a stone or something sharp in the shoe. The pain is frequently exacerbated by impact, e.g. runners can often feel severe pain every time their foot strikes the floor.
How long does it take for Morton’s neuroma to settle?
Unfortunately, Morton’s neuroma pain can stay for a very long time, mainly when there are significant biomechanical issues or if the person does a lot of impact activity and wears sub-optimal footwear, for example, if their shoes are too tight for them.
How do you treat Morton’s neuroma?
We would start by correcting the mechanics of walking and running. We would look at muscle length and strength relationship, and consider orthotics. Depending on how thickened the nerve has become, it may require an injection and, in some cases, occasionally may require surgical review.
At Complete, we can perform a full assessment of the foot. This includes a diagnostic ultrasound scan to ascertain the correct diagnosis. If the symptoms are failing to improve we may offer an injection (using ultrasound guidance) using a combination of steroid and local anaesthetic to reduce the pain and inflammation around the nerve.
If you would like further information or would like to book for an assessment of your foot pain, please contact us on 0207 482 3875 or email injections@complete-physio.co.uk