What is Morton’s neuroma?
Morton’s neuroma, also known as a neuroma of the forefoot, is a painful condition that affects the nerves between the toes, usually the third and fourth finger. Though, in itself, is not a serious condition, it can be very painful and limit the physical activity of the patient.
Definition
Morton’s neuroma is a thickening of the nerve between toes on the foot. The nerve interdigital is located between the toes of the foot and is responsible for sensation in that area of the foot. When the nerve is irritated or compressed, it can cause pain, tingling, numbness or burning sensation in the toes affected. It is a common condition that affects men and women of all ages, although it is most common in women.
Causes
The exact cause is not known with certainty, but is believed to be the result of an injury, pressure or irritation on the nerve interdigital. Some factors that may contribute to the development of a neuroma are:
- Wearing shoes that are narrow or high-heeled: The use of shoes that squeeze the toes or have a high heel, you can compress the nerve interdigital and lead to the formation of a neuroma.
- Activities that involve repetitive pressure on the foot: Some activities, such as running, dancing or jumping can have a repetitive pressure on the foot and cause the irritation of the nerve interdigital.
- Injuries in the foot: A foot injury, like a sprain or a fracture, can cause inflammation in the nerve interdigital and lead to the formation of a neuroma.
- Foot deformities: Some foot deformities, such as hammertoes, or flatfeet, they can exert pressure on the nerve interdigital and lead to the formation of a neuroma.
Diagnosis
The diagnosis is made through clinical evaluation and the realization of complementary tests. During the clinical evaluation, the physical therapist will ask the patient about their symptoms and perform a physical examination of the affected foot. During the physical examination, the physical therapist will look for signs of inflammation, pain to palpation, and changes in sensation in the affected area.
The additional tests that can be performed to confirm the diagnosis are x-ray, mri, and ultrasound. The x-ray can rule out other conditions such as arthritis or fracture, but it can’t detect the Morton’s neuroma. The mri and ultrasound are more accurate tests for the detection, since they allow you to see the size and the exact location of the neuroma.
Treatment
The treatment depends on the severity of the symptoms and the duration of the condition. In most cases, the treatment of Morton’s neuroma begins with conservative measures, such as changes in footwear, physical therapy, and medications. If these measures do not relieve the symptoms, options can be considered more invasive, such as corticosteroid injection or surgery.
- Changes to footwear: The use of proper footwear is essential for the treatment of Morton’s neuroma. The shoes must be comfortable, have enough space in the toe and a low heel. Shoes high-heeled and narrow, should be avoided.
- Physical therapy: physical therapy can help to relieve the symptoms by reducing inflammation and improving mobility of the foot. The stretching and strengthening exercises, massage and manual therapy can be helpful.
- Medications: medications such as pain relievers and anti-inflammatory drugs can help relieve the pain and inflammation associated with Morton’s neuroma. The drugs can also be administered in the form of a direct injection into the neuroma, as the injection of corticosteroids.
- Injection of corticosteroids: corticosteroid injection is a common treatment for Morton’s neuroma. The injection is given directly into the neuroma to reduce the inflammation and relieve the pain. This treatment may provide a short-term relief of the symptoms.
- Surgery: surgery is considered a last resort for the treatment of Morton’s neuroma. Surgery may be necessary if the symptoms persist after other treatments or if the neuroma is very large. The surgery involves the removal of the neuroma.
Rehabilitation
After the treatment, rehabilitation, it is important to regain the strength and mobility of the foot. The therapy can be helpful for the rehabilitation and may include strengthening and stretching exercises of the foot and the leg. They may also recommend specific exercises to improve gait and posture.
Back action
To return to the action after the treatment of Morton’s neuroma, it is important to follow the recommendation of the physical therapist and the doctor. The return to activity should be gradual and progressive to avoid the reoccurrence of the symptoms. The right pair of shoes and the use of orthotics may help prevent the recurrence of the neuroma.
Note: this article is only intended to be informational use. In any case self-diagnose. If you suffer from any medical condition, we recommend that you go to your physical therapy clinic of confidence.
Cedric Arregui Guivarch
National Coach of Basketball (CES 2014)
Bibliography and Webgrafía
- Calvo-Lobo C, Rodríguez-Sanz D, Rodríguez-Mansilla J, et al. Treatment for Morton’s neuroma: a systematic review. Gac Med Mex. 2018;154(1):28-39. doi: 10.24875/GMM.18000164
- García-Escudero J, Font-Gómez J, García-Vicente C, et al. Morton’s neuroma: diagnosis and treatment. Rev Esp Cir Orthopedic Traumatol. 2017;61(5):329-336. doi: 10.1016/j.recot.2017.08.004
- López-González D, Sánchez-Gómez R, Villar-Miguel F, et al. Treatment of Morton’s neuroma. Review of the literature. Physiotherapy. 2018;40(2):83-91. doi: 10.1016/j.ft.2017.09.004
- Real-Pérez M, Pérez-Blanco M, Casuso-Holgado MJ, et al. Effectiveness of different therapies in Morton’s neuroma: a systematic review and meta-analysis. Foot Ankle Surg. 2021;27(1):8-16. doi: 10.1016/j.fas.2020.06.005
