Reviewed by Janet D. Pearl, MD, MSc
Musculoskeletal issues like Morton neuroma are reported more frequently in highly dynamic individuals such as runners, skiers, football players, dancers and ballerinas. There are many reasons that may explain higher incidence in certain sports. For example:
In other words, any physical activity that involves the application of direct pressure or persistent force on the forefoot (or mid-foot) may increase the risk of developing Mortons neuroma. It is especially true for all jumping, hopping or compression foot activities or sports.
The key pathology in Morton’s neuroma is nerve entrapment (also referred to as intermetatarsalgia or entrapment neuropathy) just beneath the transverse metatarsal ligament. The persistent grinding or repetitive activity in the region of metatarsals as a result of hypermobility of metatarsal joints can lead to a slow crushing injury of the delicate nerve bundles. In poorly managed cases, persistent inflammation and micro-injury leads to fibrosis or nerve thickening resulting in Morton’s neuroma.
Even though most Mortons neuroma patients are middle aged, Morton’s neuroma can occur in individuals as young as 15 years (especially true for ballerinas). The most common location of a Mortons neuroma is between third and fourth toes. In a fair number of cases, two or more Mortons neuromas may co-exist and are associated with severe symptoms and compromised physical independence.
The classic symptoms of Morton’s neuroma includes burning pain on the bottom of your foot pad. The pain and burning sensation aggravates with physical activities such as walking and running. At times wearing ill-fitting shoes or excessive physical activity can also trigger the pain. A careful examination by an experienced clinician can differentiate Morton’s neuroma from other medical conditions like, gout, tendon inflammation and rheumatoid arthritis. In some cases an ultrasound may be needed. Very rarely an MRI may be employed to rule out another cause of foot pain. Usually, a detailed history and physical examination is all that is required.
Treatment of early stage Morton’s neuroma is simple and easy. In most early cases, lifestyle modification (such as wearing shoes with wide toe boxes) and simple holistic protocols like the application of a cold pack and massages are the only interventions needed. These may be combined with orthotics and non Steroidal anti-inflammatory medications. Custom orthotics are preferred in athletes due to the strain they constantly place on their feet. Corticosteroid injections may also be helpful, but they must be used sparingly and preferably done under ultrasound guidance to lower the risk of complications such as fat pad atrophy.
If these simple measures fail, then an ultrasound guided ablation procedure is often the solution.