Morton’s Neuroma: Symptoms, Causes, Risk Factors, Healing Cycle & Treatment
What is Morton’s Neuroma?
The transverse metatarsal ligament is a fibrous band that connects and binds together the metatarsal bones present in the forefoot. Irritation of this ligament, which may be due to a variety of causes including trauma to the underside of the foot, impairment of blood supply, improper footwear, lipoma, etc, causes compression in this region. Most often, the common digital nerve and its interdigital branches are affected as a result of this compression. This impairs the nerve supply to the recipient area, particularly the interdigital space between the second and the third toes, or the third and fourth toes. (1) Because of the impaired nerve transmission, patients may experience pain, tingling, numbness, and burning sensation in the said region.
Unlike what its name suggests, the ‘neuroma in Morton’s neuroma is nothing but a misnomer, that is to say, that it is not a tumourous growth of nerve or extraneural tissue. It is simply the entrapment of a nerve due to inflammation of surrounding tissue. (2)
The condition is more common in women, particularly the middle-aged. This may be due to differences that are anatomical, physical or related to lifestyle. (3)
What Are The Risk Factors?
Risk factors for developing Morton’s Neuroma include:
● Repetitive impacts such as running, jumping, rock climbing, etc.
● High-contact athletic activities.
● Wearing high-heeled shoes puts excessive pressure on the plantar surface of the forefoot.
● Ill-fitting footwear.
● Abnormal or unusual gait pattern.
● Foot deformities such as bunions, hammertoes, flat or high arches.
● History of surgery in the forefoot region. (3)
What Are The Symptoms of Morton’s Neuroma?
Plantar fasciitis commonly causes the following symptoms:
● Pain on the bottom of the foot that feels like stabbing, particularly in the area of the third and fourth toes.
● Pain in the ball of the foot.
● Prolonged standing or resting in the same position may induce the pain again.
● Pain worsens after prolonged walking or running.
● Feeling of standing on a rock.
● Symptoms begin gradually and may worsen over time.
● Initially, temporary relief to pain may be achieved by removing a tight shoe or massaging the foot. (4)
How To Treat Morton’s Neuroma?
To know how to effectively treat Morton’s neuroma, we need to understand the pathogenesis leading to the development of this painful condition.
Pathophysiology of Morton’s Neuroma:
The response of our body to an injury or wound is mediated by the immune system and the proliferation of a number of cells in the extracellular matrix. It typically involves the following stages:(6)
Morton’s Neuroma Healing Cycle
1. Inflammation: This is the first step in the process of healing. After an injury occurs, the damaged tissue recruits immune cells which release proinflammatory cytokines. This induces pain, redness, and swelling in the region. As a result of this, the affected region suffers from decreased functionality and partial immobility. (6)
2. Proliferation: In the next phase of response to injury, the cells of the extracellular matrix produce collagen and fibrin. This causes a build-up of scar tissue, causing fibrosis. Scar tissue acts as a glue to bind the edges of the injured tissue together. Additionally, fascia restrictions, muscle spasms, and trigger points also develop during this stage. (7)
3. Maturation: This is the final phase of wound healing in which the body gets rid of excessive scar tissue, muscle spasms as well as trigger points, thereby restoring the tissue to its original state. (8)
In chronic injury, such as that occurs in Morton’s neuroma, the tissue goes back and forth between the processes of inflammation and proliferation. This results in the development of excessive scar tissue and adhesions between the various layers of fascia. As a result of this, nerve supply is further impaired, resulting in chronic pain.
Some of the common but ineffective treatment modalities include:
- ● Heat and Ice: The use of heat and ice may temporarily help in pain management but they do not fix the underlying problem.
- ● ESTIM is a physiotherapeutic tool that electrically stimulates muscles. This temporary improvement in nerve conduction and alleviation of pain but does not heal the damaged tissue. (9)
- ● Foam Rollers and Massage: Massaging or rubbing against the tissue may increase inflammation due to the development of friction between the layers of the fascia that aggravates the injury.
- ● Stretching and Exercise: Stretching the already inflamed foot increases stress on it and worsens the injury. Strength gaining exercises are essential to improving mobility but they should only be done after inflammation is over.
For Morton’s neuroma, the following treatment modalities will help resolve the inflammation:
- Rest well and avoid putting excessive pressure on the forefoot.
- MagnaHeal: This tool exerts the effect of a targetted magnetic field on the area of tissue injury in order to decrease inflammation. The magnetic field penetrates up to 3 inches deep into the inflamed tissue and heals it from within.
- An anti-inflammatory diet is essential to the process of healing. Garlic, turmeric, etc, have been found to have good anti-inflammatory properties and help in the healing process. Foods high in refined sugars and carbohydrates may, in turn, increase inflammation.
- Nutritional Supplementation: If your body is deficient in essential minerals, nutrients, and vitamins, the healing process cannot be carried out. (10) To help you fix this, the ask ASTR website has a database of at least 9 healthcare providers. You can answer a simple and free online questionnaire, and find out which nutrients your body and diet are deficient in and how to gain them back.
To target the proliferation phase of wound healing, the following might be useful:
- The A3 tool acts to break scar tissue and adhesions that are present in the superficial layers. The A5 tool targets scar tissue present in the deeper layers.
- The A1 and A5 tools are used to break superficial and deep fascia restrictions, respectively.
- Normalize gait pattern and walk properly.
- Use proper footwear and avoid wearing high heels.
- Acute Morton’s neuroma can resolve with a week of rest to allow healing. However, in chronic cases, we need to target the inflammatory and proliferation stages simultaneously so that the tissue can recover.
1. Jain S, Mannan K. The diagnosis and management of Morton’s neuroma: a literature review. Foot Ankle Spec [Internet]. 2013 Aug [cited 2021 Sep 24];6(4). Available from: https://pubmed.ncbi.nlm.nih.gov/23811947/
10. Dehail P, Duclos C, Barat M. Electrical stimulation and muscle strengthening. Ann Readapt Med Phys [Internet]. 2008 Jul [cited 2021 Sep 24];51(6). Available from: https://pubmed.ncbi.nlm.nih.gov/18602713/
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