According to research in Australia, Morton’s neuroma is particularly common in women aged 50-55 years.[1] Despite this, the condition accounts for approximately 11 for every 100,000 hospital admissions.[1] Not all people with this condition will have symptoms. Upon imaging investigations, around 35% of people without foot pain will have signs of Morton’s Neuroma.[2]
Morton’s neuroma was named after Thomas Morton, an American surgeon, in 1876. He was the first to describe the inflammatory foot condition as a neuroma.
Read on to understand what you should know about Morton’s neuroma; the risk factors, treatment options and expected recovery time.
What is Morton’s Neuroma?
Morton’s neuroma (or interdigital neuroma) is a condition that causes pain underneath the balls of the forefoot (front part of the foot). It is caused by swelling of the tissue around the nerves approaching the toes, particularly between the third and fourth toes.
What are the symptoms of Morton’s neuroma?
The most common symptoms of Morton's neuroma include sharp pain in the ball of the foot; it may feel like there is a pebble in the bottom of your shoe. People may also experience numbness or a burning sensation in the ball of the foot.
Common symptoms of Morton’s neuroma
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Deep burning pain on the ball of the foot
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Increased pain when wearing tight shoes
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Numbness and tingling sensation on the toes
In some cases, it is possible for Morton’s neuroma to not cause any pain or other symptoms.
What causes Morton’s neuroma?
The most common cause of Morton's neuroma is shoes that are too tight or have excessively high heels. Over time, the shoes can compress and irritate the nerve at the ball of the foot, leading to pain and inflammation.
Common causes of Morton’s neuroma
Sports that increase the risk of Morton’s neuroma
Sports that use tight footwear and repetitive running activities that put pressure on the ball of your foot and toes can increase your risk of having Morton’s neuroma.
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Ballet
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Basketball
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Netball
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Tennis
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Marathon running
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Soccer
How is Morton’s neuroma diagnosed?
Having Morton’s neuroma can be painful and frustrating. Recreational sports and occasional events where you need to wear tight footwear can cause discomfort and limit your activities.
There are several options available when it comes to diagnosing your foot pain as Morton’s neuroma. One of the most common and most recommended by Australian GPs is an assessment from a physiotherapist.
Physiotherapists are specialised medical professionals that deal with pain conditions such as Morton’s neuroma. They are qualified to diagnose and provide proper treatment for your condition.
Your evaluation will start with a consultation. Your physiotherapist will ask you related questions regarding your condition and medical history. Take this time to discuss all your symptoms with your physiotherapist.
After establishing a background of your condition, your physiotherapist will perform a physical assessment of your foot and toes. Your physiotherapist will attempt to compress the toe region to replicate your symptoms and check for other factors that may be causing your pain.
Your physiotherapist will then create a specific treatment plan for you and will guide you through your recovery.
This will also include:
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Treatment program
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Estimated time of recovery
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A home exercise program to aid your treatment
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Pain management strategies
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Expert advice on how you can return to your activities
How is Morton’s neuroma treated?
Morton’s neuroma can affect your ability to walk and participate in sports. More importantly, it can lead to permanent nerve damage if left untreated.
There are several options when it comes to treating Morton’s neuroma. One of the more common and the treatment option referred to by Australian GPs the most frequently is physiotherapy.
Morton’s neuroma is a common nerve injury that physiotherapists routinely encounter. They are in the best position to give quality care and treatment for your injury to help you regain normal function.
The primary goal of your treatment is to decrease inflammation, manage the pain, and create a specialised treatment program to prevent a flare-up of your symptoms.
Depending on the severity of your Morton’s neuroma, a physiotherapist may provide you with a combination of the following types of treatments:
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Cryotherapy - Cold modalities can help reduce swelling and help control the pain in the short term.
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Shockwave Therapy - A relatively new treatment modality, where high bursts of energy are applied to the area, helping reduce pain and promote repair.
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Ultrasound Treatment - Ultrasound waves deliver deep heat to the soft tissues of the foot to accelerate healing.
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Deep Tissue Massage - Hands-on techniques are used to promote blood flow, decrease tension and improve pain in the foot.
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Manual Therapy - Hands-on techniques used by your physiotherapist to increase blood flow and joint mobility.
