Morton’s neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. Morton’s neuroma may feel as if you are standing on a pebble in your shoe or on a fold in your sock.
Morton’s neuroma involves a thickening of the tissue around one of the nerves leading to your toes. This can cause a sharp, burning pain in the ball of your foot. Your toes also may sting, burn or feel numb.
Morton’s neuroma seems to occur in response to irritation, pressure or injury to one of the nerves that lead to your toes.
Factors that appear to contribute to Morton’s neuroma include:
- High heels. Wearing high-heeled shoes or shoes that are tight or ill fitting can place extra pressure on your toes and the ball of your foot.
- Certain sports. Participating in high-impact athletic activities such as jogging or running may subject your feet to repetitive trauma. Sports that feature tight shoes, such as snow skiing or rock climbing, can put pressure on your toes.
- Foot deformities. People who have bunions, hammertoes, high arches or flatfeet are at higher risk of developing Morton’s neuroma.
Typically, there’s no outward sign of this condition, such as a lump. Instead, you may experience the following symptoms:
- A feeling as if you’re standing on a pebble in your shoe
- A burning pain in the ball of your foot that may radiate into your toes
- Tingling or numbness in your toes
Morton neuromas are more common in women, with a female-to-male ratio of 4:1. They tend to occur in the fifth decade of life and frequently are exacerbated by constrictive footwear. Symptoms are typically unilateral, with the third interspace most often involved followed by the second and the fourth interspaces. Simultaneous neuromas occurring in the same foot are uncommon.
During the exam, your doctor will press on your foot to feel for a mass or tender spot. There may also be a feeling of “clicking” between the bones of your foot.
Some imaging tests are more useful than others in the diagnosis of Morton’s neuroma:
- X-rays. Your doctor is likely to order X-rays of your foot, to rule out other causes of your pain — such as a stress fracture.
- Ultrasound. This technology uses sound waves to create real-time images of internal structures. Ultrasound is particularly good at revealing soft tissue abnormalities, such as neuromas.
- Magnetic resonance imaging (MRI). Using radio waves and a strong magnetic field, an MRI also is good at visualizing soft tissues. But it’s an expensive test and often indicates neuromas in people who have no symptoms.
The term neuroma, as applied to this condition, may be a misnomer. Morton neuroma may be best described as a clinical syndrome stemming from a constellation of factors related to the local anatomy and the forces applied on the forefoot with ambulation and shoe wear. Interestingly, it is not uncommon for the histopathology to be interpreted as relatively normal, even in light of classic preoperative findings and dramatic postoperative results. Clearly, the histopathology is not that of a typical neuroma. Some or all of the following may be observed:
Sclerosis of the endoneurium
Hyalinization of the walls of endoneurial vessels
Demyelinization of nerve fibers
Anatomic studies have revealed a wealth of information and helped to resolve some misconceptions regarding the etiology of this disease. The intermetatarsal space is narrower in the second and third interspaces than in the first and fourth interspaces, and this difference correlates with the clinical presentation pattern. The composition of the tarsometatarsal articulation allows relative hypermobility between the second and third metatarsals, which contributes to mechanical irritation of the nerve.
Narrow toe-box footwear can exacerbate the compression between the metatarsal heads, and hyperextension of the toes in high-heeled shoes tethers the nerve beneath the ligament and may expose it to more biomechanical stresses with gait. Less commonly, metatarsophalangeal (MTP) joint pathology, inflamed bursa, or lipomas can create compression at the level of the common digital nerve.
2ft custom Orthotics fit inside your shoe and help reduce pressure on the nerve by rebuilding the metatarsal arch which then spreads the metatarsal heads widening to normal the intermetatarsal space. 2ft Orthotics are custom-made with each individually designed orthotic molded to fit the exact contours of your feet. This custom making ensures that your foot will get lasting results. After a period of time the muscles in the metatarsal arch strengthen and the neuroma will have reduced significantly enough to wear heals for short periods. Wearing high heels for long periods without rest, risks a return of the symptoms and pain.
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Surgical and other procedures
If conservative treatments haven’t helped, your doctor might suggest:
- Injections. Some people are helped by the injection of steroids into the painful area.
- Decompression surgery. In some cases, surgeons can relieve the pressure on the nerve by cutting nearby structures, such as the ligament that binds together some of the bones in the front of the foot.
- Removal of the nerve. Surgical removal of the growth may be necessary if other treatments fail to provide pain relief. Although surgery is usually successful, the procedure can result in permanent numbness in the affected toes.
The Gait Analysis pages describe how each of the 12 common foot problems affect the way you walk and how this affects the physiology of your body as a whole. An awkward gait causing abnormal steps will change how your weight is distributed across your lower back and lower body joints. An awkward gait can lead to back pain, hip pain, knee pain, ankle pain & heel pain and in many cases; shoulder and neck pain! Its important to remember that your feet are the foundation that support your whole body. If the foundation is faulty, your whole body is affected.
Bio Human 3D Model
Click on the image to the left to see a 3d Bio Human model of the Anatomy and Physiology of your foot. By selecting any component of the anatomy of this model of your foot you can view it on its own. You can turn the model 360 degrees, zoom in and out and strip away parts to reveal the functions of the foot. This is a medical tool and is used by doctors and surgeons world wide and accurately depicts the physiology of the human foot in detail.
Select the “click to interact in 3d” to manipulate the model. Select any anatomical component using your mouse pointer. The Anatomical component will change colour. Go to the menu that appears on your screen where you can the select different menu items that allow you to manipulate the model. Note: Edit items in the menu allow you to isolate parts, dissect parts and cross section parts of the foot anatomy.