Morton’s neuroma is a type of nerve compression that affects the common plantar digital nerve. It typically occurs in the third web space of the foot, with the second and fourth spaces also being affected(Barry & et.al., 2019). In some cases, it may be caused by compression and irritation of the plantar aspect of the ligament (Munir & et.al., 2022).
According to Munir & et.al., this condition is often related to the third interdigital nerve that is associated with altered pressure distribution and overloading of the foot due to deformity and/or calf muscle tightness, which is known as painful forefoot syndrome. Females have a five times higher incidence of the condition than males, with middle-aged women being particularly affected. While it is rare for both feet to be affected, it is common to find two neuromas on the same foot.
Symptoms of Morton’s neuroma include pain localized in the plantar aspect between the metatarsal heads, which is aggravated by walking and wearing tight-fitting, high-heeled shoes, and relieved by resting and removing shoes. Abnormal forefoot sensations such as burning or aching may also occur, along with a sensation of walking on a stone or marble. Numbness, tingling, and electrical sensations may also be experienced during prolonged walking, and pain can radiate to the hindfoot or leg, causing cramps.
How do you know when you have it:
- Pain localized in the plantar aspect between metatarsal heads
- Pain aggravated by walking and wearing tight-fitting, high-heeled shoes and relieved by resting and removing shoes
- Abnormal forefoot sensations such as a burning or ache (Barry & et.al., 2019)
- Sensation as walking on a stone or marble
- Numbness, and tingling with electrical sensation may be experienced during prolonged walking
- Pain can radiate to the hindfoot or leg, causing cramps.
How to check whether you have:
- Metatarsal squeeze test – Clasping the forefoot with both hands and squeezing the metatarsal bones together with either hand and compressing the intermetatarsal nerve. If pain is felt during this test, it may indicate the presence of Morton’s neuroma.
2. Perform Mulders click test – Apply compression to the forefoot by clasping the five metatarsal heads with one hand, and then applying pressure to the intermetatarsal space by using the soft end of a tendon hammer or a pen on the sole of the foot. If an audible click is heard at the same time as pain, it may indicate the presence of Morton’s neuroma.
What I should do when I have it:
- Wearing a wide, soft-soled, laced shoe with a low heel can help to reduce pressure on the nerve.
- Ice/hot pack on the painful area for around 15mins
- Reduce body weight if overweight will cause excessive loading on the foot, increase the pain
- Avoid or reduce impact activities such as running and jumping
References:
Gougoulias, N., Lampridis, V., & Sakellariou, A. (2019). Morton’s interdigital neuroma: instructional review. Effort open reviews, 4(1); 14-24. Doi: https://doi.org/10.1302%2F2058-5241.4.180025
Munir, U., Tafti, D., & Morgan, S. (2022). Morton Neuroma. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK470249/?report=classic
Post, M. D., & Maccio, J. R. (2020). M3dhanical diagnosis and therapy and Morton’s neuroma: a case – series. J Man Manip Ther 28(1);60-67. Doi: https://doi.org/10.1080%2F10669817.2019.1611044
Traver, L. (n.d.). Morton’s neuroma:clinical assessment and management. Sport injury bulletin. Retrieved from https://www.sportsinjurybulletin.com/diagnose–treat/mortons-neuroma-clinical-assessment-and-management
Prepared By
Choo Siew Wen
Your Physio Kota Kemuning