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Morton's neuroma or Morton' s syndrome is a condition resulting in pain between the third and forth toes cause by compression of a nerve.
Symptoms typically include pain, often with pins and needles on one side of a toe and the adjacent side of the next toe. Pain is made worse by forefoot weight bearing and can also be reproduced by squeezing the forefoot to further compress the nerve. Pressing in between the third and forth metatarsals for example with a pen can also trigger symptoms.
Nerves that transmit messages to the brain from the toes pass between the metatarsal bones of the foot. If the arch in the foot is weak then this can cause the metatarsal bones to pinch the nerve causing it to become inflamed. This is most likely to happen between the 3rd and 4th bones causing a pain or numb sensation on the inside of the two toes that the nerve supplies.
Sometimes it is caused by a neuroma or benign tumour on the plantar digital nerves but it is not a true neuroma but more of a swelling of the nerves from compression. Scar tissue surrounding the nerve can also be a factor.
Morton's neuroma can be caused by ill fitting shoes which press against the nerve as well as activities involving spinning on the ball of the foot such as golfers and tennis players.
What can the patient do?
Rest. Continuing with normal training will increase pain and inflammation and prevent the injury from healing. Wear a metatarsal pad under the forefoot which will raise and spread the bones of the forefoot taking the pressure off the nerve. Wearing metatarsal pads in the shoes under the forefoot spreads the metatarsals creating more space for the nerve.
See a sports injury professional who can advise on treatment and rehabilitation. Orthotic inserts may be required to correct any biomechanical dysfunction of the foot.
What can a sports injury specialist do?
A doctor, physiotherapist or podiatrist may prescribe anti inflammatory medication such as ibuprofen. Ibuprofen should not be taken if you have asthma. Reducing the inflammation and any swelling will allow more space for the nerve and reduce pressure and pain.
The may also fit orthotic inserts into the patients shoes which help correct any biomechanical problems with the feet. This will not directly reduce inflammation on its own but may take the pressure of the nerve allowing the foot to heal and preventing the injury returning.
Taping the foot to relieve pressure on the nerve can have an instant effect on relieving pain. Exercises to strengthen the arch of the foot can also help prevent the injury returning in the future. For severe or stubborn cases surgery may be indicated.
Surgery for mortons neuroma consists of either a decompression, where more space is created for the nerve or a resection, where this part of the nerve is removed completely. This will result in some permanent minor numbness. Success rates for surgical procedures to treat mortons neuroma have a high success rate.