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Non Invasive Neuroma treatment options

Updated: Oct 10, 2023

Have you ever experienced or know someone who has experienced the feeling under the balls of their feet which feels like a pebble or stone or feels 'clicky' you may be experiencing a condition called Morton's neuroma. Let's discuss a very common foot complaint we see and treat here at Foot Body Sole in the forefoot.

What is morton's neuroma

Morton's neuroma can be an extremely painful condition in the balls of your feet (forefoot region). Morton's neuroma is a benign degenerative (inflamed fibrous) neuropathy of the common plantar nerve digital nerve which which divides and supplies the adjacent sides of the toe and typically presents in the third webspace, followed by the second and then fourth webspace respectively.

History of morton's

Nerve pain was first described by Filippo Civinini in 1835 who was an Italian anatomist (Pasero, 2006). A decade later, Lewis Durlachear (who was Queen Victoria's chiropodist) in 1845, first described the symptoms (Durlacher, 1845). In 1876, an American orthopaedic surgeon whose name is synonymous with the condition Thomas Morton, who mentioned the symptoms were due to the fourth metatarsalphalangeal joint, called the condition metatarsalgia. Morton's management was to surgically remove the joint and the adjacent soft tissue, which included the common plantar digital nerve (Morton, 1876) Morton's neuroma was first coined in 1958 (Larson, 2005).

What causes morton's neuroma

The cause of Morton's neuroma is still currently unknown and much scientific debate as to its exact nature. However, there are a few theories running around.

  1. The chronic trauma theory which suggests there is repetitive trauma in the forefoot and plantar inter-metatarsal structors, which includes the communicating branch in the third web space, this of course gets flared up when walking which places pressure when dorsiflexion of toes (heel raise when walking) and contraction of the flexor digitorum brevis stretches the common digital nerve causing injury.

  2. Histological examination has a link to the plantar digital arteries in particular, degenerative changes to the artery.

  3. At times patients can have accompanying inter-metatarsal bursitis in the second and third web space, due to it's close proximity to the common digital neurovascular bundle (collection of nerves, arteries, veins together) it has been suggested as a contributing factor.

  4. The entrapment theory is when you walk the common digital nerve becomes trapped on the anterior edge of the deep transverse metatarsal ligament and producing parasthesia symptoms.

Typical symptoms a person will experience

Symptoms of Morton's neuroma can cause significant pain and be quite debilitating for individuals where they can become anxious and apprehensive in putting weight on the ground and walking.

Individuals describe parasthesia symptoms (numbness, burning, tingling sensations) on the balls of their feet and into the toes

  • Sometimes it may feel like a pebble or a stone in their forefoot

  • Mention barefoot walking can be painful.

  • Sometimes pain may be all day, only with shoes and when shoes come off feel relief instantly to night pain that keeps them up.

Non-invasive management of Morton's neuroma

More often than not individuals recover from conservative treatment and do not require surgery, however, in some instances non invasive treatment do not always work. I will list the most common treatment options below.

  • Footwear education/recommendations, advising patients to look at a more broader shoe and avoid tight toe boxes or heels which increase pressure on an inflamed nerve.

  • Shockwave therapy, to traumatise the tissue and break up the inflammation present.

  • High level laser to increase circulation, change cell metabolism and promote healing of the tissues.

  • Dry needling to try and increase circulation in the affected area.

  • Custom orthotics to offload and provide shock absorbing to the forefoot to allow the tissues to heal

  • Prolotherapy to reduce inflammation and reduce pain

If you think or know someone who are experiencing symptoms of Morton's neuroma or similar please do not hesitate to contact us if you have more questions.

We are located at 108 Bridport St, Albert Park Vic 3206, or you can call us on 03 8648 7678. Alternatively, you can click on the book now button below and it will take you to our online booking page.

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