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Morton’s Neuroma Treatment – What are Our Options?

Nov 3, 2022

Morton’s neuroma is a painful condition that affects the ball of your foot. It is the most common compressive neuropathy after carpal tunnel syndrome, often affecting the area between your third and fourth toes. Morton’s neuroma may feel as if you are standing on a pebble in your shoe or on a fold in your sock.  However, the good news is it can, in the vast majority of cases, be cured without surgery.  We also see in clinic cases where it has been confused with other conditions such as bursitis, neuropathy, stress fracture, metarsalgia, which is why we carry out a thorough assessment before commencing treatment.

Morton’s Neuroma Symptoms

Unlike some other foot conditions, Morton’s neuroma doesn’t show any outward signs indicating any sort of issue such as swelling or lumps. However, you will likely experience pain that is often intermittent. Some experience the feeling of a pebble in their shoe, burning pain in the ball of your feet, or numbness or tingling in your toes. The pain can get so difficult that you experience difficulty walking.

If you experience any of the symptoms above for more than a few days it’s time to seek medical help. Try changing your shoes and reducing the stress on your foot once you start feeling pain, but don’t let it go for too long without intervention if the pain doesn’t subside.

Diagnosis of Morton’s neuroma

Differential diagnosis includes mechanical metatarsalgia, intermetatarsal bursitis, Freiberg disease, stress fracture, giant cell tumour (GCT) of tendon sheath, and peripheral neuropathy related to metabolic disease or entrapment of nerve at more proximal part of a body.

Causes of Morton’s Neuroma

There are a variety of causes and risk factors that can lead to the condition.

  • Certain Sports Activities: Any sports that include repetitive, high-impact movements can cause Morton’s neuroma. This includes jogging and long-distance running. Sports that also require tight-fitting shoes that put pressure on your toes can be problematic. Sports such as rock climbing, skiing, snowboarding, and figure skating all require tight-fitting shoes that could be harmful to your feet.
  • High Heels: High heels elevate your heel and place all of your body weight and excess pressure on your toes. Walking in high heels requires repetitive strides that can place a lot of pressure on the balls of your feet and your toes.
  • Other Foot Conditions: Those who already have certain foot conditions, including hammertoe, bunions, high arches, or flat feet are at a much higher risk when it comes to Morton’s neuroma.
  • Injury: Depending on the injury, a foot trauma can potentially result in the condition.

Treatment of Morton’s Neuroma

Morton’s Neuroma treatment is important as you can cause more issues by allowing the pain to continue as aside from it not being pleasant to have it can also affect your gate and alignment which can cause pain in other parts of your body further down the line e.g. knee pain, but what is the best treatment for a Morton’s neuroma/neuroma in the foot/interdigital neuroma?

Treatments may include:

  • Morton’s neuroma insoles. Specially made soft pads or insoles – to take pressure off the painful area of your foot.
  • Steroid injections- In one study, forty-five neuromas in 36 patients were injected with a single corticosteroid injection either with or without ultrasound guidance. At an average follow-up of 4.8 years, the original corticosteroid injection remained effective in 36% of the patients.
  • Morton’s neuroma surgery – is an option if you have very severe symptoms or other treatments are not working, but it is rare that this is needed and if you do go ahead with surgery there can be side effects such as loss of sensation. As part of the interdigital nerve, some minor sensation loss in the “web space” of the adjacent toes is expected. Usually, this region is very small and the numbness is inconsequential for day-to-day activities. That said, in rare cases numbness can extend to the entire toe.

Morton’s neuroma surgery is usually associated with high levels of success but some reports suggest as many as 30% of patients under-going such surgery are dissatisfied with the outcome.  Patients can sometimes derive no relief of symptoms and the cause of the pain remains unexplained. Other unfavourable outcomes include infection, stump neuroma formation or the onset of CRPS which can be extremely debilitating.  (https://online.boneandjoint.org.uk/doi/abs/10.1302/1358-992X.94BSUPP_XXII.BOFAS2010-003)

Manual therapies for Morton’s neuroma

Manual therapies are a highly effective option for the treatment of Morton’s neuroma – This can include manual therapies such as foot mobilisations and manipulations.

Mobilisations and manipulations are two non-invasive manual therapies that aim to reduce pain and restore movement into joints and surrounding tissues. They both work within the scale of your natural range of motion (RoM) available at the joints being treated.

Mobilisations use slow rhythmic movements and is performed within the passive range of motion of the joint. Its physiological effects stimulate receptors in the tissues and joint capsules. This sends feedback to the brain, effectively reminding the body of the motion which is available at that joint. Mobilisation is particularly useful as a treatment method in conditions such as Morton’s neuroma, injuries such as plantar fasciopathy and Achilles tendinopathy, during rehabilitation including high trauma, and ankle injuries.

Manipulation involves applying a specific amount of force in a very precise motion to a joint, to reduce joint restriction and restore normal range of motion. Manipulation has been shown to increase blood-flow to the affected area. Manipulation also immediately improves the mobility of the joints and reduces the pain experienced in the surrounding soft tissues. Some injuries result in adhesions and cross linkages forming around a joint limiting its movement. Manipulation can release the joint from these hindrances and return normal, smooth motion to the previously injured structure.

Manipulation has been shown to offer a better long-term result than a steroid injection.  As a non-invasive treatment it is therefore one of the best options for treatment of a Morton’s neuroma, and why we use this approach extensively in the Foot & Ankle Clinic in Darlington.

  • Laser treatment for Morton’s neuroma (which is the same thing as laser therapy for Morton’s neuroma), can be extremely effective, especially when used alongside other treatment modalities. We are fortunate in clinic to have all the leading technologies such as laser, focal shockwave and radial shockwave so allowing us to combine their use as required with patients.
  • SIS and Focal shockwave therapy for Morton’s neuroma are also extremely useful, and we use them alongside manual therapies in the clinic, but this is a discussion for another blog…

If you are suffering with foot pain caused by a neuroma or any other issue please go to our foot pain page on our website to see how we can help you https://thefootandankle.clinic/pain/foot-pain/