How to deal with a Morton's neuroma in the foot?

A Morton’s neuroma is a reasonable common painful condition affecting the ball of the foot. Between the metatarsal heads in the forefoot there are nerves, and these nerves can be irritated if compressed between those metatarsal heads. As a result of this irritation, fibrosis tissue build up around the nerve and can become painful. This is not really a true neuroma, but the word has been used for a very long time and is used by most people to describe this condition. It is more common between the third and fourth metatarsal bones

The main cause of a Mortons neuroma is shoes that are too narrow. This compresses the ball of the foot, and the metatarsal bones impinge om the nerves to irritate them and cause symptoms. A higher heel shoe and a higher body weight can also contribute to it. Those who are more active are also more likely to get this problem. Initially it just feels like an ache on the bottom of the ball of the foot. Sometimes it feels like you are walking on a sock that is scrunched up and when you check the sock is fine. As it progresses you can start to get sharp shooting pains in the ball of the foot into the toes, most commonly between the 3rd and 4th toes. Later on the pain can become quite excruciating and be present most of the time. Initially taking the shoes off and rubbing the foot can relieve it, but later on this tends not to help. Ultrasound can be used to help determine the diagnosis.

The first approach to the treatment of a Mortons neuroma is to get into wider fitting footwear to reduce the pressure that the metatarsal bones put on the nerve. Going barefoot as often as possible, especially in the early stages, can be helpful. A metatarsal pad is often used to help splay the metatarsal bones to further reduce the pressure. This pad may be stuck directly on the foot or adhered to an insole or inside the shoe. It is crucial that this is placed in such a position that it does splay the bones. If it is in the wrong position, then it may not help at reducing the symptoms. The wearing of wider shoes and the use of a metatarsal pad will generally help in most cases, especially if it is used in the early stages before it gets too advanced. If this does not help, then the next step if usually injection therapy. This injection could be just a local anaesthetic or a corticosteroid. Sometimes an alcohol injection is given to sclerose the damaged nerve tissue. If the condition progresses and these measures are not helping, the next step is surgery in which the damaged nerve tissue is removed. This can be done via an incision on the top or the bottom of the foot. If injections or surgery are used, it is still important to stick with the wider shoes or it may just happen again. Using a metatarsal pad over the long term is also advisable to stop it happening again.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.