Morton’s Neuroma
The Highlights
Plantar Digital Neuritis (PDN) or "Morton's Neuroma" is an enlargement of the plantar digital nerve and/or bursal tissue surrounding the nerve as it passes between the metatarsal bones.
It results in pain between the toes (and sometimes into the toes) and in the ball of the foot.
Our Podiatrists can diagnose this condition through physical examination and ultrasound.
Treatments include footwear advice, pads and insoles, and corticosteroid injections.
What is it and what are the symptoms?
Plantar Digital Neuritis (PDN) or "Morton's Neuroma" as it's more commonly referred to, is an enlargement of the plantar digital nerve and/or bursal tissue surround the nerve as it passes between the metatarsal bones.
In medicine, because of the combination of these tissues involved, the more modern approach is to think of it as an enlargement of the "neuroma-bursal complex". But the phrase "Morton's Neuroma" remains what most healthcare providers, patients and search engines are used to.
Because of the nerve-component of the problem, symptoms will often include classic "neuralgic" type pain such as tingling, burning, zapping, numbness or stabbing. The pain will usually come on very suddenly during a walk and is often bad enough to stop someone in their tracks and may lead them to take their shoes off and massage the area. The most common locations for symptoms are between the 3rd - 4th toes. The 2nd - 3rd being the next most common. Symptoms will also often radiate up into the toes which is a strong sign this is the issue.
Why does it happen?
This remains a point of some debate; narrowness between the metatarsal bones, excessively tight calves (leading to increased time on the ball of the foot), tight footwear, mechanical issues as the metatarsal-phalangeal joints (toe joints) and pre-existing forefoot deformities like bunions have all been cited as factors that may increase someone's risk of PDN / Morton's Neuroma. Underlying conditions like rheumatoid arthritis (which can cause swelling of bursas like the ones between the toes) could also be a risk factor. In reality it is probably a combination of different factors and may vary from person to person.
What are the treatment options?
From years of seeing forefoot pain, we can tell you the first thing to do is see an experienced Podiatrist (we like to think that's us!) because PDN/Morton's Neuroma is OVERdiagnosed - sometimes in clinic we feel as if everyone with forefoot pain is being labelled as having this when in reality there are many causes of forefoot pain, each with a different treatment protocol - far too often we see patient's misdiagnosed with this and treated inappropriately - see the experts as soon as you can.
If we find you do indeed have PDN / Morton's Neuroma (which clinical tests and, if needed, diagnostic ultrasound can help us uncover). We first need to look at the mechanics of how your feet are behaving for clues of overload on these tissue as well as ensuring you are using appropriate shoes - in fact shoes might be the single most important thing to get right.
After that we can look at exercise to optimise your biomechanics as it relates to this problem and potentially pads or foot orthoses (specialist insoles) to modify the loads on your forefoot. One of the challenges a lot of patients have found with this elsewhere is the bulk of the devices in their shoes - we have found our in-house custom orthotic system (the only one of it's kind in the Scottish Borders) to have worked really well here as we can design especially low-profile devices that are much better suited to most footwear.
We have also found Corticosteroid injections are especially helpful in settling down this condition, both in terms of reducing pain and reducing the size of the offending nerve. In our practice, these can also be done under ultrasound-guidance which increases accuracy and effectiveness.
