Morton’s Neuroma

Morton's Neuroma

Article by Alex Clarke

Morton’s Neuroma

What is Morton’s Neuroma?

A Morton’s Neuroma is incorrectly termed, with the name suggesting it is a tumour or growth.  Rather than a true neuroma, it is perineural fibrosis, which means that over time the sheath surrounding the nerve becomes irritated, inflamed, and forms a thickened scar tissue.

Morton’s Neuroma Symptoms

It usually occurs between the 3rd and 4th toes (about 65% of cases), as is pictured to the right. It is less commonly found in the 2nd web space and rarely in the 1st or 4th web spaces. You can also experience pins and needles or numbness as a result of the nerve being affected. The condition tends to occur predominantly in middle-aged females.

What Causes Morton’s Neuroma?

morton's neuroma

A Morton’s Neuroma is a result of complex biomechanical changes that occur in your feet. There are many theories about the exact cause of the scarring and thickening, but it boils down to a tissue overload. The body lays down scar tissue to try to protect the overloaded structure.

Tight-fitting shoes may exacerbate a Morton’s Neuroma. Shoes such as high heels and shoes with tight toe boxes (e.g. women’s fashion shoes and cowboy boots) are particularly damaging to the toes. These shoes have a sloping footbed and a narrow toe box. The slope causes the front of the foot to bear your weight. The angle of the toe box then squeezes your toes together.

Footwear is not the only cause of Morton’s Neuroma. Injuries to the foot can also be a factor in developing the condition by changing your foot biomechanics. Poor foot arch control that leads to flat feet or foot overpronation may make you susceptible to a neuroma. This predisposition is due to biomechanical reasons.

For specific advice regarding your Morton’s Neuroma, please consult your foot physiotherapist, podiatrist or doctor.

Morton’s Neuroma Treatment

PHASE I – Pain Relief. Minimise Swelling & Injury Protection

Pain is the main reason that you seek treatment for a neuroma. Analgesics may help. Ease your inflammation via ice therapy and techniques or exercises that unload the inflammed structures. Anti-inflammatory medications may help.

Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, unloading taping techniques, soft tissue massage and orthotics to offload the irritated nerve.

One of the most significant factors in relieving pain may be changing or modifying your footwear. An adjustment may mean adding felt, foam or gel products to your shoe to help offload the area or looking at avoiding tight fitting heels or boots.

Metatarsal domes are often very useful.

Sometimes a corticosteroid injection is required to help settle the inflammation surrounding the nerve. It would be best if you experienced good pain relief with a steroid injection. However, there are some risks that you should discuss with your physio or doctor.

PHASE II – Restoring Normal ROM & Posture

As your pain and inflammation settle, your physiotherapist will turn their attention to restoring your standard toe and foot joint range of motion and muscle length.

Treatment may include joint mobilisation and alignment techniques, massage, muscle and joint stretches, taping, or orthotics. Your physiotherapist is highly skilled in the methods that will work best for you.

PHASE III – Restore Normal Muscle Control & Strength

Your foot posture muscles are vital to correct the biomechanics that led to the overload injury. Your physiotherapist will assess your foot posture muscles and prescribe the best exercises specific to your needs.

PhysioWorks has developed a “Foot Posture Correction Program” to help you regain your healthy foot posture. Please ask your physio for their advice.

PHASE IV – Restoring Full Function

This stage of your rehabilitation aims at returning you to your desired activities. Everyone has different demands for their feet that will determine what specific treatment goals you need to achieve. For some, it is merely to walk around the block. Others may wish to run a marathon or return to a labour-intensive activity. Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals.

PHASE V – Preventing a Recurrence

A Morton’s Neuroma may recur with repeated overload. The main reason is biomechanical. In addition to your muscle control, your physiotherapist will assess your foot biomechanics and may recommend either a temporary off-the-shelf orthotic or refer you to a podiatrist for custom made orthotics. You should avoid wearing high heel shoes and shoes with tight or angular toe boxes. Your physiotherapist will guide you.

Morton’s Neuroma Surgery

Consider surgery when the non-operative treatment cannot relieve your symptoms, particularly if you have had pain for more than six months. 80% of patients who require surgery report good results, with 71% of people becoming pain-free.

Please consult your foot physiotherapist, podiatrist or doctor for individualised advice.