12 Jan What is Morton’s Neuroma?
OUCH! Pain in the ball of your foot when you step down, walk, or run? Feel like there is a large pebble or rock in your shoe? Have stubborn pain on the bottom of the foot that just won’t go away? You may be experiencing a common, yet often undiagnosed condition called Morton’s neuroma. Morton’s neuroma is a benign, yet very painful condition that occurs when a nerve running in between your toes gets irritated or compressed and starts to cause discomfort. In this article, we will discuss causes and treatments for this condition, as well as give you some exercise and stretching tools to combat your pain!
Causes and symptoms of Morton’s Neuroma
Morton’s neuroma is named for Dr. Thomas George Morton, who first described the condition in 1876. Also called intermetatarsal neuroma, because it occurs between the toes, pain from Morton’s neuroma can start intermittently and can be described as “nagging” or “annoying”. The pain is usually located between the 3rd and 4th digits of the foot on the plantar (bottom of the foot) surface, but can also occur less commonly between the 2nd and 3rd digits. It can sometimes be described as feeling like “having a pebble or rock in your shoe” or “feeling like the sock is bunched up under your foot”. It can feel like a dull ache or a burning sensation, and in some cases can radiate to other toes and areas of the foot. There is usually no noticeable swelling, and most of the time, one cannot feel a “lump” in the affected area. The person will likely have difficulty walking or performing other preferred activities.
So what causes Morton’s neuroma? There is no one definitive cause, but rather, a few factors that could lead to pain from this condition. In fact, in a small study conducted in 2000 by Bencardino et al (1), MRI performed on subjects with no current or previous foot pain demonstrated 33% of them to actually have Morton’s neuroma. So, one can walk around with this condition and be totally asymptomatic and enjoy all of their activities. But what causes the nerve to actually become irritated and start giving a person pain?
Here are a few potential causes:
- High heels – this is actually thought to be the most prominent cause of Morton’s neuroma. When feet are placed in high heels for long periods of time, the tissue between the toes can become compressed. Also, because of the shoe forcing the foot into plantar flexion (toes pointed down position), extra pressure shifts to the forefoot while walking and can cause irritation.
- High arches and bunions – here again, these cause a mechanical disadvantage for the foot, shifting unnecessary pressure to the forefoot
- Hammer toes – similar to the above, hammer (claw) toes, alter the mechanical forces of the foot when trying to navigate surfaces. The forefoot cannot extend fully, and therefore becomes compressed over time.
- Highly repetitive activities, or activities where the feet are compressed into shoes – activities such ballet dancing and skiing require special (and often tight) shoes to perform. Repetitive activities such as running or racquet sports can also place increased pressure and stress on the forefoot.
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What actually is a neuroma? And should I see a doctor?
A neuroma is also defined as a “pinched nerve” or “nerve tumor” in an area. It is most commonly found in the previously described area of the foot, but could actually occur anywhere in the body. The neuroma is benign, and does not spread or grow to other areas of the body. Because it is a space occupying lesion, it can press on other nearby nerves and structures, and cause radiating pain to closely localized areas.
As a general rule, it is a good idea to seek consultation from a medical professional when you are experiencing any sort of prolonged or disruptive pain cycle for more than a few days. Morton’s neuroma can usually be picked up by a soft tissue imaging test, such as a CT scan, MRI, or ultrasound. Additionally, an x-ray may be ordered to rule out a stress fracture. Anti-inflammatories may be prescribed to calm down the irritation around the nerve. In most scenarios, a ‘graduated’ treatment approach will be utilized, which means that conservative treatments will be first line defense. In fact, in a study by Schreiber et al in 2011 (2), it was found that Morton’s neuroma pain relieves itself with conservative treatments 80% of the time – that’s great news!
Have you considered or been recommended a cortisone injection for the management of Morton’s neuroma? Get educated on cortisone shots here!
Help the pain go away! Common treatments rendered
As stated above, pain from Morton’s neuroma can often be relieved considerably with conservative treatments, including rest, a steroid injection, and anti-inflammatories. However, the biggest and most effective conservative treatments are thought to be exercise, stretching, and physical therapy! Physical therapists can show you how to strengthen and stretch your feet and ankles, as well as provide hands on soft tissue treatments to calm down irritation and inflammation.
Here are a few stretching exercises that we love for the foot and ankle!
Calf Stretch – Off Step
- HOW: Place an elevated surface next to a wall. Stand on the surface and use a wall for support. Straighten one leg as you use your toes on the surface and let your heel drop to the ground, stretching the calf on that side. Hold stretch for 30 seconds.
- FEEL: You should feel a stretch in your calf.
