A Morton's neuroma is an irritation of a nerve in your forefoot, this irritation can cause some inflammation in the nerve which causes you pain often with associated numbness and tingling. Typically it affects the 2nd, 3rd and 4th toes.
Most common symptoms:
Pain in the forefoot when you stand up for long periods of time
Pain when you stand on your toes
Pain when you walk or run
Can feel like a small pebble underneath the ball of your foot
Burning, tingling or numbness in the area or referring into the toes
Why does this happen?
Morton’s Neuromas can occur for a wide variety of reasons and some are still not 100% clear.
The main causes could be a change in footwear, or continual wear of narrow footwear or simply overuse from sport.
As you can see from this photo, If you continuously wear narrow footwear, your foot bones get squeezed together. This creates a narrow space for the nerve to be in. This continual narrow space causes an inflammatory response in the nerve. Once the nerve becomes slightly thickened it increases the irritation and pain when you walk/stand.
How is it treated?
The key to treatment for this condition is an accurate diagnosis. There are a number of conditions that affect the forefoot area and the treatment does differ depending on the condition.
Our initial focus is to manage this conservatively. This involves taping, shoe additions such as metatarsal domes, rigid footwear or orthotics. The main focus is to quickly reduce pressure on the affected nerve and allow the surrounding tissue to settle down. Occasionally a course of anti-inflammatories can help this process.
We find in most cases conservative management can effectively reduce the pain and provide a very satisfactory long-term solution. However, in some cases further interventions may be required.
Typically we will organise an ultrasound scan to determine the extent of the neuroma and the exact location. Ultrasound scans by an experienced radiologist can very accurately assess the area and provide significant details that are vital in creating an effective treatment plan.
Cortisone (steroid) injection is a common treatment for Morton's neuroma and has been shown to be effective. We recommend if it is necessary, to have the injection guided by ultrasound by a recognised sports doctor who specialises in this area. Another option is radiofrequency ablation therapy that involves a heated needle being inserted into the neuroma and cauterising the neuroma itself.
For persistent cases that do not resolve, then surgery can be recommended. The surgery involves removing the neuroma and is shown to have a high success rate to resolve the symptoms. Like any surgery, it does have inherent risks but for cases that don't respond to conservative management or injection therapy then this is an option that can be considered.
If you suffer from forefoot pain then we can help! At our Essendon clinic, we can accurately assess and diagnose the cause of your pain through our experienced practitioners and referral partners. We have excellent relationships with the best radiologists in Melbourne and have a Sports Physician on site who can provide injection therapies if required.