Video Transcript

In this video we will discuss metatarsal neuromas. A neuroma is characterized by a thickening of the nerve tissue, typically presenting in one of the interdigital nerves of the foot. These nerves are in between the long bones of the foot bringing sensation to the toes. As the tissue thickens, the nerve and surrounding structures become compressed, resulting in pain, tingling or burning sensation in the ball of the foot.

High heeled footwear or shoes that are narrow in the forefoot can exacerbate these symptoms. Foot orthosis with the metatarsal pad and additional cushioning can support and offload this area. By reducing the depression of the metatarsal arch, symptoms are reduced or eliminated. Combining your orthotics with a low heeled shoe that fits the width of your foot will assist in alleviating your symptoms.

Morton’s Neuroma

What is Morton’s Neuroma?

Morton`s neuroma is the irritation and compression of a common plantar digital nerve in your foot, often causing numbness and tingling in the toes. With a true neuroma, this compression is a result of thickening of the tissue around the nerve itself. Morton’s neuroma (named for the first doctor to describe the condition), most commonly affects the common plantar digital nerve between the third and fourth metatarsal bones, which causes pain in the third and fourth toes.

What do people with Morton’s Neuroma experience?

Symptoms of Morton’s Neuroma can include:

Numbness in toes
Tingling in toes
Shooting pain
Burning pain
Radiating pain to adjacent toes
Feeling as though sock is bunched up or wrinkled
Increased pain with activity
Relief upon removal of footwear

Risk factors

Risk factors for Morton’s Neuroma:

High heels
Tight or illfitting footwear
High impact activity
Other foot complications (bunions, hammertoes)

Morton’s Neuroma Treatment

A stepped approach is often taken for the treatment and management of Morton`s neuroma, moving from least invasive to most invasive. Less invasive treatments include metatarsal pads, footwear modifications, and offtheshelf (OTS) and custom foot orthotics. These options can be discussed with your pedorthist and other healthcare professionals for conservative treatment of symptoms.

More invasive options, such as medication, corticosteroid and sclerosing alcohol injections, and surgery, may be discussed with your family physician to determine an appropriate treatment plan.

Conservative treatments for Morton’s Neuroma:

Ensure that footwear has adequate width and extra depth in the toe box. This will allow the foot enough room to splay and help minimize mechanical compression of the common digital nerve from the shoe.
Try Metatarsal pads. These work to offload the neuroma by supporting your distal transverse arch. Metatarsal pads can be incorporated into a shoe on its own or on a custom made Morton’s Neuroma orthotic.
Decrease high impact activities. High impact activity can increase pressure on the feet and worsen symptoms. Reducing this type of activity and ensuring the use of proper footwear can aid in prevention of symptoms of Morton’s Neuroma.
Maintain a healthy weight, which can reduce physical stress and pressure on the foot. Consult your family physician or a dietician for more information and directives.

Prevention of Morton’s Neuroma

Although the exact cause of Morton’s neuroma is unknown, possible causes include irritation, pressure, or injury to the common digital nerve. Proper Footwear is a crucial factor in prevention of pain.

Staying active with Morton’s Neuroma

Staying active with Morton’s neuroma is possible. Choosing appropriate type and fit of footwear for the given activity is crucial. Footwear should provide adequate width and depth to reduce mechanical pressure on the foot. High impact activity can increase the amount of stress placed on the foot, increasing irritation and worsened symptoms. Choosing lower impact activities can reduce stresses.

Do you suffer with the numb and tingly toes of a Morton’s Neuroma?

To feel better, read on!

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Listen To Our Podcast Episode with Dr. Ian Alexander, MD and Foot Surgeon in Ohio State Box

How can SoleScience help you feel better?

Your SoleScience Pedorthist will create an individualized treatment plan that suits your specific needs, goals, and symptoms. We will work with you to determine not only what we need to do to address your current concerns, but also to prevent future problems.

Your pedorthist will complete a thorough and comprehensive foot examination at your initial appointment. A comprehensive follow-up exam will ensure that you are meeting your goals and allow your pedorthist to reassess your Morton’s Neuroma treatment plan (as necessary). During these appointments we will:

Assess joint and muscle function, including range of motion and gait assessment
Assess your footwear for both fit and function
Identify any risk factors that can be modified and make recommendations for change
Identify areas of risk with specialized tools such as pressure mapping (F-Scan or
Pedograph)
Discuss a treatment plan, which may include a change in footwear, activity modification, or custom foot orthoses and/or a complementary treatment referral (such as physiotherapy)

In addition to your individual treatment plan, your SoleScience Pedorthist will provide you with educational resources to help you best maintain your foot health.

Our take on the need for orthotics for Morton’s Neuroma

Custom foot orthoses can be a useful tool in reducing symptoms of Morton’s neuroma. Metatarsal pads can be incorporated into the device to support the distal transverse arch, reducing the amount of mechanical compression on the affected nerve. Custom foot orthoses allow the device to be modified to suit your needs. When it comes to Morton’s neuroma and metatarsal pads, individual tolerance differs widely. It’s possible that very small differences in the device could result in large differences in symptom relief. This makes the ability to modify a device advantageous to ensure maximum comfort.

Custom vs OTS Orthotics for Morton’s Neuroma

OTS, or offtheshelf foot orthoses, are prefabricated and can be fit to shoes right from the shelf. These devices are matched as a best fit to your foot and are often somewhat customizable. The key factor when looking for OTS devices with Morton’s neuroma is the metatarsal pad component to support the distal transverse arch and assist in offloading the nerve.

An OTS device with a metatarsal pad may be enough to relieve your symptoms. If not, custom foot orthoses are manufactured specifically around a 3D model of your foot and are easily modified to suit your needs.

Footwear recommendations

Choosing appropriate footwear can play an important role in the management of Morton’s neuroma. When considering shoes, ensure there is adequate width and extra depth in the toe box to avoid excessive pressure on the foot and compression of the affected nerve.

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