Mortons Neuroma

What Does a Mortons Neuroma Feel Like

Ouch, these Mortons Neuroma’s can really hurt the ball of your forefoot! At first, you’re like…. have I got a small pebble in my shoe, or am I walking on a crease in my sock! With a Mortons Neuroma you’ll really feel a sharp pain under your foot and it will make you want to take your shoe off and squeeze your foot. The pain is usually between the 3rd and 4th toe and some patient’s tell us they have this burning sensation too or a numbness that extends into the small toes. If you’ve had one of these you will know what we are talking about and how sore these things can be. The pain is due to the lining around the nerve becoming irritated and swollen.

Treatment for Mortons Neuroma

Fear not, there are several treatment options for as nasty Mortons Neuroma. Of course, surgery is an option, but that’s not where we start. We start with the more conservative measures like footwear changes and orthotics. In fact, a pair of orthotics with a metatarsal dome on top will lift and separate your metatarsal bones, take pressure off your neuroma and give relief. Needles and scalpels come much, much later if your nasty nerve does not respond to these gentle measures.

Case Study – Mortons Neuroma

Mortons Neuroma After a Change in Running Shoes: By Karl Lockett – Sports Podiatrist

A fit and healthy gentleman of 42 years, presents to the Sports Podiatrist complaining of a Mortons Neuroma. He is a high level runner and has completed 7 marathons in his amateur career, currently running approximately 70 K’s each week. He informs the Sports Podiatrist that over the course of his running career he has endured several conditions such as Plantar Fasciitis, Shin Splints and the occasional stress fracture in the metatarsal bones. However, this is the first time he has had a Mortons Neuroma and it is affecting his training. He was referred for an x ray, and then Ultra sound scan of his right foot by his GP and the report from the radiologist confirmed the presence of a Neuroma between the 3rd and 4th metatarsals. The GP suggested he stop running and take some anti-inflammatory medication and if that did not relieve him of his condition, to then seek the help of a Sports Podiatrist. Typical of runners, he declined the suggestion of rest, and headed straight to the Podiatrist for assessment and treatment.

Running Shoes

The patient informed the Sports Podiatrist that the pain from his Mortons Neuroma had been present for approximately 12 weeks and that 3 weeks prior to this, he had changed from a Brooks Glycerine running shoe, to a Nike Free. Most runners would know the difference in the level of support that these very different running shoes offer.

Assessment by Sports Podiatrist

The Sports Podiatrist applied pressure to the dorsal aspect of the metatarsal shafts and inter-metatarsal space, of the right foot. Pain was reported. Pressure was then applied to the plantar aspect of the same metatarsal area and once again there was a reproducible pain. Finally, the Podiatrist applied lateral pressure to all metatarsals via a gentle forefoot squeeze. There was a typical clicking sensation in the area of the Mortons Neuroma and the patient demonstrated a considerable jump response. The Sports Podiatrist carried out the same assessment on the left foot for comparison and there was no crepitus or pain. It was concluded and confirmed that the patients symptoms were typical of Mortons Neuroma.

Explanation of Mortons Neuroma

It was explained to the patient by the Podiatrist that a Mortons Neuroma is an inflammation and irritation of the sheath of a nerve that sits in between the metatarsal bones. Most commonly, the nerve that is affected is the inter metatarsal nerve that runs between the 3rd and 4th metatarsal bones. However, the condition can affect other nerves, between other metatarsals. Scar tissue can sometimes develop around the nerve sheath if the condition persists for long enough. Mortons Neuroma is a common condition that Sports Podiatrist’s treat on a regular basis.

Did the Running Shoes Cause the Mortons Neuroma?

The change in running shoes that took place, only 3 weeks prior to the onset of the Mortons Neuroma, was an event that could not be overlooked. Was it just coincidence or did the softer, lighter, flatter Nike Free affect the patient’s right foot? The Sports Podiatrist explained to the patient that the Nike Free offered much less support than the Brooks Glycerine, due to the fact that the mid sole of the shoe is much more flexible. This allows the foot to spread more than it would in the Brooks, during forefoot loading / mid –stance and this in turn produces more movement of the metatarsals. In effect, there is more load and an increase in force transmitting through the forefoot when running in softer running shoes and this has more than likely caused irritation of the nerve, leading to the Mortons Neuroma.

The lower heel to toe drop offered in the Nike Free also means that forefoot loading occurs earlier, and potentially with more force, than in a running shoe with a greater gradient. This change in shoe angle could also have contributed to the development of this Mortons Neuroma.

Biomechanical Assessment

The Sports Podiatrist placed ink markers on the patient’s feet and legs and then observed him running on a treadmill. His gait cycle was captured using digital software on an iPad and replayed in slow motion, allowing both the patient and the Podiatrist to analyse his foot function. This patient demonstrated mild rear foot pronation, but significant mid foot pronation. His foot posture index was 3 degrees right and 4 degrees left but his standing medial arch heights measured 21mm right and 23mm left. Medial bulging of the navicular area and midfoot was apparent during gait, and he demonstrated an abducted foot position at heel strike.

Treatment for Mortons Neuroma

It was explained to the patient that in order for his Mortons Neuroma to recover it was important to de-load the compression on the nerve. This could be achieved via the use of a metatarsal dome.

The Podiatrist explained to the patient that he had a foot type that dropped through the medial arches during running and that this could be treated with sports orthotics, made from Carbon Fibre, which would be slimline and lightweight in his shoes. The orthotics would incorporate the metatarsal dome mentioned above, and this would lift and separate the 3rd and 4th metatarsal bones, taking pressure of the nerve. With continued use, the decompression should allow the neuroma to heal.

It was also suggested to the patient that he apply ice packs to his right foot at least once a day to reduce inflammation.

Finally, the Podiatrist explained to the patient that he should revert to his original running shoes. His Brooks Glycerine would offer more support and would allow the Mortons Neuroma to heal much quicker.

A note: this is not to say that the Nike free running shoes are inappropriate for every runner. Factors to consider are foot type, body weight, running style, frequency of training and the presence of a foot injury. Some people run with minimal running shoes and do not encounter foot problems as a direct result of the shoe.

This case study should not be taken as general advice for a Mortons Neuroma. Please seek the help of a Sports Podiatrist if you have foot problems.