What shoes should I wear for Morton’s neuroma?
We are frequently asked, what shoes should I get for my Morton’s neuroma? Shoes are critical in the prevention and treatment of Morton’s neuroma.
Poorly fitted or inappropriate shoes can make forefoot overloading mechanism worse (especially in women) resulting in Morton’s neuroma. The overloading mechanism refers to over-riding of metatarsal bones on each other due to forceful impact or other dynamic factors especially when walking in high-heeled shoes with narrow toe boxes. If this overlapping is not addressed, it may affect the integrity of intermetatarsal nerves, which can result in an entrapment syndrome and a neuroma formation.
Some anatomical characteristics that are strongly associated with Morton’s neuroma are:
- Low ball-heel ratio also known as heel to toe drop
- High height of toes
- Poor arch support
- Poor biomechanical balance due to instability of support around the ankles.
Congenital or acquired musculoskeletal defects and certain habits/ lifestyle choices can further worsen the stability of the foot.
Morton’s neuroma and shoes:
While it is a fact that little can be done to alter the anatomical characteristics of the foot, research suggests that correct footwear reduce the risk of developing Morton’s neuroma. An appropriate choice of footwear can influence your walk (gait), movement and connective tissue and bone alignment.
What type of shoes are associated with high risk of Morton’s neuroma?
A recent study reported in Foot & Ankle International(1) suggested that certain risky styles in the footwear can make you more prone to develop Morton’s neuroma and other foot conditions. These include:
- Use of very high heels on regular basis (more than 2.5 inches). Risk is even higher with pencil heels as compared to block-heels
- Narrow- toe box
- Worn-out sole or inadequate padding of the base
- Ill-fitting or improperly fitting shoes
Recommended footwear for Morton’s neuroma:
Based on current recommendations and guidelines, correct shoes for Morton’s neuroma can help in managing the pain and discomfort (especially in early or moderate cases of Morton’s neuroma). Furthermore, removal of the inflammatory or entrapment source (such as narrow toebox shoes) can help in the restoration of natural foot anatomy. Shoes are important and helpful in dealing with morton’s neuroma pain, but they are not a cure and should be combined with the appropriate conservative treatment or procedure as needed.
Here is what we advise our Morton’s neuroma patients:
- Get shoes that work with you not against you. When you are looking for Morton’s neuroma shoes, you should do so during the evening if possible. Your feet are typically bigger at the end of the day, so you will need shoes with at least a half-inch of toe room. When trying on shoes, be sure to stand, walk, and light jog in them to see how they move with your feet.
- Shoes with proper arch support: If you have a highly dynamic or active lifestyle, make sure to invest in high quality shoes. The most important feature of running shoes is an adequate arch support that helps in offsetting the pressure and strain by acting as a shock- absorber. Optimal arch support is more important if you have certain foot conditions or related high risk factors such as an abnormal posture or inadequate gait.
- The right-size pair of footwear: Are you aware that in about 60% of the general population, the size of the right foot is different from the left foot? In about 80% of individuals, it is the right foot that is slightly smaller than the left foot. While it is not necessary to buy different sized shoes, it is very important to be consistent with the type of footwear. However, if your shoe size differs by more than 1½ sizes, you should get custom-made shoes (or buy mismatched size footwear) to minimize the risk of straining the connective tissue architecture of your foot. If you are experiencing pain or discomfort in your feet, it is important to see an expert for accurate evaluation of your foot size.
- Wide-toe box shoes: Use of wide toe box shoes is critical to prevent direct impact of pressure and force on the forefoot. A wide toe box prevent the over-riding of metatarsal bones on each other, which tends to occur in narrow toe box or high heeled shoes. Make sure that your shoes have a wide enough toe box to cope with your feet at the very end of the day when feet tend to swell.
- Very low or zero drop shoes. Get shoes completely flat shoes so that they don’t put any pressure on the bones in the ball of your feet (where your Morton’s neuroma is located).
- Use of custom–orthotics: Orthotics especially customized orthotics, correct problems with stance and gait as well as provide padding and cushioning to the inflamed connective tissue elements by offsetting the pressure.
- Adjustable Fitting Shoes: Keep in mind that too narrow or too roomy shoes are equally bad for the integrity and stability of the foot. Therefore, we prefer shoes with adjustable fitting (such as laces, straps etc.) to adjust the setting according to your level of comfort.
- Throw away those old shoes. Finding good shoes for Morton’s neuroma also means knowing when to retire them. A good pair of shoes will not last forever. If you hang on to your shoes when the heels and tread are worn out, you can exacerbate your condition and cause more pain.
According to the results of a clinical study conducted in Morton’s neuroma patients(2), the use of correct Morton’s neuroma shoes is helpful in treating early or moderate Morton’s neuroma pain, especially when combined with other conservative measures. Correct shoes and foot support can also help preventing/ managing other foot conditions such as callouses, hammer toes, neuromas, heel spurs, bunions, metatarsalgia, plantar fasciitis and pronation.
Morton’s neuroma is a progressively debilitating condition of the foot that typically involves the third intermetatarsal space. Fortunately, with correct shoes, conservative care and, if needed, the appropriate procedure for resistant Morton’s neuroma, you can alleviate your symptoms.
(1) Makki, D., Haddad, B. Z., Mahmood, Z., Shahid, M. S., Pathak, S., & Garnham, I. (2012). Efficacy of corticosteroid injection versus size of plantar interdigital neuroma. Foot & ankle international, 33(9), 722-726.
(2) Saygi, B., Yildirim, Y., Saygi, E. K., Kara, H., & Esemenli, T. (2005). Morton neuroma: comparative results of two conservative methods. Foot & ankle international, 26(7), 556-559.
Don’t Suffer Any Longer…
Janet D. Pearl, MD, MSc is the Medical Director of The Center for Morton’s Neuroma and Complete Spine and Pain Care, an interventional and integrated Pain Management program located in Framingham, Massachusetts. Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Fellowship program. She is the former Director of a satellite pain center of the Brigham and Women’s Hospital, Pain Management Center, located at the HealthSouth Braintree Rehabilitation Hospital. Dr. Pearl held academic appointments at Harvard Medical School and Tufts Medical School. She serves on the Health Care Services Board of the Commonwealth of Massachusetts Department of Industrial Accidents since 2000 as one of its physician representatives and is Chair of the Committee on Pain Management.