If Only I Knew who Mr. Morton was…

*** This article was written by the late Marie-Catherine Bruno: Friend, Colleague, Physiotherapist, Athlete and Pedorthist Extraordinaire.

Have you ever felt
some tingling or pain between your toes when you were walking? If you have, you probably have already met Mister Morton!

What it is…

Morton’s neuroma is a growth on a nerve, in particular on one of the dorsal digital nerves; nerves that lie deep in your foot.  A neuroma can be benign and grow for no reason, or it can also be a form of adaptation for a nerve suffering from too much pressure or friction (basically a callus forming on the nerve). 

What happens…

The dorsal digital nerve runs between the metatarsal bones and there is very limited room  for the nerve, so whenever the space is decreased, there is increased pressure on it and one can feel tingling, pins and needles, pain and /or numbness from the pressure on those nerves.  In most cases it is felt between the 3^rd and 4^th toes, but it can actually happen between any toes.  

The cause…

Sometimes, we don’t really know why you suddenly grow a neuroma.  However, if it is from pressure or friction, then we can identify the cause much more easily.  The transverse arch in your foot, located at
the ball of the foot, can be an issue. It is important that this area is not compressed in any way, because if it is, this is when pressure develops on the nerve.

Things that can put pressure on this arch are:

1) Narrow shoes: which squeeze the bones of the arch and trap
the nerves between them

2) Bone degeneration: with conditions like osteoarthritis or
rheumatoid arthritis which causes chronic inflammation, cartilage destruction,
and capsule and ligament laxity resulting in a transverse arch that collapses.

3) Inflammation: if you suffer from a foot or ankle injury like a sprain, the inflammation travels downwards,  thanks to gravity, and it ends up in the toe
area, taking up some of the precious space for nerves and blood vessels. 

4) Poor circulation: if you suffer from a systemic disease like diabetes or have poor venous return, you may have chronic swelling in your feet.  This extra fluid takes up space and again increases the pressure between the metatarsal bones. 

5) High heels: move the body weight forward, generally on the ball of the foot.  Those bones are not designed to support all of the body weight and therefore frequent use of high heels causes the transverse arch to collapse. 

6) Rigid shoes: some cheaper shoes have a sole that is too rigid at the ball of the foot, so in order to bend it when walking, you have to increase the pressure on the ball of the foot, creating the same problem as above with high heels. 

What to do…

Before you think of any extreme treatment, try to take away the cause of the increased pressure on the metatarsal bones.  Footwear is fairly easy to modify.  If you notice redness on the sides of your feet or ball of foot, your shoes are definitely too narrow.  Go shopping (if you really love those shoes, then have a shoe maker stretch them). 

If you think your transverse arch has collapsed, the only way you can restore it is with a metatarsal pad.  It is a domed shaped pad that goes under the foot, just before the ball of the foot.  You can purchase self-adhesive pads from many places.  The down side is that you need a pair for all of your shoes.  The easiest, but not the cheapest solution, is to have them built in a pair of orthotics. 

If you think your soles are too rigid, try switching them out for soles that have some flexibility. 

Compression socks can help with circulatory conditions, inflammation and injury and help to move fluid out of the foot. 

If you have modified all of the factors that you possibly can and you still get pain or other signs from the neuroma , then you may have to get it surgically removed.  Although this is a last resort!

Still unsure? Ask your physiotherapist for help!