Morton’s Neuroma – nerve pain in my foot

“I suffer intermittently from a strong nerve pain in the middle toe of my left foot.  Do you think you could be of help to me in this.
Thank you”

This sounds like a Morton’s Neuroma.

Classically this is an extremely severe shooting nerve pain stimulated by squeezing up from the base of your foot in the space between between the 2nd and 3rd or 3rd and 4th toes quite close to the ball of your foot.  Often causing numbness and tingling in the affected toes.

The thickening, or enlargement, of the nerve that defines a neuroma is the result of compression and irritation of the nerve. This compression creates swelling of the nerve, eventually leading to permanent nerve damage. The nerve gets squeezed by the adjacent bones during walking, creating astonishing levels of pain and is, unfortunately, quite common.

In the clinic, a positive indication to a Morton’s Neuroma is that I have to scrape you off the ceiling after squeezing your foot in this way!

What Causes a Neuroma?

Anything that causes compression or irritation of the nerve can lead to the development of a neuroma. One of the most common offenders is wearing shoes that have a tapered toe box, or high-heeled shoes that cause the toes to be forced into the toe box.

People with certain foot deformities – bunions, hammer toes or v.flat feet are at higher risk for developing a neuroma. Other potential causes are activities that involve repetitive irritation to the ball of the foot, such as running or racquet sports. An injury or other type of trauma to the area may also lead to a neuroma. (see below)

causes of pain for mortons neuroma

Treatment
1st option
Icepack to reduce swelling and inflammation  –  avoid narrow fronted shoes  –  change your activity to stop the over-loading at your toes, chose shoes with a well shaped fore-foot rocker to reduce the load and stress over your toes – Clark’s wave, MBT, Fit-flop.

2nd
Orthotics –  often highly successful
Insoles to spread the transverse arch (across ball of foot) creating as much space as possible between the bones of your foot where the restriction or crimping has occurred and reduce the mechanical trigger.
Improving the bio-mechanics of your gait keeps your foot in the best position during walking -controlling the trigger and allowing the nerve inflammation to subside
Ensure shoes are wide at the fore-foot and do not squeeze and restrict the ball of your foot.  It may be worth having shoes stretched slightly to give more space – NB trainers/running shoes are normally very wide over the forepart but do vary significantly with each manufacturer.

3rd
cortizone injection to reduce swelling and inflammation

This can work very well to reduce the acute inflammation but the effects are often short lived and the pain will often recur after 3 months or so.

4th – and normally the very last option!
Surgery to chop out a chronically damaged nerve

Although this can work very well in obvious cases, it is not the best option as this problem can often recur in an adjacent toe.   Care must be taken

hope this helps