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Stretching Exercises - Gentle stretching exercises to help relieve muscle tension and prevent stiffness.
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Therapeutic Exercises - Exercise techniques to correct impairments and support your recovery.
A typical physiotherapy session with your local physiotherapist will last anywhere between 30-60 minutes. It is not uncommon for patients to feel the benefits in just one session.
Next step - Creating a treatment plan made for you
After your evaluation, your physiotherapist will create a specific treatment plan based on your lifestyle to maximise your recovery.
Self-care for Morton’s neuroma
If you think you have Morton’s neuroma, here are the best things you can do and avoid.
Things to do:
- Rest
Pain is aggravated by inflammation and irritation of the nerve on your foot. Take a break from your activities for a few days until the inflammation subsides.
- Ice
Apply ice to the sore areas of your foot to decrease pain and manage the inflammation.
- Massage
Apply gentle pressure on areas of your foot to relax the muscles and relieve tension on the ball of your foot.
- Stretching your foot
Gently stretch the muscles and tendon of your foot and calves to relieve tension and maintain your normal range of motion.
Things to avoid:
- Avoid wearing high-heeled shoes
Wearing high-heeled shoes alters the normal weight distribution to the ball of your foot.
- Avoid a tight-fitting toe box
Avoid wearing footwear with tight toe boxes to prevent compression of your toes and irritating the nerve.
Do I need a specialist or surgery?
Several diagnostic imaging can be done to check the presence of Morton’s neuroma and rule out other conditions that may cause painful symptoms.
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Ultrasound (sonography): Used to accurately demonstrate the thickening of the nerves on your toes and check for other conditions such as bursitis.
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X-ray: Evaluates the presence of arthritis and stress fractures that may be causing forefoot pain.
Through guided ultrasound, your GP may provide a corticosteroid injection to help manage pain and decrease inflammation. Orthotic pads and arch supports can also be prescribed to lessen pain.
Surgeons may also perform surgery to remove Morton’s neuroma. However, the advancement in medicine provides alternative treatment approaches such as guided sclerosing alcohol injections and the use of radiofrequency to heat up parts of the neuroma.
Your GP may coordinate with your physiotherapist to maximise your recovery and to provide you with pain treatments that don’t rely on surgery and pain medications.
What is the recovery time / prognosis for Morton’s neuroma?
Ultimately, recovery time is dependent on being proactive and seeking professional treatment along with the severity of your foot pain and injury.
Full recovery from Morton’s neuroma can be achieved within 4 weeks depending on the severity of the condition. People who undergo surgical removal of Morton’s neuroma can bear full weight within 3 to 6 weeks after the surgery.
Rest, shoe modifications and lifestyle changes are the key to treating and preventing flare-ups of Morton’s neuroma.
Physiotherapy can improve your overall outcome and recovery through intensive rehabilitation.
Can Morton’s neuroma be prevented?
The advice below will help prevent Morton’s neuroma or help with recovery if you already have it.
Stretch your foot and calf muscles to relieve tension on the ball of your foot.
- Wear slippers or open footwear
Wear slippers or wide toe box shoes to lessen the pressure on your toes.
- Apply ice on your foot after intense activities
Applying ice after intense running activities or sports can help manage inflammation on your foot.
Wear athletic shoes with proper cushioning on the ball of your foot to minimise pressure on the digital nerves.
Outlook and the main takeaways
Having Morton’s neuroma can be frustrating. Pain and discomfort are usually felt when the foot is compressed from wearing tight and high-heeled shoes. It is essential to make lifestyle modifications and take extra care of your foot when you have Morton’s neuroma.
Book a visit with a physiotherapist today to have your foot assessed and to help you manage your pain and improve your overall function.
Anatomy of Morton’s neuroma
The tibial nerve runs from the back of your leg down to the tarsal tunnel of your foot. From here it splits into three branches: the calcaneal, lateral plantar, and medial plantar branches.
At the bottom of the foot, the medial and lateral plantar nerves give rise to the digital nerves which run along the web spaces of your toes.
Chronic and repetitive compression of the toes irritates the portions of the nerves around your toes. This results in inflammation and enlargement of the nerve resulting in pain and discomfort over time.
