If you experience pain in your foot that feels like there’s a pebble in your shoe, you might need to see a podiatrist for a condition known as Morton’s Neuroma, or intermetatarsal neuroma.
Most people give little thought to the health and function of their feet unless or until they start experiencing issues that cause pain and decrease mobility. Repeated stress or compression on a nerve, referred to as a neuroma, can lead to a thickening or enlargement of the nerve.
If left untreated, a neuroma can cause moderate to severe pain. In the case of Morton’s Neuroma, the condition is located in the ball of the foot.
Understanding the causes of Morton’s neuroma and being able to identify early symptoms will lead to more effective treatment and better recovery times.
What is Morton’s Neuroma?
In short, Morton’s neuroma is a condition that creates instability in the forefoot that leads to chronic irritation from inflammation or thickening of the tissue surrounding a nerve in the ball of the foot between the toes.
This type of neuroma usually occurs between the metatarsal bones in the third and fourth toes, but sometimes between the second and third as well.
Because of the location between the metatarsal bones, it is sometimes referred to as an intermetatarsal neuroma.
There are a number of different causes, but an intermetatarsal neuroma is more common in people who are middle-aged, especially women and those who lead very active lifestyles or whose job requires long hours on their feet.
Morton’s Neuroma Causes
One of the most common causes of Morton’s Neuroma is poor fitting or tight shoes, like high heels, ballet slippers, or ski boots. These types of footwear force the toes into a narrow position and compress the nerve over a period of time.
Morton’s neuroma can sometimes be the consequence of repetitive movements, especially for athletes in sports that require running, sprinting, and quick stop and start motions, like basketball, tennis, and other court sports.
An injury to the ball of the foot that damages the nerves may also create issues that cause Morton’s neuroma.
An intermetatarsal neuroma can be related to other foot-health problems that include:
- Hammer toes
- Turf Toe
- Flat feet
- High arches
Whatever the cause, it’s best to seek a diagnosis and treatment from a podiatrist or foot specialist as early as possible. While the condition is manageable, permanent nerve damage can occur over the long-term. This is why recognizing and identifying the symptoms of Mortons neuroma is key.
Morton’s Neuroma Symptoms
Morton’s neuroma symptoms often tend to appear gradually and grow worse over time if left untreated. Many people will start feeling what’s often described as a burning sensation in the ball of the foot between the third and fourth toes.
What is sometimes confusing for people dealing with this issue is the absence of any visible inflammation or swelling in the area where the pain is located.
Some of the more common symptoms of Morton’s neuroma can include:
- Tingling or burning sensation in the ball of the foot
- Feeling as if there is a small rock or marble in the shoe
- Pain that may be intermittent or last for days on end
- Numbness or a prickly sensation in the toes
- Difficulty walking normally because of the pain
It is best to seek treatment as soon as symptoms start to present.
Mortons Neuroma Treatment
A visit to a podiatrist or sports physician is recommended for a thorough diagnosis before beginning Mortons neuroma treatment.
A physical examination of the foot, along with a discussion of the symptoms and recent physical activity is generally enough to diagnose the condition.
However, some doctors may want to see x-rays, an ultrasound, or an MRI to rule out bone fractures or damage to other soft tissue that may be complicating the problem.
After a diagnosis, intermetatarsal neuroma treatment approaches will range from conservative to more involved, depending on a person’s pain level and the amount of time they’ve struggled with the neuroma.
In general, Morton’s Neuroma treatment will follow this type of trajectory:
1. Rest and Ice
Ceasing activity that causes pain in the ball of the foot, resting the foot, and icing the painful area can help relieve pressure and reduce inflammation.
2. Anti-inflammatory Pain Medications
Using over-the-counter anti-inflammatory medications, like ibuprofen (Advil) or naproxen (Aleve), will help with the pain and decrease inflammation in the foot.
3. Massage the Area
Massaging the effected area can help ease radiating pain and discomfort while improving blood flow to the area to aid in healing.
4. Proper Footwear or Orthotics for Intermetatarsal Neuroma
Wearing appropriate footwear for whatever activity is causing intermetatarsal neuroma pain is a must for healing, and can help avoid the symptoms before they ever begin.
Using footpads or prescription orthotics in the shoe will also help alleviate pressure on the compressed nerve.
5. Morton’s Neuroma Physical Therapy
Morton’s neuroma physical therapy might be recommended as way to learn what types of footwear will be most appropriate for healing. In addition, learning stretches that loosen tight tendons and ligaments, as well practicing exercises to strengthen the ankles and toes can help during and after recovery.
6. Shockwave Therapy
Extracorporeal Shock Wave Therapy (ESWT), also known as EPAT, or simply Shockwave Therapy, is a noninvasive method for triggering the body’s own healing response mechanism and relieving pain.
A Shockwave Machine delivers impulse pressure waves to the tissue in the affected area, which increases blood flow, reduces inflammation, creates new blood vessels, and promotes faster recovery.
Because Shockwave is a nonsurgical procedure, therapy sessions can be performed during physical therapy or at any point in the healing process.
7. Steroid Injections
Injections of anti-inflammatory corticosteroids at the site of the Morton’s neuroma can reduce pain and swelling. However, many physicians will use caution with steroid injections because they can damage other healthy, surrounding tissue.
8. Morton’s Neuroma Surgery (Neurolysis or Neurectomy)
Morton’s Neuroma surgery is typically reserved for severe cases where other, more conservative approaches have failed to yield relief. Surgical approaches can include removing part of the nerve tissue, using extremely cold temperatures to treat the nerve, or decompression techniques that involve cutting ligaments and other soft-tissue surrounding the nerve.
Many times, the size of the neuroma will be a determining factor in the type of surgery. If it is small, a neurolysis will be able to save the nerve. In the case of a more severe condition that is much larger, a neurectomy will remove the damaged nerve.
There is always a risk associated with surgery, along with significantly longer recovery times, and this option should be thoroughly discussed ahead of time.
The painful symptoms of Morton’s Neuroma from wearing tight fitting shoes or repetitive movements during sports can be successfully treated using the methods outlined above.
If identified and diagnosed early, there shouldn’t be any need for surgery to repair the injury. However, prolonged activity while enduring the pain of an intermetatarsal neuroma could cause the condition to become worse and require a surgical approach like a neurectomy or neurolysis.
To avoid surgery and a lengthy recovery period or downtime, see a podiatrist or athletic trainer at the first signs of pain between the toes in the ball of the foot.