Symptomatic condition that results in pain especially between third and fourth toes of the foot due to compression of the nerve is said to be Morton's Neuroma or Morton's Metatarsalgia or Plantar Neuroma. This syndrome is often confused with plantar fasciitis.
Causes of Morton's Neuroma or Morton's Metatarsalgia or Plantar Neuroma
Transmission of messages from foot to the brain starts from toes through the nerves which pass between the long bones behind the toes (metatarsal bones). When the arch of the foot is damaged or becomes weak, this will lead to pinching of the nerves due to compression and inflammation occurs. In the most of the cases, metatarsal bones usually pinch the nerves that pass between third and fourth toes. Along with inflammation (swelling) severe pain and numbness is elicited which is usually on the inner side of these two toes from where the nerves pass through.
In some cases, Morton's Neuroma or Morton's Metatarsalgia or Plantar Neuroma can be caused by benign tumor or neuroma on the nerves that are situated between the toes. These nerves are called plantar digital nerves. This neuroma can be developed as a result of improper fitting shoes or insoles that tend to compress the nerves. In athletes, this condition will be worse because they tend to overuse the foot, usually seen in tennis players, golfers, runners, etc.
Signs and Symptoms of Morton's Neuroma or Morton's Metatarsalgia or Plantar Neuroma
- When the foot is squeezed, you will experience pain.
- When the bones of the foot are slightly pressed, the pain is elicited.
- Pain with walking especially longer distances.
- Pain between the toes.
Treatment for Morton's Neuroma or Morton's Metatarsalgia or Plantar Neuroma
- Stop doing the activities the moment pain is developed and take rest.
- If the inflammation and pain does not subside, then consult a sports injury specialist or a Podiatrist.
- Metatarsal pads are manufactured especially for these types of sports injuries by wearing which metatarsal bones will be spread apart and raised which will decrease the pressure that the nerves receive.
- Consult a sport injury specialist for formulating rehabilitation program to work on avoiding future damage to the nerves and foot structure.
Who Is A Sports Injury Specialist And What Does He Do?
- A sports injury specialist is a professional who is especially trained to treat, strengthen, and gives advice on future care of the foot.
- Sports injury specialist performs formal physical test to know the status of the injury based on which treatment modalities will be suggested.
- He will recommend orthotics that best fits the foot.
- To relieve the pressure off the nerve, he will tape the foot.
- After initial fomentation, anti-inflammatory meds will be prescribed.
- Once the pain and swelling subsides, sports injury specialist will suggest strengthening exercises to regain lost strength of the arch of foot.
Surgery for Morton's Neuroma or Morton's Metatarsalgia or Plantar Neuroma
The aim of the surgery would be to decompress the nerve creating the required space for the nerve. In severe cases, resection of part of the affected nerve will be done to help alleviate pain. After resection, some part of the resected site will become numb. Overall success rate of surgical treatment of Morton's neuroma has always been high. In any case, physical rehab after the surgery is important to regain lost strength and to continue further normal activities.
How to Assess Morton's Neuroma or Morton's Metatarsalgia or Plantar Neuroma?
A common and simple test can be used to assess Morton's Neuroma or Morton's Metatarsalgia or Plantar Neuroma. Physical therapist will hold heads of the metatarsal bones and will squeeze them in order to compress the nerve that is situated in between the metatarsals. Physical therapist will use fingers and tip of the thumb and sole to analyze the amount of pain that is developed when pressed. More importantly, physical therapist will look for the cause of the pain i.e., whether it is due to overpronation or any other factor involved.
Rehabilitation for Morton's Neuroma or Morton's Metatarsalgia or Plantar Neuroma
- Important aim of rehabilitation program is to help alleviate pain and swelling by stretching the affected muscles, regaining full strength and returning back to normal activities.
- To achieve this, a sports injury specialist will first start the treatment by applying cold therapy. One should always make sure not to put ice directly on the affected part of skin which will lead to burning of the skin (ice burns). The simple process is to either wrap the foot in a wet towel or use ice pack to avoid direct contact of ice with the skin. Application of ice should be done for 15-20 mins once in every two hours initially. Over the course of reduction of pain and swelling, then frequency of application of ice can be decreased.
- Over the course of treatment, one should ensure to stay away from any sorts of sports activities. The aim of this is to make sure that the foot is not involved in any type of pressure related activities.
- In cases where providing rest to the foot is not possible, then sports injury specialist will suggest placement of padded bridge under forefoot which will help spread the bony structure and will decrease the pressure exerted on the foot.
- The specialist will suggest orthotics if the foot is likely to overpronate.
- In most cases, swelling and pain will subside with initial treatment in few days of starting the treatment, if done appropriately. In severe cases, which do not respond to initial treatment, then the sports injury specialist may suggest going for corticosteroid injection along with padding of the foot.
- As a last resort, if rehab treatment fails to alleviate pain and swelling, then sports injury specialist may recommend surgical treatment.
Why Stretching and Strengthening Exercises for Morton's Neuroma or Morton's Metatarsalgia or Plantar Neuroma is Important?
- Stretching and strengthening of the foot is very important to regain the lost strength and to perform usual and customary activities of daily living without pain and discomfort. These stretching and strengthening exercises are very, very important for sportsmen, especially if the injury is occurred at a very young age.
- These exercises can be started the moment pain allows the foot to take certain amount of pressure. Gradually, the number and frequency of the exercises will be increased making sure that the foot is safely taking the pressure during the time of performance of exercises.
- One should have an idea that stretching and strengthening exercises are totally different and have different advantages.
- The aim of the stretching exercises is to stretch the Achilles tendon and muscles.
- The aim of the strengthening exercises is to regain lost strength of the foot making sure that the foot is safe and there are no chances of inflammation. These exercises also help in improving and maintaining the transverse arch of the heel.
How To Assess Complete Fitness?
- After the treatment, if you can walk without any problem, pain, and take the pressure on to the foot, then it does not mean that you are back to normal fitness. If you can continue daily activities for a couple of weeks, then start activities like jogging and running.
- In case of biomechanical problems like overpronation, if the problems are not rectified using orthotics, then the chances of reinjuring the foot are high.
- Any activities related to jogging and running should be performed under supervision of sports injury specialist who will formulate a program based on which these activities will be carried out safely.