Morton’s neuroma is a painful condition of the forefoot caused by impingement of the interdigital nerves between the metatarsals of foot. Therefore, it is also known as interdigital neuroma or intermetatarsal neuroma. Morton’s neuroma is a very common condition and females are usually more prone to this condition owing to their use of high heels. However, men are not exempted from this condition as they also may traumatize their forefoot during sports injury or structural biomechanical misalignment.
The pain caused by Morton’s neuroma can be very distressing and debilitating for some people and hamper their daily activity rendering them inactive as the pain is aggravated with walking motion and alleviated with resting. The pain is sharp, burning, electric and shooting in nature that seems to radiate from the third and fourth metatarsal area (most commonly affected area followed by second and third metatarsal area) to the phalanges.
The first treatment strategy to relieve pain is to make changes and modifications in footwear, including changing from high heels to short heels, narrow toe box footwear to broad toe box footwear. In addition to these changes, metatarsal pads are used to redistribute pressure from the metatarsals, which are the epicenter of pain, to remove the pressure from this area and assisting in walking.
Where Do You Place The Pad For Morton’s Neuroma?
Metatarsal pads are commonly known as met pads and are usually prescribed for relieving pressure from metatarsal head, not only used for Morton’s neuroma, but also for other conditions, including metatarsalgia, arthritis, pes planus, foot ulceration, sesamoiditis and diabetic peripheral neuropathy.
The pain in Morton’s neuroma is felt on the ball of the foot, so it is quite normal to consider that relieving this area off of pressure by placing metatarsal pad over the ball of the foot will relieve pain from this area. However, this is the biggest mistake one can make as placing a met pad over the ball of foot may aggravate the condition, instead of relieving it.
Met pads are available in various shapes, sizes, designs and materials such as felt, cork, polyurethane foam, latex foam and silicone. They are available in the form of prescription insoles or are manufactured in prefabricated form. The prescription of metatarsal pads solely depends on the condition being treated, as one type, size or design of metatarsal pad may work for one condition, but not for another. They can be available as dome shaped, donut shaped or U shaped; however, dome shaped is the preferred option as per patient satisfaction.
Although, the effectiveness of pain control depends on intensity or location of pain, comfort and material of the pad, shape and design of the material, till date placement of the pad is the most important factor to be considered for positive results. The ideal placement of met pads is 6.1 to 10.6 mm proximal to met heads, which results in maximum pressure alleviation.
The tricky part is placing a met pad proximal to met heads and if you are unable to achieve this, then you should consult your podiatrist for proper placement of met pads, as when incorrectly placed, it will cause more trouble than good. The first step in the placement of met pads is the identification of the ball of foot or metatarsal heads. The padded area on the plantar surface relates to the metatarsal head. It is easier to identify in an old shoe, as metatarsal heads will be worn out areas in the liner of the shoe.
In new shoes, it will be more difficult to locate the ball of the foot, which can be manually felt by pressing and feeling on the plantar surface of the foot. Replicating this on the liner, the met pad should be placed proximal to the ball of the foot and adjusted properly in the liner and the liner and met pad placed back in the shoes.
The use of met pads can be discomforting in the first week, but it will surely provide relief from Morton’s neuroma pain. If not after regular use, then consult a podiatrist.