Morton's Neuroma: Symptoms, Causes, Tests, and Treatments

If you sometimes feel like you are "walking on a marble," with persistent pain in the ball of your forefoot, you may have a condition called Morton's neuroma. It affects the nerves between the toes, most commonly the area between the third and fourth ones. This condition occurs when there's a compression of the nerve branches (common plantar digital nerves) between the metatarsal heads of your forefoot, leading to an enlargement/thickening of the outer layer of the nerve called the "sheath." The symptoms arise due to irritation and pressure against the nerve.

Morton's neuroma affects women more than men, especially those between the ages of 40 to 50 years. Here's everything you should know about Morton's neuroma.

Symptoms

If you have Morton's neuroma, you may experience the following:

• A shooting, stabbing, or burning pain radiating to your toes, especially during weight-bearing activities like walking or running
• You may feel like a pebble or lump is stuck under your foot when you walk
• Unpleasant tingling or numbness in your foot

Causes

Morton's neuroma is caused by irritation, pressure, or injury to your common plantar digital nerves. It is often linked to the following risk factors:

• High heels: Wearing tight, pointy, or high-heeled shoes can place extra pressure on the balls of your feet.
• High-impact activities: Engaging in high-impact activities like running and jogging and sports that require you to wear tight shoes—such as snow skiing or rock climbing—can put extra pressure on your foot.
• Foot deformities: Other foot problems, including flat feet, metatarsalgia, plantar fasciitis, and high arches, increase the risk of developing Morton's neuroma.
• Trauma: Injury to the foot can predispose you to develop Morton's neuroma.

You should definitely visit your healthcare provider if you experience the following:

• Sharp pain between your toes
• Inflammation between your toes
• Numbness between your toes
• Pain and swelling under the balls of your feet

Morton's Neuroma Click Test

Morton's neuroma diagnosis is highly accurate (99%) through typical complaints of plantar webspace pain, paraesthesias, numbness aggravated by weight-bearing activities and relieved by rest and massage, and clinical tests. The Mulder's click or squeeze test is among the most effective and common clinical tests for Morton's neuroma.

It involves squeezing the metatarsal heads together with one hand to reproduce the usual pain or a click. The doctor grasps your foot with one hand, compresses it, and puts a little pressure on the third metatarsal space with the index finger of his other hand, the soft end of a tendon hammer or a pen. Mulder's sign is positive if the pain is reproduced with a clicking sign, whether or not it's accompanied by paresthesia.

Other tests for Morton's neuroma include Tinel sign, Gauthier, and Sullivan tests.

Treatment Options

There are conservative and surgical treatment options available to treat Morton's neuroma. However, there is usually no need for surgery as symptoms improve after the following:

• Changes in Footwear: A shoe with a wide toe box, low heel, and soft sole allows your toes to spread out, evenly redistributes pressure on your feet, and reduces pain.
• Cryotherapy and Massage: This helps to reduce the burning sensation and pain you feel.
• Lifestyle Modification: Resting, avoiding high-impact activities such as running and jumping, and losing weight can all help with the symptoms.
• Orthoses: Custom shoe inserts and metatarsal pads may help relieve irritation by changing the position of forces on the forefoot and separating the bones, thereby reducing the pressure on the neuroma.
• Injection: One or more corticosteroid injections can reduce the nerve's swelling and inflammation and bring some relief.

Easing Morton's Neuroma Pain

Morton's neuroma can be very painful, impacting your activities of daily living and quality of life. However, many people have achieved lasting relief through a combination of the above treatment options without going through surgery. Remember, the first line of treatment is to relieve pressure on the painful spot, so it's important to find the best insoles for Morton's neuroma for your particular foot.