Morton's Neuroma
A Morton's Neuroma is also known as Interdigital Neuroma, an Intertarsal Neuroma or a Forefoot Neuroma
If you have Morton's Neuroma , you will be experiencing inflammation induced pain, numbness and tingling due to pressure on a nerve. The location of the inflammation will be at the "head" of the metatarsal - this is where the metatarsal bone ends and the toe bones (known as "phalanges") begin. This area is most commonly known as the "ball of the foot".
What is Mortons Neuroma?
Morton's neuroma is where there's a thickening of tissue around a nerve in your foot that's been irritated or damaged. The symptoms can often be eased with treatments you can try yourself.
The swelling along the nerve is not cancerous (benign); the reason that area along the nerve swells is unknown. However, as the swelling starts - this puts pressure on the nerve itself, causing more irritation and inflammation.
Where Does Morton's Neuroma Occur?
The location of the inflammation will be at the "head" of the metatarsal - this is where the metatarsal bone ends and the toe bones (known as "phalanges") begin. Experiencing Morton's Neuroma between the third and fourth toe is most common (by far) though it can happen between the second and third toe. Other locations beyond this are rare.[1]
What Does Neuroma Mean?
Neuromas are noncancerous (benign) tumors found on nerves throughout the body. They involve a growth of extra nerve tissue. With Morton’s neuroma, there’s no growth and no tumor. Instead, the existing tissue around the nerve becomes inflamed and gets bigger.
The term "Neuroma" is misleading in the case of Morton's Neuroma, as there is no actual neuroma with this condition.
From the above quotation, we can say that a Morton's Neuroma is not actually a neuroma at all. Neuromas are tumors on the nerves, but for Morton's Neuroma, there is no tumor or growth - it is inflammation of existing tissue around the nerve. Despite this, it is typically quite painful and difficult to get rid of.
Who Is Most At Risk of Getting Morton's Neuroma?
"About 1 in 3 people have Morton's Neuroma." [2]
Morton's Neuroma is 8 times more common in women than in men.
Morton's Neuroma most commonly affects people aged 30 to 60 years old.
It is generally accepted by the medical community that tight toed shoes and/or high heels will aggravate the condition. It possible that this could also be a causal factor.
You are more likely to get Morton's Neuroma from overuse injuries such as excessive running on hard surfaces without proper shoes.
You are more likely to get Morton's Neuroma if you have spinal stenosis (narrowing of spinal canal).
If you are experiencing instability around the toe joints (often caused by flat feet or high arches), you are more likely to get Morton's Neuroma.
You are more likely to get Morton's Neuroma if you have suffered an injury resulting in inflammation in the area.
What Are Symptoms of Morton's Neuroma?
The most common symptoms of Morton's Neuroma include:
- Pain - sharp stabbing or burning pain in the ball of the foot. This may spread out into the toes when you are active on your feet. In most cases, there is little to no pain at night.
- Irritation - there is often a sensation that there is a pebble or marble under the ball of the foot.
- Tingling / Numbness in Toes - this is not as common as the above
Symptoms often worsen when tight fitting narrow shoes are worn since they compress the phalanxes (toe bones) and pinch the nerve. High heeled shoes transfer more bodyweight to the ball of the foot; such shoes are also known to aggravate the condition.
How Long Does It Take To Heal From Morton's Neuroma?
There is no clear time duration for Morton's Neuroma and Harvard Health Publishing states that it will not disappear on its own.[1] Symptoms will typically come an go depending on causal factors such as shoewear and the amount of time spent on your feet. For mild cases, symptoms of the condition will likely go away in a matter of weeks after resting, changing shoewear (low heels, wide toes, good arch support), using orthotic inserts, etc.
What Causes Morton's Neuroma?
The exact cause of Morton's Neuroma is not known, but as stated earlier, some factors are associated with the condition.
Factors that may contribue to Morton's Neuroma:
Tight Shoes (especially ones with pointy ends that compress the toes together)
Loose Shoes
Running on Hard Surfaces With Improper Footwear
High Heels
Most of your bodyweight is transferred to your forefoot when you wear high heels.
Excessive Weight
One of the recommendations for alleviating Morton's Neuroma is to lose weight. Perhaps added weight on the ball of the foot creates more compressive pressures between the toes, worsening the condition.
Spinal Stenosis
Spinal Stenosis is a narrowing of the spinal canal.
Foot Conditions - Bunions, Hammertoes
Some conditions in the feet that develop over time can increase your risk of developing Morton’s Neuroma.
Sports
Running and racquet sports put a lot of pressure on the ball of the foot. Foot injuries are more likely in athletes - such injuries increase the risk of Morton's Neuroma.
Foot Abnormality
If you were born with a foot abnormality, you are more likely to have an irritated or damaged nerve in the ball of the foot. This can lead to Morton's Neuroma.
How Is Morton's Neuroma Diagnosed?
