Morton ‘s  neuroma  is a degenerative pathology of the plantar nerves . It is characterized by a pain in the foot localized in the area between the third and fourth toes.

The most well-known and common symptom consists in many cases in noticing the very painful presence of a pebble in the shoe.

If neglected it degenerates causing a fulminating pain that becomes chronic and can extend from the foot to the leg . Generally, the condition worsens when standing upright, especially when walking. The condition tends to predominantly occur in middle-aged women.

But what are the  causes of  Morton’s disease ?

First, the creation of a thickness of the connective tissue of one of the nerves , caused by some incorrect lifestyle , such as the use of high-heeled shoes. 

Surely, in parallel with the adoption of an appropriate therapy, it is recommended to switch to more comfortable, low shoes that do not force the foot to be subjected to stresses in a narrow environment. 

Morton’s Neuroma Symptoms

There are no external signs of this pathology, however there are very specific symptoms : 

– Intense pain , such as due to the presence of a foreign body in the shoe or sock;
– A fulminant pain localized in the forefoot area , ie in the front part of the limb, which can also radiate to the fingers;
– Tingling or numbness in the toes;

The Causes of Neuroma

Neuroma appears to be the result of complex biomechanical changes occurring in our feet . However, what is the cause of the scar formation and thickening that characterize this type of pathology? Basically the most accredited explanation theorizes an overload of the tissue structure . A scar formation of the connective tissue occurs as an attempt by our body to protect the overloaded structure.

The nerves of our toes are located in an area bounded by the metatarsal heads. In particular, the nerve between the third and fourth metatarsal tends to get trapped between the bones of the metatarsal causing a swelling of the nerve, accompanied by pain

The onset of Morton’s neuroma is often attributed to the use of tight shoes, but the opinion is not unanimous. Most of the time it is caused by poor foot mechanics . People who run barefoot are also prone to the problem, so it doesn’t seem to be a matter of tight or too high-heeled shoes.
Here we list some of the causes recognized today as valid by medical science :

– Foot anomalies : the foot can be the carrier of morpho-structural anomalies, present from birth or caused by trauma. These anomalies are the main causes of contact problems that cause problems with the connective tissue of the nerves;

– Wrong footwear: although many exclude this cause a priori, there are many specialists who attribute Morton’s disease to the prolonged use of narrow shoes or shoes with excessive heels. The forefoot would in fact be overloaded causing an unnatural torsion, which would have as a consequence the inflammation of the nerve area;

–  Incorrect posture : the way in which we support the foot during the motion must be characterized by complete balance. Even a small imbalance is enough to cause one area of ​​the foot to become overloaded with respect to all the others. The metatarsal area is rather delicate and becomes inflamed with some ease; 

– Dynamic stress : it is an expression that is used when athletes are subjected to repeated stresses in certain areas of the foot. It happens in disciplines such as football, running and volleyball. All of these sports are more likely to cause Morton’s disease than others;

– Overpronation: while pronation is a normal movement that our foot performs during walking, running or during sports, overpronation occurs when the limb continues to rotate instead of starting the thrust phase. This misbehavior of the foot during walking causes pain in the long run. It is estimated that over 60% of people who exercise overpronation try to compensate by rolling their ankles and walking with the outside of their feet. A good indication would be to check the condition of the sole of the shoes. Wear in a particular area is an indication of possible defects in the mechanics.

Morton’s Neuroma Treatment

Pain is the first cause that leads the subject to seek treatment. Pain relievers and anti-inflammatory drugs can certainly help. The inflammation can subside thanks to the application of ice. However, particular techniques or exercises can also help to relieve the overload of the inflamed parts.
The physiotherapist usually uses a series of tools to carry out a treatment, which aims to reduce pain by acting on the inflamed area. Among these we can mention:

– the application of ice ;
– electrotherapy ;
– acupuncture ;
– massage of the plantar area ;

Massages are quite effective because they are able to act directly on the nerve area .

One of the most effective remedies , to be used in parallel with therapy or as a prevention of the problem, is the use of specific footwear . In many cases it is recommended to use felt, foam or gel insoles to help relieve stress in the area .

During the stabilization phase of pain and inflammation , the physiotherapist will focus on restoring the normal biomechanics of the foot . Treatment may include joint mobilization and alignment techniques, massage, muscle stretching and orthosis , to limit excessive pronation of the foot.

The posture of the foot muscles is vital for correcting the biomechanics that led to the overload injury. In this case, the physiotherapist will be able to evaluate the posture of the muscles and prescribe suitable exercises to restore their correct position and functionality. This phase of rehabilitation is aimed at making the subject return to the full exercise of his habits of life, both those of normal walking and those relating to physical and sporting activities

In this sense, the physiotherapist will personalize the rehabilitation to help the subject achieve his specific goals.

Surgical treatment

Occasionally it is necessary to resort to surgery for Morton’s neuroma when conservative treatment, i.e. physiotherapy and all other medical practices adopted to avoid surgery in the operating room, are unable to relieve the symptoms of Morton’s neuroma.

Surgery involves, through neurolysis, the freeing of the enlarged nerve from adhesions and inflammation of the surrounding tissues that compressed it. By eliminating the compression, the digital nerve endings travel to the toes unhindered.

In particular , it is possible to resort to the intervention if the pain has lasted for more than six months without any improvement . It should be noted that eight out of ten patients benefited from the surgery, while seven out of ten patients no longer felt any pain in the foot.