If you are experiencing forefoot pain, numbness, tingling or have the sensation like you are walking on a marble or a pea a Morton's Neuroma may be the culprit.
The common plantar digital nerves run between the metatarsal (long) bones in the foot. They are responsible for giving sensation to the toes. A Morton's Neuroma most commonly affects the nerve between the third and fourth metatarsal bones, causing pain and numbness in the third and fourth toes. It can also affect the nerve between the second and third metatarsal bones, causing symptoms in the second and third toes.
So what exactly is going-on to cause an interdigital neuroma?
Morton's Neuroma is thought to develop as a result of long-standing stress and irritation to the plantar digital nerve. A neuroma is formed by irritation and rubbing of the nerve, similar to the way a callus is formed on your skin from excessive rubbing or pressure. The tissue surrounding the nerve gradually thickens and swells to protect itself, forming a mass of fibrous tissue. When the arch of your foot collapses, it causes excess force to shift onto the smaller bones in the ball of your foot, the excess force tends to collapse the metatarsal arch breaking down the tissues underneath. As the tissue around the nerve thickens to protect itself, it occupies more space and is more easily compresses and irritated. Eventually, the tissue surrounding the nerve gets so big that it is sensitive to every step and it can even spread the toes.
Footwear that is too tight through the ball of the foot, high heeled footwear which place the foot in a position causing additional pressure on the forefoot and an increase in activity can exaggerate the pain of a Morton's Neuroma.
Symptoms of a Morton’s Neuroma include sharp shooting pain, burning sensation, numbness, tingling, pain radiating into the toes and even a lack of feeling in the area. Some describe the pain of a Morton's Neuroma like walking on a marble or stone. It is usually worsened by walking and pressure on the forefoot. Diagnosis can be made by eliciting pain while pinching soft tissue between the toes. You may also notice that you can see an increased gap or space between your toes. Moving your toes in certain directions may also cause a clicking sensation as the enlarged nerve slides under a nearby ligament. Typically removing your footwear, resting and massaging your foot provides relief.
Narrow fitting footwear can cause compression of the long bones in the foot, compressing and irritating the nerves. Ensure that footwear has adequate width and extra depth in the toe box. This will allow the foot enough room to splay and help minimize mechanical compression of the nerve from the shoe. Lower heel height can help transfer pressure away from the ball of the foot helping to decrease compression on the nerve.
Custom made orthotics designed to support and restore the function in your foot, as well as restore proper weight distribution and remove the abnormal pressures causing the nerve to thicken can heal and shrink the nerve back to normal size.
A metatarsal pad can help to offload the neuroma by supporting the metatarsal arch that runs through the ball of the foot.
More invasive options, such as medication, injections, and surgery, may be discussed with your family physician to determine an appropriate treatment plan.