Difference between revisions of "Mortons Neuroma"

Revision as of 16:49, 12 October 2012

Morton's Neuroma is a common problem with runners and normally causes a burning pain in the forefoot, just behind the 3rd and 4th toes (sometimes behind the 2nd and 3rd toes). The pain often radiates towards the toes, and sometimes there is numbness rather than pain. The underlying cause is inflammation of the nerve between the bones of the forefoot, often triggered by narrow or tight shoes. I have had good results with the simple fixes described below, and I have had reports of other runners with similar success.

The pain is felt in the area highlighted in red. It is often a burning pain that radiates out towards the toes.

The is the most common location for the inflamed nerve that causes a Morton’s Neuroma. The nerve gets compressed between the bones in the forefoot.

Here is a cross section of the foot showing the location of the nerve.

1 Fixing Morton's Neuroma

I used the overnight stretch sock combined with modifying my shoes to remove the Morton's Neuroma I had. Other runners have tried these two approaches successfully. I believe these approaches are low cost, low risk techniques that are worth trying out before resorting to more intrusive techniques.

1.1 Overnight Stretch Sock

I found that using "Comfy Toes Foot Alignment Socks" has provided me with more relief than any of the other treatments I tried. A similar product is Happy Feet. These socks are intended to be used so that they stretch the gap between each toe, as shown below. I wore the socks like this overnight and found it helped quite a bit, but it did trigger quite a bit of pain as the toes were stretched in the night. (You can see the scar tissue on my feet from Epidermolysis Bullosa.)

This is how the socks are supposed to be used.

I changed the usage so that all the stretch was between the toes that have the Mortons Neuroma, as shown below. This increased the stretch quite a bit and relieved the Mortons Neuroma further. It also reduced the pain I experienced overnight from the stretch.

This is the way that I found to be most effective.

1.2 Changing Shoes

It is absolutely critical to avoid any footwear that squeezes the forefoot. This will aggravate the nerve, so don't wear any shoe that puts any pressure on the sides of the forefoot. It may help to go up a shoe size, but I cut away the shoe where it touches the sides of the forefoot like this:

A friend did a rather more subtle change, opening up just the sides where the forefoot touches the shoe

1.3 Other Treatments

The following are a list of other possible approaches to treating a Morton's Neuroma. None of these worked very well for me, but Your Mileage May Vary.

• Check for alternative causes. One runner found their pain was caused by calluses!
• Toe stretchers can help spread the metatarsal heads. I've used Pampered Toes and it seems to help a little.
• Many people find that a metatarsal pad in their shoes help relieve the problem. I know of runners who will not run without metatarsal pads.
• Orthotics may help, though I personally dislike orthotics and believe they are likely to cause other problems.
• A simpler alternative to orthotics is to build up the insole of your shoes under the first metatarsal and big toe area. This can reduce the pressure on the nerve. The insole can be build up with layers of duct tape and I know of at least one runner who has benefited from this approach.
• Cortisone injections can help reduce the inflammation of the nerve, but often multiple injections are required. Typically injections are given 1-3 weeks apart.
• Injections of alcohol can be used to kill off (sclerosing) the nerve.
• If nothing else works, the nerve can be surgically removed, which is generally successful, though there are cases of the end of the removed nerve becoming inflamed and causing problems. If this approach is taken, it is recommended that the nerve is removed through the top of the foot to prevent problems with the sole of the foot and reduce recovery times.
• X-Rays and a professional evaluation can be useful to rule out other possible problems.
• Ice may help, but it does not seem as effective on this problem is it is on muscular problems.
• Strengthening the muscles that flex the toes and support the arch of the foot may help. Typical exercises include scrunching up a towel with the toes, or picking up marbles with the toes.

2 Understanding Morton's Neuroma

2.1 Symptoms

Below is a list of possible symptoms with the percentage of patients who reported them based on two studies. Where both studies included a response there are two percentages.

• Pain increased with walking (91%)
• Relief by rest (89%)
• Plantar (sole) pain (77%)
• Pain in Forefoot (76%)
• Relief by removing shoe (70%)
• Pain radiating to toes (62%)
• Burning Pain (54%)
• Pain between toes (43%)
• Numbness into toes or foot (40%/23%)
• Aching or sharp pain (40%)
• Inability to wear fashionable shoes (39%)
• Pain up foot or leg (34%/11%)
• Cramping Sensation (34%)
• Pain at rest (19%)
• History of associated injuries (15%)
• Pain at night (10%)
• Pain in entire foot (9%)

2.2 In depth information

The best in-depth information on Morton's Neuroma is from the Google Book's copy of comprehensive textbook of foot and ankle surgery, Volume 2