- Compensation: Keep your knee straight as you stretch. Keep your toes on the surface to create the best stretch.
Half Kneeling Soleus Stretch
In a kneeling position with one leg up and your foot flat on the ground. Lean forward as much as you can bending your knee and slightly bringing your heel up off the ground. Hold that position until you feel a good stretch in your calf. You should feel a stretch in your calf and into your Achilles’ tendon. Make sure the heel lifts off the ground, but not too much that you don’t feel a stretch in your calf.
Bear Position Big Toe Stretch
Get set up at the top of a down dog position with your heels lifted and weight supported through your toes with your big toe facing forward. Perform the stretch by lowering your body down and letting your knees bend by simultaneously letting your heel rise more and your big toes move into extension. Hold for a moment, then return to the start and repeat. You should feel a deep stretch in the big toe itself, and potentially under the arch of your foot. Avoid rolling your foot/ankle in and out excessively as that will create a twisting motion at your big toe joint. Focus on pure linear motion.
And here are a few great ‘go-to’ strengthening exercises for the foot and ankle that can help to put your foot at more of a mechanical advantage.
Seated Ankle Inversion – Banded
Anchor a band under the bottom of one foot. Cross the other leg over placing that ankle on top of the other knee. Loop the band around the foot. The band should be pulling your ankle/foot down. From here, move your foot up against the resistance of the band. You should feel the muscles of your lower leg working and around the inside of your ankle. Don’t let the band control you and snap your ankle back. Slowly control the motion!
Side Step – Band Around Forefoot
Get set up with a band positioned around the front of your feet. Assume a mini squat position, keep your feet facing at 12 o’clock if not slightly turned out, and side step. You should feel the hip muscles and the muscles around the outside of your shins/calves working with this exercise. Do not let your arches drop, or lose optimal foot and ankle position.
Pogos – Alternating
Remember, graded exposure is essential for those recovering from an issue like this and who want to get back to impact exercises. Pogos are one of our favorite exercises to bridge the gap from rehab to performance.
- HOW: Get set up in a standing position. Begin the exercise by bouncing from one foot to the other on the balls of your feet and repeat as if you were jumping/hopping in place.
- FEEL: You should focus on maintaining a stiff/rigid foot and ankle as well as your legs, like you are bouncing on a pogo stick. You want to keep your legs stiff so that you ‘bounce’ like on a pogo spring.
- COMPENSATION: Do not let your knees excessively bend or your heels touch the ground; stay stiff and bounce on the balls of your feet.
Want to learn more about exercises that can help you improve foot strength? Read our blog below!
What about footwear?
One of the easiest ways to prevent the recurrence of Morton’s neuroma is to wear the right kind of shoes. What is the “right kind” of shoes, you ask?
- Tight fitting shoes should be minimized or avoided altogether. Ditch those high heels! (Or save them for extra special occasions only.)
- Choose shoes that have a wide toe box. Extra room in the forefoot will also allow for more free range of motion and flexibility while walking
- A custom orthotic insert can be very helpful to accommodate for high arches, bunions, hammer toes, or other foot deformities, if this is the cause of your pain.
- Wearing padded socks or cushions can be helpful, especially if you perform a job that involves a lot of standing or walking.
Want to get back to running safely after a foot injury or pain? Check out our article on how to change running form safely!
So, if you feel like you are walking around with a rock or pebble in your shoe, or there is a nagging pain on the bottom of your foot that just won’t go away, consider Morton’s neuroma as a potential cause! See your doctor or physical therapist, who can point you in the right direction to becoming pain free. Foot pain shouldn’t limit the activities you love. Check out some of the resources we have listed here, or reach out to us for more info!
- American Journal of Roentgenology. 2000;175: 649-653. 10.2214/ajr.175.3.1750649
- Schreiber et al. J Fam Pract. 2011 March;60(3):157-168
About The Author
[P]REHAB Writer & Content Creator
Taryn was born and raised in Maine and still resides there with her boyfriend and son. Taryn received her Doctorate in Physical Therapy from Husson University in 2010, and also carries a Bachelors in Kinesiology and Human Movement Science. She is a Certified Lymphedema Therapist, a Certified Crossfit Level 1 Trainer, and a NASM Certified Nutrition Coach. Taryn has 10+ years of experience in many different realms of PT, from the young athlete to the geriatric patient. Taryn considers herself a ‘lifelong learner’. She has special interests in oncology care and breast health, dry needling, and Crossfit training. In her free time, Taryn enjoys fitness, spending time with her family, continuing education, writing and reading, and is very excited to be a part of The [P]Rehab team to educate and empower others to take control of their own health and wellness.