Morton's Neuroma (Morton's Syndrome)
Morton’s Neuroma is also referred to as Morton’s metatarsalgia, Morton’s Neuralgia, Plantar Neuroma and Intermetatarsal Neuroma. A neuroma is the thickening of nerve tissues. The most common location for this to occur is in the foot, between the 3rd and 4th toes. However, it can occur in other areas of the foot. Morton’s syndrome occurs when the metatarsal bones (the toes) press on the plantar digital nerves. This causes the nerves, which transmit messages from the brain to the foot, to become inflamed. This usually happens because the arch of the foot has weakened, and the gap between the metatarsals narrows.
It usually only occurs in one foot and is more common in women.
Ill-fitting shoes or laces tied too tight. Check shoes. Laces can put pressure on the nerve and can cause numbness.
High heeled shoes, (especially those over 5 cms) can cause the toes to become compressed.
People with bunions, high arches or flat foot are particularly susceptible to Mortons’ Syndrome.
Athletes’ who spin on the soles of the feet can suffer from Morton’s Syndrome as asports injury, for example tennis players or golfers. Ballet dancers might also be susceptible to this symdrome.
Morton’s Syndrome can be caused by a benign tumour pressing on the plantar digital nerves.
Pain is usually experienced at the base of the toes, usually felt on the outside of the toe and the inside of the next toe, usually the 3rd and 4th toe.
Pain has been compared to as an electric shock; it is sharp and very painful.
It usually occurs when walking and can be so severe that the patient is forced to stop and remove the shoe to alleviate the pain.
Pain felt when the lateral (outside) of feet are squeezed.
It can feel as if there is something in your shoe.
Barefoot walking can alleviate pain.
Pain is lessened if the foot is lifted off the ground.
It is important to check the patient’s shoes to make sure they are fitting properly.
A doctor or physiotherapist might suggest an MRI scan to assess whether the metatarsals are compressed and whether the plantar digital nerves are inflamed.
Rest: is essential to prevent further damage and to assist recovery. The amount of rest is dependent on the severity of the injury. It is important to avoid any exercises that put a strain on the injury and exercise should be avoided until the muscles have completely recovered.
In the sub acute (3 days to 3 weeks) and the chronic stage (3 weeks to 2 years) it is important that training should be adapted to avoid putting pressure on the plantar digital nerves or any exercises that put excessive strain on the ball of the foot. A physiotherapist or doctor can advise when exercise should be resumed and what exercise would be appropriate. It is important to always warm up and cool down properly when exercising.
Ice treatment: Ice, can be applied for 10-15 minutes, every 2-3 hours in the acute and sub- acute stage (frequency can be reduced according to recovery, and can be continued for as long as deemed necessary). In the sub-acute stage (3days – 3 weeks) heat therapy can be applied, usually in the form of a hot bath.
NSAIDS (anti-inflammatories) and paracetamol can be taken to aid pain relief. Medical advice should be sought, in case of possible side effects.
Steroid injections (under medical guidance) can alleviate pain and can be an effective form of treatment, but it is recommended exercise should be avoided for 1-2 weeks after an injection.
Orthotics can improve gait and avoid the build-up of pressure on the plantar digital nerves. It is important to consult a podiatrist, who can perform gait analysis and give advice on appropriate foot wear.
A metatarsal raise might be advised to help take the pressure of the nerve by spreading the bones of the metatarsal.
Massage can help aid recovery, and improve joint mobility and range of movement. It should not be administered during the acute stage. If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.
A physiotherapist or podiatrist can recommend strengthening, flexibility and proprioceptive exercises in the sub-acute and the chronic stage of recovery. Initially exercises should focus on strengthening the arch of the foot. The intensity of the exercises should be increased gradually and in a controlled way. Cycling or swimming (with a pull buoy) is a good way of maintaining fitness while the foot recovers.
If alternative treatments fail, Surgery is usually advised and is an effective form of treatment. Recovery can take up to between 2-3 months.
Published: February 24, 2012Author: Sophia Cross, BA (Hons) MA
Morton's Neuroma Treatments