Defined

Commonly associated with Metatarsalgia (see Ball of Foot Pain), Morton's Neuroma is commonly an entrapment of the interdigital nerve, neuroma - pinched nerve, nerve tumour or swollen nerve are some common terms for a rather painful condition.  A neuroma is usually situated between the third and fourth toes.  They are characterised by a sharp, lancinating (stabbing) pain, usually when the patient is wearing shoes.  The patient feels that they may need to remove their shoe and rub their foot for relief.  When a foot pronates, not only does the longitudinal arch collapse, but so does the transverse arch.  In doing so the metatarsal heads come closer together causing pressure and chafing on the nerve lying between the third and fourth metatarsal bones.

Symptoms

Morton's Neuroma exhibits similar symptoms to Metatarsalgia, but may also cause numbness, tingling and discolouration of the third and fourth (lesser) toes.

Biomechanical Aetiology

Please refer to aetiology of Metatarsalgia.  Tight fitting ladies shoes tend to aggravate this condition because they squeeze the metatarsals together, pinching the nerve.

Treatment

Treatment using ICB Orthotics may greatly assist in the early stages of Morton's Neuroma when damage to the nerve sheath is minimal.  Orthotics re-align the metatarsal shafts, re-distribute the weight on the foot and prevent interdigital nerve impingement.  Severe fibrosis of the interdigital nerve may require surgery.  However, the use of orthotic devices may prevent further problems post-operatively.

Additional Treatment

Ice therapy.  Wear wider shoes to allow the metatarsals to spread.  Joint mobilisation using the NAS Technique.  A custom orthotic will correct the falling longitudinal arch and in turn the transverse arch.  A "Morton's Foot Deformity" is where the great toe is shorter than the second toe.  This puts more pressure on the transverse arch during gait.  If a neuroma is present, it will be exacerbated by this foot type (in this case an ICB metatarsal dome will be added to the orthotic to assure relief to the neuroma).

Exercises

Intrinsic forefoot exercises.

Content & Images © 2006 Footsteps Orthotics Pty Limited