Usually, a doctor can diagnose Morton's Neuroma from a physical exam. There are a number of conditions that can cause pain in the ball of the foot, and your doctor, through the physical examination will likely be able to elimate most other conditions.
Knowing that Morton's Neuroma pain worsens when there is compressive force on the toes/ball of foot, your doctor will likely compress the toes while looking for pain and tenderness. In some cases, the doctor may test for numbness in the webbing between the toes. If there are multiple locations of pain on one foot, this will generally indicate that the condition is not Morton's Neuroma but rather inflammation of the toe joints and/or metatarsalgia.
Range of Motion in the toes along with other joints may be tested to eliminate arthritis or joint inflammation. Your doctor may also test for "Mulder's Click" - done by squeezing the foot to check for a click between the toes. Mulder's Click is sometimes present with Morton's Neuroma.
An X-Ray of the foot may be requested to eliminate the possibility of a bone fracture. If your doctors has not eliminated other possibilities, an MRI or ultrasound examination may be required.
What Steps Should I Take To Get Rid of Morton's Neuroma?
Remove Contributing Factors, If Possible
This could mean a variety of things such as losing weight, and/or changing your everyday footwear. Try wearing shoes with thicker soles or insoles that will provide more cushioning when walking around on hard surfaces like concrete or tiled floors. If you wear high heeled shoes or shoes with pointy toes, stow them away or get rid of them. If your shoes are too narrow, get rid of them and start wearing wider shoes.
It is not uncommon for Morton's Neuroma symptoms to return from time to time. In such cases, use conservative treatments including rest and good footwear can keep it in check. If it gets too bad, however, your physician will likely recommend surgery.
See Your Physician
If pain persists, go see your physician or podiatrist as they will be able to evaluate the degree of your specific condition and advise accordingly. They may recommend the following treatments:
- conservative treatments such as rest, removal of contributing factors - especially poor footwear, orthotic shoe inserts and/or metatarsal pads & anti-inflammatory medication (approx 50% success rate [3])
- corticosteroid injections (approx 50% success rate [3])
- Nerve Ablation - either via chemical ablation or radiofrequency ablation. (approx 70% to 80% success rate [3])
Approximately 80% of people suffering from Morton's Neuroma will respond positively to conservative treatments [1] outlined above. Keep in mind, however, that inflamed and injured nerves can take months to improve once the underlying factors have been corrected. Basically, recovery is a long slow process. For the other persistent and disabling cases, surgery will be required and recommended.
Surgery
If pain persists even after several months of conservative treatment, surgery may be recommended. Surgery could involve 1) removing the neuroma or 2) widening the space around the affected nerve by removing tissue compressed from a cyst or scar tissue. The surgery will likely be done using local anesthetic (numbing the area). If some of the nerve is removed, permanent numbness between the toes may result.
Surgery Success Rate
Surgery is usually very successful - 80 to 95 percent of surgery outcomes result in symptoms disappearing. In about 5% to 20% of the cases, symptoms may return in time, although a repeat surgery will still result in a very high success rate (80 to 95%)
Surgical intervention with neurectomy (removal of part of the nerve) or decompression of the nerve has the highest success rate, with most studies reporting an 80 to 95% success rate.
To summarize, regardless of the degree of severity of your morton's neuroma, it is a good idea to start the following conservative treatment options as soon as you can:
- rest the foot as much as possible
- avoid activities that cause pain
- getting fit for custom orthotics or shoe inserts with metatarsal pads is recommended
- wear shoes with solid support along the ball of foot area
- if there is inflammation, use cold treatments to reduce swelling
- visit a podiatrist (foot doctor) or physician to get a proper diagnosis and evaluation
A change in activity, rest and better shoes & orthotics might be all that is needed to recover. Surgery is typically performed only as a last resort. Once you have undergone a course of conservative treatments recommended by your doctor for at least 3 months or more and have shown no improvement, they may consider it - but each case is unique to the individual.
It's generally understood by doctors and surgeons, that surgery will introduce more scar tissue into the foot. This added scar tissue will be problematic, requiring PT and conservative treatment options post-surgery. This is why surgery is only performed as a last resort for chronic foot injuries or a fractured bone that won't heal with conservative treatment methods.
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Sources:
1. Harvard Health Publishing. (2023) Morton's Neuroma - Harvard Health. Retrieved May 01, 2023, from https://www.health.harvard.edu/a_to_z/mortons-neuroma-a-to-z
2. (2023) Morton’s Neuroma: Causes, Symptoms, Diagnosis & Treatment. Retrieved May 02, 2023, from https://my.clevelandclinic.org/health/diseases/15118-mortons-neuroma
3. (2023) Morton's Neuroma - OrthoInfo - AAOS. Retrieved May 02, 2023, from https://orthoinfo.aaos.org/en/diseases--conditions/mortons-neuroma