Morton’s Neuroma

What is it?

Morton’s Neuroma is a common foot problem consisting of a benign tumor-like enlargement of a nerve at the ball of the foot. It is usually located between the third and fourth toes, occasionally between the second and third. This condition is not a true tumor but rather a thickening of the tissue around the nerve.

Symptoms of a Morton’s Neuroma include sharp pain, burning sensation and even a lack of feeling in the area. It is usually worsened by walking and excess pressure on the ball of the foot. This is a soft tissue deformity and will not show up on x-ray. Diagnosis is made by eliciting pain in the area between the toes with pressure on the nerve. Sometimes an increased gap or space (“the daylight sign”) between the third and fourth toes exists. Moving the toes in certain directions may also cause a clicking sensation as the enlarged nerve slides under a nearby ligament.

How did I get it?

A neuroma is formed by irritation and rubbing of the nerve, similar to the way a callus is formed on the skin from excessive rubbing or pressure. The nerve “skin” gradually thickens to protect itself, forming a benign tumor. When the arch of the foot collapses, it can cause excess force to shift away from the big toe and onto the smaller bones of the forefoot. These smaller bones are not designed to handle the excess loads, so the force tends to break down the tissues under them, including the nerves running between them to the toes. As the nerve thickens to protect itself, it occupies more space and is more easily rubbed. Eventually, the nerve gets so big that it is sensitive to every step and it can even spread the toes, called “the daylight sign” since you can see light between the toes, as pictured above. Shoe wear that is too tight in the toe area, high heels that place additional pressure on the forefoot, and an increase in activity are also thought to exacerbate the pain of a Morton’s Neuroma.

How is it treated?

The initial goal in the relieving the symptoms of Morton’s Neuroma is to unload the excess pressure on the ball of the foot and any symptoms of pain that may be present. The next step is to address the underlying cause of the symptoms associated with Morton’s Neuroma.

Anti-Inflammatory Agents:

Cortisone can be injected into the area to control inflammation and pain. This may be helpful in reducing the pain temporarily but does not address the cause of the symptoms. Overuse of injected steroids can result in side effects such as weight gain and increased blood pressure and can interfere with proper healing, which is why patients only receive a limited number of injections.

Surgery:

In cases that do not respond to conservative measures, a doctor may recommend surgery. The surgery is thought to be very successful in reducing the pain of a Morton’s Neuroma but is a last resort as it comes with risks. The surgery involves the removal of both the tumor and some of the nerve. This often causes permanent numbness in the affected toes. The nerve will grow back slowly over time. If the underlying cause of the original problem is not treated, the nerve will become a “stump neuroma” which is often more painful than the first one. If considering surgery, talk to more than one doctor carefully about the benefits and risks.

Custom Foot Orthotics:

Custom made CBAS foot orthotics will address Morton’s neuroma by restoring arch height and function. This will effectively help restore proper weight distribution over the first metatarsophalangeal joint (the big toe) and ensure the forces being passed through the forefoot are not excessive, removing abnormal pressures that cause the nerve to thicken. The nerve can then heal and shrink back to normal size. When this is done the cause of Morton’s neuroma is being addressed rather than just the symptoms.

CBAS unlike typical custom orthotics, are designed to help restore proper arch height and function of an individual foot, determined by a unique way of capturing an impression of the arch with the foot arranged in an optimal position, then completely supporting it, only allowing the arch to flex accurately at a calibrated rate. The CBAS orthotic is the only calibrated custom orthotic that is designed with an individual’s body weight, foot flexibility, and activity level in mind, creating true biomechanical shock absorption. This truly restores proper foot function so that abnormal joint positions and stresses can be reversed allowing affected tissues to heal and normal joint function to be restored. In this way the CBAS custom orthotics provide the best option for both the primary therapy and preventative care in helping relieve the symptoms associated with Morton’s Neuroma.

What help can I expect to get from CBAS orthotics?

With a proper diagnosis along with a well-rounded management plan including CBAS othotics, the forecast is excellent. It’s not unusual get over 90% of the cases to respond favorably to proper orthotic management if addressed early enough.

This page provides a general overview on this topic and may not apply to everyone. Please talk to your health care provider to address your individual situation.