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MORTON'S NEUROMA

A Morton’s or intermetatarsal neuroma is pain from the nerves that pass between the bones that join onto your toes (metatarsals). Nerves pass between each of the metatarsal bones to supply the toes. Small fluid filled sacs called ‘bursa’ also sit in this gap to act like a cushion. There is no tumour in this condition. Instead, pain from a Morton’s neuroma is caused by a combination of irritation of the nerve, scar tissue that develops around the nerve, and inflammation and swelling of the bursa. This leads to a nerve entrapment—the nerve becomes compressed and cannot move as freely. It occurs most commonly between the second and third, or third and fourth metatarsals. 

What causes Morton’s neuroma?

Morton’s neuroma is usually caused by excessive loading to the metatarsals. The reason for this may vary between different people—in runners it may be due to load on the metatarsal arch, for example. This is different to the larger foot arch. Morton’s neuroma is commonly associated with narrow-fitting shoes and high heels. It is up to 10 times more common in women and usually seen in those aged 40–60 years old.

How do I know if I have a Morton’s neuroma?

A Morton’s neuroma causes pain between the metatarsal bones of the foot with weight-bearing (such as standing or walking). This pain can often ‘shoot’ down into the toes and sometimes can feel like burning or tingling. It may also lead to numbness of the affected toes. Your physiotherapist will be able to diagnose this condition by carefully questioning how your symptoms behave. They may try and reproduce your symptoms in certain weight-bearing positions, and may also examine your foot posture and footwear. It will also be important for your physiotherapist to carefully diagnose the cause of your pain, as a number of different conditions also cause pain in the same area, including stress fractures and arthritis, which require different management.

How can physiotherapy help with a Morton’s neuroma?

Your physiotherapist will need to investigate what is mainly causing your pain and make modifications (it may be advised to change from narrow constricting footwear to something wider). To settle pain quickly, you may be advised to avoid any aggravating activities for a short period. Your physiotherapist can provide exercises to strengthen the foot muscles. They may also tape your foot or prescribe an orthotic to help with pain. Often a small dome of padding placed under the middle of your forefoot is effective at settling pain and supporting the metatarsal arch across your foot. In cases where conservative treatment is not effective, it may sometimes be necessary to consider a surgical review.

How effective is physiotherapy for a Morton’s neuroma?

A lack of research exists studying treatments for Morton’s neuroma. A recent Cochrane Review (summary of other previous research) reported that there was insufficient evidence to assess the effectiveness of any treatment for this condition. Most research focuses on surgical techniques, which are only necessary in severe circumstances, or corticosteroid injections. Further research is required in this area.

What can I do at home?

Trying to avoid aggravating activities for a short period may be helpful for your pain. Ice over the painful area may also help with symptoms. Wearing shoes with a wide toebox and avoiding narrow shoes is advisable. Activities that don’t require weight-bearing through the foot (such as seated exercise or swimming) should not cause any pain and may help to maintain activity levels.

How long until I feel better?

Outcomes for Morton’s neuroma are hugely variable and depend on the severity of the case. For mild cases, if simple changes such as altering footwear are effective, symptoms may resolve within 1–2 months. More complex cases may require injections and at least six months for complete resolution. In some cases, people have surgery, though this is uncommon.