Morton’s Neuroma: High Heel Pain!

Morton’s Neuroma by Matthew Craig and Ben West 

 

MN Heel

 

 

 

 

 

 


Are you the kind of person who:

  • Loves to wear fashionable high heels (or tight/ill fitting shoes)
  • Participates in sports involving high impact activities such as running/jogging.
  • Has a ‘dodgy’ foot deformity (bunions, hammertoe, high arch/flat feet)

And are suffering from pain, burning, numbness and tingling between two toes of the foot? Then there may be a good chance that you are suffering from a condition called Morton’s interdigital neuroma.

So what is Morton’s neuroma??

Morton’s – Refers to the American surgeon Thomas George Morton (1835-1903) who first described the condition in 1876.

Neuroma– Thickening of the nerve tissue that may develop in various parts of the body.

Morton’s neuroma commonly occurs between the third and fourth toes. It involves thickening, or enlargement, of the interdigital nerve due to compression and irritation. This compression causes enlargement of the nerve, eventually leading to permanent nerve damage. About three out of four people diagnosed with Morton’s neuroma are women with the most commonly affected age bracket ranging from 40 to 50, however it can occur at any age.

Causes

The exact cause of Morton’s neuroma remains unclear. However the following may play a major role in its development:

MN Hammer Toe

MN Overpronation

 

 

 

 

 

Wearing tight, narrow or high heeled shoes (main offender)

  • Flat feet
  • High foot arches
  • Foot deformities (bunions, hammertoe, hyper-flexible feet).
  • Sports involving repetitive irritation to ball of foot (running)
  • Injury or trauma to the area.
  • Excessive pronation
Symptoms

Acute symptoms begin gradually and are usually brought on by wearing poor footwear or performing certain aggravating activities.  Symptoms can be relieved temporarily by removing footwear, massaging the foot or avoiding aggravation.

However, as the condition progresses and the nerve becomes further inflamed, it can cause more permanent damage and may take several days to a week to improve.

Symptoms typically follow:

  • Tingling between the 3rd and 4th toes
  • Sharp, shooting or burning pain in the ball of the foot or toes
  • Pain progression
  • Pain with wearing shoes or pressure on the area.
Diagnosis

Early diagnosis is vital for prevention of more invasive treatments such as surgery. Examination involves the reproduction of symptoms, revealing localised tenderness and a palpable “Murlder’s” click on compression of the metatarsal heads in more chronic cases.

MN Foot Squeeze Test

MN Foot Ultrasound

MN Ultra 2MN Ultra 1

 

 

Ultra sounds or MRI may also used to rule out other bone involvement.

Conservative method of treatment

“About 70% of patients have success with conservative treatment”.

 Acute Phase:

  • RICE + light lymphatic massage
  • Padding over the ball of the foot to spread the load when weight bearing
  • Physiotherapy manual techniques + exercises to maintain arch in foot
  • Physiotherapist biomechanical analysis
  • Replacing shoes with a wider toe to ease the pressure on the nerve

 Chronic Phase:

  • Corticosteroid injection into the foot
  • Physiotherapy manual techniques +padding under the foot
  • Physiotherapist biomechanical analysis
  • Placing orthosis in shoe if excessive pronation apparent
Surgical treatment

In some cases, surgery is needed to remove the thickened tissue and inflamed nerve. This helps relieve pain and improve foot function. Numbness after surgery is permanent.

Prognosis:

“About 70% of patients have success with conservative treatment”.

For the one in four people who don’t require surgery, symptoms can be managed conservatively with good affect. Of those who choose to have surgery, about three out of four will have good results with relief of their symptoms. However recurrent or persisting (chronic) symptoms can occur after surgery. Sometimes, decompression of the nerve may have been incomplete or the nerve may just remain ‘irritable’. In those who have had cutting out (resection) of the nerve (neurectomy), a recurrent or ‘stump’ neuroma may develop in any nerve tissue that was left behind. This can sometimes be more painful than the original condition.

 

MN Running Heels

 

 

 

 

 

 

Summary:

  • Early diagnosis of initial symptoms is the key for preventing permanent damage of the nerve.
  • Wearing proper footwear with correct arch support that is non compressive on the foot bones is a central prevention strategy used for treating Morton’s neuroma.
  • Surgery is not 100% effective and a conservative approach should always be taken before going under the knife.
  • If you have any questions or fit some of the criteria for Morton’s neuroma please come in book an appoint at bounceREHAB for a consultation today.

 

Ballet Dancers

Contact us for an appointment by:

Emailing admin@bouncerehab.com.au or call(02) 9571 7606

 

 

 

 

Mortons Neuroma WRITTEN BY:

Matthew Craig (Principal Physiotherapist at bounceREHAB)
&
Ben West (final year Physiotherapist, Newcastle University)