A Morton’s neuroma is a thickening and fibrosis of the tissue that surrounds the digital nerve leading to the toes. It commonly affects the 3rd intermetatarsal space (the nerve that supplies the 3rd and 4th toes) but can also affect the 2nd intermetatarsal space (the nerve that supplies the 2nd and 3rd toes).
Trauma, irritation or excessive pressure on the nerve causes it to swell and thicken, thus creating a neuroma.
Symptoms include pain on weightbearing and some patients describe as if they are walking on a pebble or stone. Tightly fitted or high heeled footwear can exacerbate the pain. Burning, numbness and sharp shooting pains can also be felt.
Conservative treatment is the first line measure and this involves:
- Footwear changes. Selecting a shoe with a lower heel and a broader toe box will help alleviate pressure on the nerve.
- Orthotic therapy in combination with appropriate padding can help with any biomechanical anomalies contributing to the development of the neuroma and can help offload the painful area.
- Manual therapy such as mobilisations, dry needling/ acupuncture, low level laser therapy and ultrasound can help with reducing surrounding inflammation and pain relief.
If these measures fail, consideration for injection therapy may be given. This is done under ultrasound guidance and tends to work well in synergistic combination with orthotic therapy. If these still do not resolve the pain, surgical removal of the affected portion of the nerve may be required.