Morton's Neuroma

Morton’s Neuroma is a painful condition caused by the thickening of a nerve that runs between the metatarsal bones. This thickened nerve gets pinched between the heads of the metatarsal bones, the deep transverse ligament, and the ground, causing pain and inflammation. Morton’s neuroma most commonly happens between the 3rd and 4th metatarsal bones, or the 2nd and 3rd metatarsal bones.

Symptoms

• Pain, burning and/or numbing in the ball of the foot, extending to the toes
  
  
• Usually 2 toes are involved
  
  
• Feels like you’re stepping on a marble or pebble
  
  
• Feeling of a “mass” between the bones in the ball of the foot

• Footwear – Tight footwear with pointed toes. High heels.
  
  
• Wide Feet, Bunions and Hammer Toes – Take up more room in shoes, causing the metatarsal bones to get squeezed together.
  
  
• Depressed Transverse Arch – aka the “metatarsal arch”. If this arch is depressed, the metatarsal heads sit closer together, decreasing nerve space.
  
  
• Flat feet – Overpronation causes more sheering between the metatarsal bones. 

Treatment

Rest – Rest is an essential step in recovery. You will need to decrease or stop activities that cause the pain. Activities such as running, walking, stair climbing, and jumping  are particularly aggravating. Swimming and biking are good low impact alternatives. Many people are disappointed that they cannot participate in an activity they are passionate about during this time. Just remember that you will get back to that activity faster if you rest and heal now.

Wide Fitting Running Shoes – Wide fitting good cushioned running shoes are vital. A forefoot rocker can also help reduce stress to the forefoot area. Avoid tight shoes, pointed shoes, and high heels.

Custom Orthotics – These products offload the painful area. They may incorporate a “metatarsal pad” to increase intermetatarsal space, so the affected nerve has more space.

Medications – Anti-inflammatory medication can help manage pain and inflammation.

Non-Resolving Cases

Corticosteroid Injections – Performed by a chiropodist. Corticosteroid injections to the affected nerve help to reduce pain and inflammation.

4% Alcohol Sclerosing Injections – A series of injections of 4% alcohol to slowly reduce the sensitivity of the affected nerve. Usually a series of 3-7 injections performed 10-14 days apart greatly reduces pain.

Surgical Intervention  – Sometimes it is necessary to cut the deep transverse ligament to give the neuroma more space. Another option is a “neurectomy”, which removes the neuroma entirely.

Prevention

To prevent recurrence, it is important to wear well fitting, wide shoes and custom orthotics with metatarsal pads. Avoid tight fitting footwear with pointed toes or high heels.