Pain in the Forefoot? It Could Be a Morton’s Neuroma!

diagram of where morton's neuroma occurs in the feet

What is a Morton’s Neuroma?

To understand what a Morton’s Neuroma is and how it occurs, we first must take a small anatomy lesson.  As can be seen in the image above, our feet contain long bones called Metatarsals – which connect our midfoot to our toes.  These bones have nerves running in between them, which provide sensory information to our brains.  A Morton’s Neuroma can occur when these bones compress the nerve running in between the, and the friction causes thickening of the nerve tissue.  This can be seen below as a red lump in between the third and fourth metatarsals.

 

A Morton’s Neuroma is most common in middle aged women.  Whilst it generally occurs in the third metatarsal space as is pictured above, it can be found in the second or fourth metatarsals spaces also.

The compression of nerves between bones can occur due to a person having naturally narrow feet. Another cause, and probably the most common one, is footwear that is not wide enough for the forefoot. Shoes like high heels, footy boots, and ballet flats are all prime candidates for causing this injury. However, even having runners that are too narrow for your foot can be to blame.  The nerve compression can also be caused by repetitive stress, often due to sport, running, and walking long distances.

 

What Does a Morton’s Neuroma Feel Like?

The thickening of the nerve tissue between the bones of the foot can be extremely uncomfortable, causing pain to the ball of your foot, and a range of other symptoms. Some patients report feeling like a pebble is under their foot.  Other patients report feelings of burning, numbness, and tingling, which are all the usual signs of nerve related pain.

The discomfort can often lead to difficulty walking and symptoms will often be relieved by resting your feet, or walking without shoes.  This allows the metatarsals to spread, reducing the pressure placed on the digital nerve.

If a Morton’s Neuroma is not treated properly in its early stages, the neuroma will thicken to the point where walking barefoot no longer spreads the metatarsals enough to reduce symptoms.  When left this long untreated, going for a walk can often lead to the pain spreading to the rearfoot, or even causing cramping in your leg.

 

How Will My Podiatrist Diagnose a Morton’s Neuroma?

Patient History:

The first step to diagnosing a patient with Morton’s Neuroma involves taking a detailed medical, surgical, and footwear history.  As well as conducting a range of assessments.  This will help indicate if you have the risk factors that are generally present with this injury.  It will also lead us to perform further assessments to rule out any other injuries.

Palpation:

The next assessment we will perform involves touching/palpating your foot to find out exactly where the pain is coming from.  As we mentioned earlier, Morton’s Neuroma is often located in the third intermetatarsal space, however, it can also occur in the second or fourth intermetatarsal space.  If we find the pain is coming from one of these locations, we can move on to our next assessment to confirm our suspicions.

Mulder’s Click Test:

The next assessment we will perform is called the Mulder’s click test.  This test involves squeezing the forefoot medio-laterally.  A positive test will result in a clicking or crunching sound coming from your forefoot.  This may also reproduce symptoms such as numbness, tingling or pins and needles, as we are applying compression to the nerve.

Imaging:

In some cases, imaging will be required to confirm the diagnosis, and rule out any other conditions, such as fibroma, or a stress reaction of the metatarsals.  If all our previous tests indicate without doubt that you have Morton’s Neuroma, this step may not be necessary.  However, if there are any doubts, your podiatrist may send you for an x-ray and/or an ultrasound.  This can help to determine the exact condition causing pain and discomfort.

 

How is a Morton’s Neuroma Treated?

Morton’s Neuroma treatment options vary greatly.  The severity of the pain, and whether other treatment modalities have been tried previously will help determine the treatment option for you.  As a rule of thumb, your podiatrist will generally begin with the more conservative treatment options and then utilise other options as necessary.  The aim is to return the affected nerve to its normal thickness, thus reducing irritation.

 

Footwear:

As we mentioned earlier, ill-fitting footwear is one of the leading causes of Morton’s Neuroma.  So, this leads us to our first treatment option.  We want to ensure that the footwear you are wearing allows the metatarsal bones to spread.

This reduces the compression and friction placed on the digital nerves.  Your podiatrist will generally recommend a runner with a wide ‘toe-box’.  Many of the popular runners sold at retail stores will have wider options available on request.  Don’t worry – we won’t be putting you in an ugly pair of shoes!

 

Met Dome:

The next conservative treatment option for Morton’s Neuroma is the use of a metatarsal pad.  Also known as a ‘met-dome’, this pad lifts up the middle three metatarsals, causing an arch in the forefoot.  This arch increases the space between the metatarsals.  Like how wider footwear allows the metatarsals to spread, this treatment also reduced the amount of pressure placed on the digital nerves.

 

Orthotics:

Orthotics can be used in a range of ways to help in the treatment of Morton’s Neuroma.  Because all feet are different, how your foot functions will dictate how your podiatrist might use orthotics to treat Morton’s Neuroma.  We may help you by adding a permanent met dome to your orthotics. We may alter your midfoot or rearfoot to reduce the amount of pressure you apply to your forefoot when walking or running.  This will allow you to get back to walking, running, or sports, without this injury appearing again.

 

Corticosteroid Injections:

You may have heard of your favourite footy players or athletes using corticosteroid injections to get through a game, or season, for a range of injuries.  This option works great for reducing the symptoms of Morton’s Neuroma in the short-terms, however the neuroma will often start causing issues again after just weeks or months.

Corticosteroids injections are also known to occasionally cause side effects such as fat pad atrophy and discolouration of the skin.  This treatment option is generally only used as a treatment modality when more conservative options have been unsuccessful.

 

Surgical Excision:

In severe cases of Morton’s Neuroma or when all other treatment options have failed, it may be necessary to remove the thickened portion of the nerve.  This surgical excision can be done quite easily, leaving just a small scar.  The surgical excision is effective in eradicating any pain, however, this will usually result in a small area of skin between your toes with a loss of sensation.  This is left as a last resort to its invasive nature and the side effects that may occur.

 

If you are located in Melbourne, and experiencing any pain or discomfort in your feet or lower limbs, come visit the team at Watsonia Podiatry.  Our team of awesome podiatrists are here to relieve you of any pain and help your feet be the best they can be!  You can book online here, or call us on 03 9432 2689 to book your appointment with us today!