Mortons Neuroma
What is a Morton's Neuroma?
A Morton's Neuroma is a painful condition involving the nerve supply between the bones in the ball of the foot.
The exact cause is still unclear, however, excessive pressure and/or compression forces acting on the forefoot are probably mostly responsible for why the nerve becomes irritated or injured.
Patients commonly report pain in the second (between second and third metatarsal) and third (between third and fourth metatarsal) space. The condition is more likely to occur in women compared to men due to narrow and high heeled shoes.
The natural history of a neuroma may vary from person to person but if left untreated it may lead to permanent nerve damage.
Symptoms
- Burning, tingling, aching or cramping sensation in the area between the third and fourth metatarsal heads which can radiate into the third and fourth toes
- Pain may become worse when wearing tight shoes or walking for long distances
- Numbness in the ball of the foot or toes
Treatment
Treatments maybe conservative or operational.
Non-operational
Footwear
Initial treatment may involve wider fitting shoes with more cushioning. Tight shoes and shoes that lack cushioning will likely compress and irritate the nerve.
When it comes to selecting appropriate athletic or running shoes, consider the following shoe width guides:
- For Men – 2E (wide) or 4E (extra wide)
- For Women – D width (wide) or 2E (extra wide)
From our experience we have found this type of shoe (or something similar) to be very useful for patients who have a wide foot and symptomatic mortons neuroma:
For more information on these shoes, you can visit the company's website.
Another shoe that we recommend is the HOKA Bondi 7. This shoe is ideal for patients who require a shoe that they will be standing and walking in for long periods of time. The shoe has a tonne of cushioning and a rocker sole to help further offload the ball of the foot. The shoe is available in standard and wide widths.
To find out if the shoe fits properly remove the innersole from shoe, place it on the ground and then stand on it. If the front of the foot is overhanging the edges of the innersole then the shoe is too small.
Ice
In addition, patients may also benefit from icing the ball of the foot once – twice daily, anti-inflammatory medication, in-shoe padding and cortisone injections.
Padding
In-shoe padding techniques can be used to help offload and reduce pressure on the nerve when standing and walking.
Orthotic therapy
In most instances, the above advice will help most people. Sometimes people may require foot orthotic therapy. In the right situations, foot orthotic therapy may be helpful in reducing the compression forces on the nerve.
Foot orthoses will have a tendency to take up more room in the shoe thus making the shoe tighter. As a result, unless wider fitting shoes are able to be worn foot orthoses are unlikely to work or will worsen your symptoms.
Operational
Lastly, if conservative management is unsuccessful surgical treatment may be an option.
Morton’s Neuroma surgery (neurectomy surgery) can be done as a day surgery procedure as it only requires a small incision of 2-3 cm to take the neuroma out. Surgical excision of a Morton’s Neuroma has good clinical results and high overall patient satisfaction in the long term.