Mortons Neuroma

Morton’s neuroma is a painful condition affecting the ball of your foot, most commonly the area between the third and fourth toes. It involves a thickening of the tissue around one of the digital nerves leading to your toes. This thickening, or neuroma, can cause sharp, burning pain or numbness in the forefoot. While not life-threatening, Morton’s neuroma can significantly impact comfort and mobility. Seeking timely diagnosis and treatment from a podiatrist in Singapore is important for effective management.

Symptoms often start gradually and may come and go, frequently aggravated by certain shoes or activities. Common signs include:

• Sharp, Burning Pain: Felt in the ball of the foot, which may radiate into the affected toes (usually the third and fourth toes).
• Feeling of Standing on an Object: A sensation like walking on a pebble, a fold in your sock, or a marble under the ball of the foot.
• Numbness or Tingling: Altered sensation or pins-and-needles in the affected toes.
• Pain Worsens with Constricting Footwear: Symptoms are often aggravated by wearing tight, narrow, or high-heeled shoes.
• Relief Upon Removing Shoes: Taking off shoes and massaging the foot often provides temporary relief.

If you experience persistent pain or unusual sensations in the ball of your foot, professional evaluation is recommended.

Morton’s neuroma develops in response to irritation, pressure, or injury to one of the digital nerves in your forefoot. Key contributing factors include:

• Constricting Footwear: High heels or shoes with a tight, narrow, or pointed toe box squeeze the metatarsal bones together, compressing and irritating the nerve. This is a very common cause.
• Foot Deformities: Conditions like bunions, hammertoes, flat feet (pes planus), or high arches (pes cavus) can alter foot mechanics and put extra pressure on the nerves.
• Repetitive Stress: High-impact activities like running or court sports can subject the forefoot to repeated trauma. Certain occupations requiring prolonged squatting or pressure on the forefoot may also contribute.

Previous Foot Injury: Trauma to the foot can sometimes lead to nerve damage or inflammation, contributing to neuroma development.

• Chronic Pain: Persistent and worsening pain that can limit daily activities, exercise, and footwear choices.
• Nerve Damage: Prolonged compression can potentially lead to permanent nerve changes.
• Altered Gait: Limping or changing walking patterns to avoid pain, which may cause secondary pain in other parts of the foot, leg, hip, or back.

Diagnosing Morton’s neuroma involves a careful assessment by a podiatrist at Fine Podiatry Clinic:

• Medical History: Discussing your symptoms, when they occur, the types of shoes you wear, your activity levels, and any previous foot problems.
• Physical Examination: Your podiatrist will examine your foot for tenderness, swelling, or any visible lumps. They will palpate (feel) the spaces between the metatarsal bones to pinpoint the source of pain.
• Specific Tests: A common diagnostic test is the Mulder’s sign (or click), where the podiatrist squeezes the metatarsal heads together while applying pressure to the space between them. A palpable click or reproduction of your pain can indicate a neuroma.
  • Imaging (Sometimes):
  • X-rays: May be taken to rule out other causes of forefoot pain, such as stress fractures or arthritis. Neuromas themselves are soft tissue and don’t show up on X-rays.
• Ultrasound or MRI: These imaging techniques can help visualize the neuroma and confirm the diagnosis, especially if it’s unclear from the physical exam or if other conditions are suspected.

Treatment aims to relieve pressure on the nerve and reduce inflammation. Most cases respond well to conservative (non-surgical) care.

• Non-Surgical Treatments: Our primary approach focuses on conservative methods tailored to your needs:
  • • Footwear Changes: Switching to shoes with a wider toe box, lower heels, and good cushioning is often the first and most crucial step.
    • Padding and Taping: Specific padding techniques (e.g., metatarsal pads) can be applied to lift and separate the metatarsal bones, reducing pressure on the nerve.
    • Custom Orthotics: Prescription insoles designed to improve foot mechanics, provide support, and redistribute pressure away from the neuroma are highly effective for many patients.
    • Activity Modification: Temporarily avoiding activities that aggravate symptoms.
    • Injection Therapy: In some cases, corticosteroid injections may be used to reduce inflammation and pain around the nerve. Other types of injections might also be considered.
• Surgical Options: Surgery is typically considered only if conservative treatments fail to provide adequate relief after several months. Surgical options might involve removing the affected nerve (neurectomy) or releasing pressure around the nerve

Note: Early intervention often leads to better outcomes. Our podiatrists will work with you to find the most effective, least invasive treatment plan.

While not all neuromas are preventable, these steps can help reduce risk and manage mild symptoms:

• Wear Appropriate Footwear: Avoid shoes that are too tight, narrow, or have high heels, especially for prolonged periods. Choose shoes with ample room for your toes.
• Use Arch Supports or Pads: Over-the-counter or custom orthotics can help distribute pressure correctly.
• Maintain a Healthy Weight: Reduces overall pressure on your feet.
• Rest Your Feet: Avoid activities that cause forefoot pain when symptoms flare up.
• Massage: Gently massaging the forefoot may provide temporary relief.