Interdigital Neuromas (Morton's Neuroma)
What is it?
Interdigital neuromas (often referred to as Morton’s neuroma) is thought to be due to swelling and scar tissue formation on the small nerves which run between the toes and foot bones. They commonly become a problem between the 3rd and 4th toes but may also develop in other areas. See Figure 1. An intermetatarsal bursitis can cause a similar pain.
How did I get it?
Morton’s neuroma seems to occur in response to irritation, pressure or injury to one of the nerves that lead to your toes. Over pronation and tight shoes are often associated with the condition. Figure 2 illustrates this compression of the nerves.
How is a diagnosis made?
Sports medicine professionals are able to diagnose and manage neuromas successfully. The diagnosis is usually based on clinical examination however an ultrasound or MRI may confirm the presence of the swollen tissue.
What are the symptoms?
The runner with a neuroma may complain of numbness of the involved toes or pain that increases with activity and is usually felt between the third and fourth toes. The pain is usually ill-defined and localised to the forefoot. It may cause a radiating pain into the toes. Weight-bearing, particularly in tight occlusive footwear or intense forefoot running may exacerbate the painful symptoms. The pain may be described as ‘shooting’ and sometimes ‘burning’. Pins and needles or sharp pain may be experienced when the forefoot is squeezed together and pressure is applied on the foot.
What should I do?
If you experience these symptoms removal of the shoe will reduce the pressure on the nerve and should reduce the pain and discomfort being experienced. Changes should be made to your footwear which may be causing pressure on the nerve tissue. If the pain continues after these changes then one should seek a sports medicine professional. You shouldn’t continue to perform intense activity on feet which are experiencing painful symptoms. Tight footwear, particularly high heels will increase the pressure on the forefoot and should be avoided if possible. If treated appropriately there should not be any long-term effects of Morton’s neuroma.
What does rehab involve?
Activity Modification:
Reducing provocative activities such as running and jumping will facilitate recovery. If your symptoms are very severe you may have to stop these activities altogether until the pain settles. If your symptoms are mild it may be safe to continue activity but at a lower level.
Pain Medication:
Pain medication is not particularly effective but can still be considered depending on the degree of pain being experienced. A trial of anti- inflammatories or simple pain relief medication like paracetamol may be worthwhile initially.
Footwear assessment:
Sometimes a change in footwear is all that is needed. Usually a wider forefoot so that the toes are not squeezed together will assist in alleviating symptoms.
Orthotics:
A padded metatarsal support can be very helpful in reducing pain.
Cortisone injection:
Cortisone is a potent anti- inflammatory drug. For many conditions / injuries its use has
been debated and its effectiveness questioned however for Morton’s neuroma, Cortisone has proven to be both safe and effective.
Radiofrequency Ablation:
Radiofrequency ablation is a procedure where the nerve is intentionally burnt so that it can no longer experience pain. This is not performed in Townsville.
Surgery:
Surgery is warranted if all other measures have been exhausted and the symptoms persist for longer than 6 months.