Morton’s Neuroma: Causes, Symptoms, Treatment, and Rehabilitation

What is Morton’s Neuroma?

Morton’s neuroma, also known as intermetatarsal neuroma, is a benign enlargement of the nerve tissue between the metatarsal bones. It commonly occurs between the third and fourth toes but can also affect other areas of the forefoot. This thickening is typically a response to irritation, compression, or repetitive trauma to the nerve.

Causes of Morton’s Neuroma

Morton’s neuroma can result from several contributing factors, including:

• Footwear Choices:

  • High-heeled or narrow shoes that compress the toes.

• Foot Biomechanics:

  • Flat feet, high arches, or other structural issues.

• Repetitive Trauma:

  • Activities involving impact or pressure on the forefoot, such as running or dancing.

• Medical Conditions:

  • Arthritis or bunions that alter foot alignment and increase nerve pressure.

Symptoms of Morton’s Neuroma

Key symptoms of Morton’s neuroma include:

• Sharp, burning pain in the ball of the foot.

• A sensation of stepping on a pebble or marble.

• Tingling, numbness, or cramping in the toes.

• Symptoms worsening with activity or tight footwear and improving when barefoot.

Diagnosis of Morton’s Neuroma

Clinical Examination

• Symptom Review: Understanding pain patterns and triggers.

• Physical Assessment: Palpation of the affected area to reproduce symptoms.

Imaging Studies

• Ultrasound: Identifies thickened nerve tissue.

• MRI: Provides detailed imaging for more complex cases.

Treatment for Morton’s Neuroma

Non-Surgical Treatment

1. Footwear Modifications:

   • Wear shoes with a wide toe box and good arch support.

   • Avoid high heels and tight-fitting footwear.

2. Orthotics:

   • Custom orthotics or metatarsal pads to reduce nerve pressure.

3. Pain Relief:

   • NSAIDs (e.g., ibuprofen) to reduce inflammation.

   • Apply ice packs to alleviate swelling.

4. Physiotherapy:

   • Stretching and Strengthening: Improve foot alignment and reduce nerve stress.

   • Manual Therapy: Relieve pressure on the nerve.

   • Gait Retraining: Optimize walking mechanics.

5. Activity Modification:

   • Reduce high-impact activities to minimize irritation.

Advanced Treatment Options

• Corticosteroid Injections:

  • Reduce inflammation and pain around the nerve.

• Alcohol Sclerosing Injections:

  • Used in severe cases to reduce nerve pain by shrinking the neuroma.

Surgical Treatment

If conservative management fails, surgery may be recommended to remove the neuroma or release surrounding structures to alleviate nerve compression.

Rehabilitation for Morton’s Neuroma

Effective rehabilitation focuses on symptom relief and prevention:

• Flexibility Training:

  • Stretching exercises for the calf muscles and plantar fascia.

• Strengthening Exercises:

  • Target intrinsic foot muscles to improve support and balance.

• Proprioception and Balance Training:

  • Enhance stability to reduce nerve stress during movement.

• Progressive Return to Activity:

  • Gradual reintroduction of activities, prioritizing proper footwear and biomechanics.

Preventing Morton’s Neuroma

To minimize the risk of developing Morton’s neuroma:

• Wear supportive, well-fitting shoes.

• Use custom orthotics if needed to address biomechanical issues.

• Avoid repetitive activities that place excessive stress on the forefoot.

• Maintain a healthy weight to reduce foot pressure.

Morton’s neuroma can significantly impact your mobility and quality of life, but with the right treatment, recovery is possible. At Palms Physiotherapy & Allied Health, our dedicated team is ready to guide you toward relief and recovery. Reach out today for expert care tailored to your needs.