Treatment for Morton’s neuroma (syndrome) involves reducing pain and inflammation, stretching the muscles of the foot, strengthening exercises and gradually returning to full fitness.
Aim of rehabilitation
Morton’s syndrome causes pain, numbness, and tingling between the third and fourth toes in the foot from compression of a nerve which passes between the metatarsal bones. The aim of treatment is to:
- Reduce pain and inflammation
- Prevent compression on the nerve in the future
Reducing pain and inflammation
- Apply ice or cold therapy to the foot for 10 to 15 minutes every hour initially if possible reducing frequency as required as pain and inflammation is relieved. Do not apply ice directly to the skin as it may cause ice burns. Wrap in a wet tea towel or use a commercially available cold pack.
- Rest from painful activities. This may initially mean staying off your feet altogether. Continuing to exercise on the foot will not allow the inflammation to reduce and the injury to heal. It is important to maintain fitness through non-weight bearing exercises such as swimming or cycling or use the opportunity to work on upper body strength.
- A metatarsal lift or pad is a small padded insert which is worn in shoes under the forefoot. It raises the central part of the forefoot spreading the metatarsals, increasing the space between them taking the pressure off the nerve.
- The initial pain and inflammation should go away within a few days if looked after properly. However more chronic cases that do not respond to rest and ice and padding may require a corticosteroid injection as well as padding.
- If overpronation is obvious then the use of orthotics is essential to prevent recurrence. If there is still no improvement then surgery may be required.
Mortons neuroma exercises
As soon as pain allows exercises should begin. Morton’s neuroma exercises should include stretching for the calf muscles and plantar fascia (along the bottom of the foot).
Plantar fascia stretch
It is important to start Mortons neuroma exercises very gradually, especially with strengthening exercises. It is important to ensure the nerve is not inflamed again. Strengthening exercises are aimed at maintaining and improving the transverse arch of the foot.
Morton’s neuroma exercises – Return to running
When the athlete can walk without pain and have good mobility and flexibility they can begin to return to running. For biomechanical problems such as overpronation are not corrected with orthotics then it is more likely the injury will recur at this stage. An example of a gradual return to running is given below:
- Day 1 – walk 4 minutes, jog 2 minutes, repeat 4 times
- Day 2 – rest
- Day 3 – walk 4 minutes, jog 3 minutes, repeat 3 times
- Day 4 – rest
- Day 5 – walk 3 minutes, jog 4 minutes, repeat 4 times
- Day 6 – rest
- Day 7 – walk 2 minutes, jog 6 minutes, repeat 4 times
References & further reading
- Owens R, Gougoulias N, Guthrie H et al. Morton’s neuroma: clinical testing and imaging in 76 feet, compared to a control group. Foot Ankle Surg 2011;17(3):197–200.
- Bignotti B, Signori A, Sormani MP et al. Ultrasound versus magnetic resonance imaging for Morton neuroma: systematic review and meta-analysis. Eur Radiol 2015;25(8):2254–62
- Markovic M, Crichton K, Read JW et al. Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton’s neuroma. Foot Ankle Int 2008;29(5):483–7.