Neuroma’s are commonly occurring causes of foot discomfort and pain in people who perform extensive weight bearing activities such as sports or work. A neuromais a thickened bulge on the nerve branch which may be caused due to constant compression of the nerve involved. A neuroma that most podiatric patients present with is called Morton’s neuroma and occurs between the 3rd and 4th metatarsal bones in the foot. Patients will often describe an uncomfortable pain occurring between the bones in the ball of the foot which can be exacerbated when pressure is applied. The discomfort can become quite debilitating if left unattended.
What causes a Morton’s Neuroma to occur?
Morton’s neuroma is often caused by compression of the nerve in the foot. This compression can be caused by either structural abnormalities or certain behaviours.
Some common physical traits associated with increased risk of neuroma include:
– Flat feet or highly mobile/flexible feet
– Genetic predisposition.
More commonly though, are the behavioural characteristics that underlie the development of a neuroma. Some of these include:
– Wearing shoes with tight toe boxes (pointy toed shoes and heels)
– Wearing shoes that are too tight for the foot.
– Excessive periods of weight bearing in unsupportive/inappropriate shoes.
– Certain sports that require repetitive irritation of the ball of the foot, such as court sports, soccer, football, etc.
What are some symptoms of a Morton’s Neuroma?
Symptoms range widely depending of patient characteristics but generally some of the more commonly presented symptoms include:
– Tingling, burning or numbness in the ball of the foot which may extend to the toes.
– Pain, particularly on palpation of the space inbetween the 3rd and 4th metatarsals.
– Palpable mass underneath the ball of the foot.
– Symptoms may be alleviated by physical therapies such as massage but may progressively get worse over the course of a few weeks.
– Pain may be reported as becoming more intense as a neuroma grows in size.
How is a Morton’s Neuroma diagnosed?
A podiatrist is able to perform a full biomechanical assessment which may involve referring you for ultrasound imaging of the area to confirm the presence of a neuroma. During the course of the assessment, a podiatrist will often be able to reproduce the discomfort by directly palpating most commonly affected areas as well as obtaining a clearer image as to what exactly is the contributing factor to the cause of the neuroma. Combining this with a thorough patient history, a podiatrist can create a treatment plan unique to your specific circumstances.
What are some treatments for Morton’s neuroma?
There are a number of conservative treatments available that may alleviate the discomfort associated with a Morton’s Neuroma. Any treatment protocol however should be made specific to the patients circumstances as no single patient is the same. Some treatments may include:
– Padding of the foot to reduce compressive forces.
– Icing to help reduce swelling
– Orthotic devices to help with foot and lower limb alignment. This is often quite effective at controlling excessive pressures in the foot.
– Shoe modifications.
– Medications such as anti-inflammatory drugs to help with pain and swelling.
– Cortisone injections which will help with pain.
– Activity modification.
Surgery is often indicated when other conservative methods of treatment have failed. The surgical procedure required will depend on the nature of the neuroma, but generally will involve the excision of the offending lesion followed by a strict offloading and rehabilitation plan which can help ensure long term recovery.
If you or anyone you know is suffering from a Morton’s neuroma, our podiatrists at The Podiatry Centre can help.
Dr Anel Kapur (Podiatrist)