Is Massage Good For Morton’s Neuroma?

Morton’s neuroma is a very common condition afflicting the people of United States. It is ten times more common in females than in males and is most commonly seen in middle-aged individuals. It is also known as interdigital or intermetatarsal neuroma. It is caused due to entrapment of interdigital nerve between the metatarsal ligament and metatarsal bone. This leads to swelling and irritation of the nerve responsible for the pain and parethesia symptoms in Morton’s neuroma when the swollen nerve is compressed between the metatarsals due to various reasons.

The main goal of the treatment is removing the aggravating factors that trigger nerve compression or exert unnecessary pressure on interdigital nerves. The most common management is modifying footwear from high heels to low heels and narrow toe box shoes to broad toe box shoes. Pain and inflammation are addressed by using NSAIDs, anesthetic and corticosteroid injections. Other conservative methods include the use of metatarsal pads, shockwave therapy, cryotherapy, physical therapy. If the symptoms persist even after 6-12 months of conservative therapy, surgical intervention is considered. Surgery involves either the excision of the plantar digital nerve or releasing the metatarsal ligament. However, excision of the nerve may lead to permanent numbness of the toes.

Apart from the above treatment options, massage therapy is also an alternative strategy to alleviate symptoms of Morton’s neuroma. Although, massage therapy is a good option for the treatment of intermetatarsal neuroma, it should be done with caution. Careful attention should be paid to avoid deep pressure between the metatarsal heads, doing which might compress the nerve further and aggravate the symptoms instead of resolving them. In addition to this, manipulation of the toes with hyperextension should also be avoided to avoid aggravation of symptoms.

The best massage results are achieved by massaging along with manipulation and mobilization of the metatarsal heads and other local structures of the foot and leg.

Metatarsal manipulation can be done by pulling apart and holding the metatarsal heads to help stretch and increase mobility of the adjacent muscles. This technique can be combined with the use of toe spacers. Stretching the metatarsals can help relax the foot muscles. There are many muscles that attach to the foot, so it is important not only to treat the smaller intrinsic muscles, but also the larger muscles of leg, including calf muscles and Achilles tendon.

Postural alignment is also an important aspect as people with Morton’s neuroma develop modified gaits to avoid pressure on the painful foot. Postural alignment should also be addressed for better balance and anatomical integrity to avoid undue stress on Morton’s neuroma. Just massage therapy is not enough, addressing the biomechanical problem and reversing it is the key to long-term management of Morton’s neuroma. Therefore, massage therapy can be used as an adjunct to other therapies to alleviate pain symptoms.

Although, Morton’s neuroma may be asymptomatic, it is usually symptomatic with symptoms of pain, numbness, tingling, and burning sensation. Generally, the pain is sharp, shooting, electric and seems to radiate from the affected metatarsals, which usually are the third and fourth metatarsals, to the phalanges. The pain may range from irritating to debilitating. The pain is known to be aggravated by walking or running motion and relieved by rest or removing the shoes and various manipulations of the foot; however, pain in several cases has been noted at rest too without any aggravating factors.

The exact cause of Morton’s neuroma is unknown, however, the most probable cause is considered to be due to increased mobility of the metatarsals and continuous motions leading to compression of the nerve between metatarsals leading to nerve irritation and inflammation. Patients with injury or trauma to this area are more susceptible to Morton’s neuroma. High heels and tight shoes with narrow toe box are common precipitating factors for Morton’s neuroma. Anatomical aberration or structural misalignment of the forefoot is also considered a contributing factor.