Morton’s Neuroma

 

A Morton’s neuroma is a painful condition which affects the forefoot. It is usually felt between the third and fourth toe and is often described by patients as feeling like there is a “pebble in their shoe” or “a fold on their sock”. This is caused by the thickening of tissue around one of your nerves that run between the long bones in your foot (metatarsals).

De Quervains tenosynovitis

Symptoms of Morton’s Neuroma

 

Symptoms of Morton’s Neuroma can include:

  • A burning pain in the ball of your foot.
  • Stinging, tingling or numbness in toes.
  • A feeling of a stone or something sharp in your shoe.
  • Pain usually worsens with walking or running
  • Worse when wearing tight shoes or high heeled shoes

The pain progressively gets worse if not treated. It may start as only feeling the pain with walking, however as the nerve gets further irritated the pain can become constant.

Causes of Morton’s Neuroma

 

  • Wearing tight, pointy and high-heeled shoes have been linked to developing Morton’s neuroma.
  • Altered foot biomechanics such as having a flat arch or tight calves alters the pressure on the third and fourth toe and results in overloading of the foot in that region (Gougoulias et al, 2019).

    Anatomy

     

    The interdigital nerves run between the metatarsal bones and into the toes. The transverse metatarsal ligament runs along the heads of the metatarsal bones, the interdigital nerve may then get entrapped by the transverse metatarsal ligament causing inflammation and irritation (Hochberg et al, 2011). The most commonly affected interdigital nerve is the one that passes between the third and fourth metatarsal bone.

    De Quervains tenosynovitis

    How to diagnose

     

    At your consultation, one of our highly skilled physiotherapists will ask a series of questions and perform a physical examination to help develop a diagnosis. The assessment will include checking your foot and ankle range of movement, strength and flexibility of the surrounding musculature, specific diagnostic tests and functional tests to assess biomechanics. 

    Diagnostic ultrasound can be performed in the clinic to confirm diagnosis.

    Physiotherapy Treatment

     

    Physiotherapy treatment may include:

    • Assessing and working on correcting the biomechanics of walking and running.
    • Reviewing footwear to reduce pressure on neuroma.
    • Prescription of an independent exercise program to stretch the calf and strengthen the intrinsic muscles of the foot.
    • Advice on insoles to offload the neuroma.

      Injection Therapy

       

      If symptoms have not improved with Physiotherapy and Podiatry after 2-6 weeks, or if the pain is affecting your ability to  perform everyday activities such as walking to work or the shops, you may want to consider an ultrasound guided steroid injection.

      Steroid injections use a small dose of corticosteroid (a strong anti-inflammatory drug) and are injected under ultrasound-guidance. Current evidence found that injections performed under ultrasound guidance are more accurate and more effective at reducing pain and improving function than landmark guided injections (Daniels et al, 2018).

      If you are experiencing symptoms similar to those described above and want to find out what is causing your pain, please get in touch and one of the team will assess, diagnose and advise on the best treatment option for you. Please contact us on 0207 636 5774 or email reception@oxfordcircusphysio.co.uk

      References

      Daniels, E.W., Cole, D., Jacobs, B. and Phillips, S.F., 2018. Existing Evidence on Ultrasound-Guided Injections in Sports Medicine. Los Angeles, CA: SAGE Publications.

      Gougouglias, N. Lampridis, V. and Sakellariou, A. (2019) A morton’s interdigital neuroma: instructional review. EFORT open reviews. 4(1).pp. 14-24.

      Hochberg, M.C, Silman, A.J., Smolen, J.S., Weinblatt, M.E. and Weisman, M.H. (2011)Rheumatology, 5th Edition, Volume 1. Pp.794. Mosby Elsevier, Philadelphia.