Morton's Neuroma is also known as or related to:
Numb toes, numb feet, neuroma, inter-digital neuroma
Description:
Morton’s neuroma refers to the inflammation of the nerve that passes between the joints of the forefoot and supplies feeling to the smaller toes of the foot.
The nerve that supplies feeling to the 3rd and 4th toes is most prone to irritation due to two larger nerve branches combining in this spot. This nerve accounts for 90% of neuroma’s in the forefoot with the other 10% occurring with the nerve that supplies the 2nd and 3rd digits.
Symptoms:
As the nerve becomes inflamed it causes all sorts of feelings in the forefoot and the smaller toes such as tingling, altered sensations, stabbing pain, deep pain and numbness.
Causes:
Any pressure that squeezes the forefoot such as tight shoes will cause the bones in the forefoot to compress and irritate the inter-digital nerve that supplies feeling to the smaller toes.
As the nerve becomes irritated, the lining of the nerve swells and puts increasing pressure on the nerve. As the pressure increases the symptoms of altered sensations, pain and eventually numbness as feeling through the nerve is blocked.
Treatments:
Correctly diagnosing this condition with an experienced podiatrist is essential as damage to the surrounding joints, ligaments, joint linings, fluid filled sacks and other structures causes localised swelling that puts pressure on the same nerve and produces that same symptoms.
True Morton's neuroma treatments can include wide fitting footwear, cushioned soled shoes, low heels, metatarsal dome pads, specifically designed padding or orthotics, changing run technique from forefoot striking, ultrasound guided cortisone injections or surgical excision.
Here is our preferred order of treatments for Morton's Neuroma that we will progress through quite quickly to get relief:
1. Shoe Lacing
Backing off the laces at the front of your shoes are critical. Take the laces completely out of the shoes and skip the bottom holes to create more room for the front of your foot
One of our Shoes Feet Gear podiatrists shows how to do a volume lacing technique to reduce pressure on the forefoot. This creates more width in the front of the shoe to help with Morton's neuroma, inter-metatarsal bursitis, bunions and wide feet.
This volume lacing can also be combined with lock lacing to create more width in the forefoot and keep the heel firm.
2. Identify Problem Shoes
If the pain is worse in certain shoes, stop wearing them! Go and buy yourself a correctly fitted wide pair of shoes. The wider the better! Shoes Feet Gear has access to wider models of shoes than normally available off the shelf.
3. Metatarsal Dome Pads
These little dome shaped pieces of rubber can be pure gold. The idea is to try and lift one of the joints up and out of the way to create more room between the joints vertically as well as horizontally. They are very hit and miss, but if they are in just the right position, then they can be amazing. We have some techniques to try and get these in just the right position and it is worth a few attempts.
4. Orthotics with Dome Pads
It is rare to use an orthotic for this condition, however feet that roll outwards can put more pressure on the inflammed nerve at toe off. An orthotic set-up to get the foot rolling off the big toe area can work to relieve this problem.
5. Ultrasound Guided Cortisone
This is for very stubborn and usually long standing Morton's Neuromas that haven't responded to the standard treatments. The causative factors of tight fitting shoes, etc need to be removed before using cortisone, otherwise there is a high chance that the cortisone will wear off in a few weeks and the continued nerve irritation will inflamme the Neuroma once again. Once the neuroma causes have been removed, cortisone is a strong anti-inflammatory that can get the swollen nerve to shrink quickly. It is hoped that this kick start is enough to allow the body to keep reducing the inflammation long term for recovery. Ultrasound is used to visualise the nerve and to deliver the cortisone accurately.
6. Other Low Evidence Treatments
If ultrasound guided cortisone hasn't effectively settled the neuroma, there are many other suggested treatments that could be explored. It is important to remember that these have low evidence for success and can be expensive.
7. Surgical Excision
Surgically removing the inflammation and scarring around the nerve or the whole nerve itself is an option. This is quite successful as far as foot surgeries are concerned. There is generally a reasonable recovery period before full activity can be resumed and there may be a small patch of numbness near the toes long term. If the conservative measures have failed, this is a viable option.
Summary:
If the nerve has been irritated for a long time, then permanent scarring forms and can make this condition difficult to resolve completely. So make an appointment as soon as possible to have this condition diagnosed and treated properly.