Morton’s neuroma, also known as interdigital neuroma, is a nerve tissue growth in the forefoot between the toes. The growth often leads to a lot of pain, but is a benign, non-cancerous condition. Morton’s neuroma is usually found between the third and fourth toe; however, on rare occasions can also be found between the third and second toes. The cause of Morton’s neuroma is not clear; however, the irritation of the regional nerve leads to inflammation, scarring or tumor of the nerve. The symptoms are felt due to irritation of the nerve between the metatarsals.
Does Physical Therapy Help Morton’s Neuroma?
Morton’s neuroma is diagnosed based on the history, symptoms, locations and physical examination. Foot X-ray may be ordered to rule out differential diagnosis of stress fracture and on occasion foot MRI also may be ordered to confirm the diagnosis of Morton’s neuroma.
The treatment plan of Morton’s neuroma starts with conservative therapy and may involve surgical intervention, if conservative therapy fails. The conservative management of Morton’s neuroma is incomplete without the involvement of physical therapy. A physical therapist is the best person to approach regarding various adjustments and the first one is adjustment in the footwear. Footwear with wide toe box, soft soles and low heels are the best choice with avoidance of high heels, narrow toe box and non-padded footwear. The use of wide toe box footwear is advocated to give space between metatarsals to avoid their squeezing in the shoes and irritating neuroma further.
Since, the neuroma may be further irritated by putting pressure on it and that involves walking too. To avoid this and redistribute pressure from the metatarsals, metatarsal pads are recommended to alter the alignment of the metatarsal heads. This prevents irritation and compression of the interdigital nerves and onto Morton’s neuroma.
Orthotics helps correct mechanical imbalances of the foot in cases of flat foot or high arched foot.
In addition to adjustment in the footwear, physical therapy may involve contrast therapy, which involves alternative use of ice pack and heating pad to alleviate inflammation. Deep tissue massage and stretching exercises increase the flexibility of the ligaments as well increase the toe mobility and muscle strengthening of muscles affected by Morton’s neuroma. These strengthening exercises help prevent Morton’s neuroma from recurring.
Other forms of physical therapy include cryotherapy, ultrasound, and moist heat. These treatment options are directed towards the painful site to control pain and inflammation in the area. These therapy sessions may also include phonophoresis and iontophoresis to push anti-inflammatory medication directly to the painful site. These treatment options are usually helpful for patients who are unable to tolerate injections.
Physical therapy is not only plays a pivotal role in conservative management of Morton’s neuroma, but is also an important part of post-surgical rehabilitation program. Post-surgery, physical therapy has an integral role in rehabilitation of the normal activity and range of motion of the muscles along with alignment of ligaments and muscles and their strengthening for proper movement of foot, so that regular daily activities can be performed.
Pain In Morton’s Neuroma
There have been various theories regarding the pain caused by Morton’s neuroma and the most probable cause derived is the irritation of nerve due to entrapment of nerve between the metatarsals and ligaments due to bone squeezing. This chronic irritation can lead to pain and paresthesias. This irritation of the nerve can be triggered by wearing high heels or narrow toe shoes, injury to the foot, flat foot or high arched foot that may lead to changed biomechanics of the foot.
The pain of Morton’s neuroma is felt between the toes or the ball of the foot and is radiating, sharp, burning, shooting pain that may be accompanied by numbness and tingling of the toes. This sensation is aggravated by putting pressure on the foot and relieved by resting the foot. Sometimes, it might be accompanied by a feeling of swelling between the toes.