Morton’s Neuroma

A Morton's neuroma is a thickening and fibrosis of the tissue that surrounds the digital nerve leading to the toes. It commonly affects:

• 3rd intermetatarsal space (nerve supplying 3rd and 4th toes)

• 2nd intermetatarsal space (nerve supplying 2nd and 3rd toes)

Trauma, irritation or excessive pressure on the nerve causes it to swell and thicken, thus creating a neuroma.

Symptoms

Patients may experience:

• Pain on weightbearing

• Sensation of walking on a pebble or stone

• Burning sensations

• Numbness

• Sharp shooting pains

Pain can be exacerbated by tightly fitted or high heeled footwear.

Treatment Options

Conservative Treatment (First Line)

• Footwear changes

  • Lower heel height

  • Broader toe box to reduce nerve pressure

• Orthotic therapy with appropriate padding

  • Helps with biomechanical issues

  • Offloads painful area

• Manual therapy

  • Mobilisations

  • Dry needling/acupuncture

  • Low level laser therapy

  • Ultrasound

Advanced Treatment

If conservative treatment fails:

• Injection therapy under ultrasound guidance (works well with orthotic therapy)

• Surgical removal of affected nerve portion (if all other treatments fail)