Morton’s Neuroma and How Physiotherapy Can Help

Morton’s Neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. It involves the thickening of the tissue around one of the nerves leading to your toes, which can cause sharp, burning pain, numbness or tingling in the affected toes.

Morton’s Neuroma

Morton’s Neuroma is not actually a true neuroma but rather a thickening of the tissue around a nerve leading to the toes. This thickening can result in compression and irritation of the nerve, causing pain.

Key characteristics of Morton’s Neuroma include:

• Sharp, burning pain in the ball of the foot
• Tingling or numbness in the toes
• A feeling of standing on a pebble or having a fold in your sock
• Pain that worsens with activity or wearing tight shoes

Causes and Risk Factors

The exact cause of Morton’s Neuroma is not clear, but several factors can contribute to its development:

• Footwear: Wearing high heels, tight shoes, or shoes with a narrow toe box can compress the toes and irritate the nerve.
• Foot Structure: Individuals with certain foot deformities such as bunions, hammertoes, flat feet, or high arches are more likely to develop Morton’s Neuroma.
• Repetitive Stress: Engaging in activities that place repetitive stress on the feet such as running or sports that involve jumping can increase the risk of developing this condition.

Symptoms of Morton’s Neuroma

The symptoms of Morton’s Neuroma can vary but commonly include:

• Pain in the ball of the foot that may radiate to the toes
• A sensation of a lump or something inside the ball of the foot
• Tingling or numbness in the toes
• Pain that worsens with activity or wearing tight shoes and improves with rest or removing shoes

Diagnosis

A healthcare provider can often diagnose Morton’s Neuroma based on your symptoms and a physical examination. They may:

• Press on the ball of your foot to check for a tender spot
• Move your toes to see if it causes pain
• Order imaging tests such as an X-ray, ultrasound, or MRI to rule out other conditions

Physiotherapy for Morton’s Neuroma

Physiotherapy plays a crucial role in managing and treating Morton’s Neuroma. A physiotherapist can develop a personalized treatment plan to relieve pain, improve foot function, and prevent the condition from worsening. Here are some key physiotherapy interventions for Morton’s Neuroma:

1. Pain Relief Techniques:
   • Ice Therapy: Applying ice to the affected area can help reduce pain and inflammation.
   • Ultrasound Therapy: Using sound waves to generate heat within the tissue can reduce pain and promote healing.
   • Massage: Gentle massage can help relieve muscle tension and improve blood flow to the affected area.
2. Footwear Advice:
   • Proper Footwear: Wearing shoes with a wide toe box, low heels, and good arch support can help reduce pressure on the nerve.
   • Orthotics: Custom-made orthotic inserts can provide additional support and cushioning to the foot, helping to alleviate symptoms.
3. Stretching and Strengthening Exercises:
   • Calf Stretch: Stretching the calf muscles can help improve flexibility and reduce tension on the foot.
   • Toe Stretch: Gently pulling the toes apart can help relieve pressure on the nerve.
   • Foot Strengthening: Exercises to strengthen the muscles of the foot can improve overall foot function and support.
4. Manual Therapy:
   • Joint Mobilizations: Gentle movements to improve the mobility of the joints in the foot.
   • Soft Tissue Mobilizations: Techniques to release tight muscles and improve tissue flexibility.
5. Activity Modification:
   • Activity Modification: Adjusting your activities to reduce stress on the foot can help manage symptoms. This may involve avoiding high-impact activities and choosing low-impact exercises like swimming or cycling.
6. Gait Analysis and Correction:
   • Gait Analysis: Assessing your walking pattern to identify any abnormalities that may be contributing to your symptoms.
   • Gait Correction: Providing exercises and advice to correct any issues with your gait and reduce stress on the foot.
7. Education and Self-Management:
   • Education: Teaching you about the condition and how to manage it effectively.
   • Self-Management: Providing strategies for managing symptoms at home, such as proper footwear choices, home exercises, and self-massage techniques.

Stretching Exercises for Morton’s Neuroma

Stretching exercises can help alleviate symptoms and improve foot flexibility. Here are some specific stretches recommended for individuals with Morton’s Neuroma:

1. Calf Stretch:
   • Stand facing a wall with your hands on the wall at shoulder height.
   • Place one foot behind the other, keeping the back knee straight and the heel on the ground.
   • Lean forward, bending the front knee until you feel a stretch in the calf of the back leg.
   • Hold for 20-30 seconds and repeat 2-3 times on each leg.
2. Toe Stretch:
   • Sit on the floor with your legs extended in front of you.
   • Gently pull your toes back towards you, holding them for 20-30 seconds.
   • Repeat 2-3 times.
3. Plantar Fascia Stretch:
   • Sit with one leg crossed over the other.
   • Hold the toes of the crossed leg and pull them back towards your shin until you feel a stretch in the arch of your foot.
   • Hold for 20-30 seconds and repeat 2-3 times on each foot.

Strengthening Exercises for Morton’s Neuroma

Strengthening the muscles of the foot and lower leg can help support the foot and reduce symptoms. Here are some recommended strengthening exercises:

1. Towel Scrunches:
   • Sit with your feet flat on the floor and place a towel under your toes.
   • Use your toes to scrunch the towel towards you.
   • Repeat 10-15 times.
2. Marble Pick-Ups:
   • Place a few marbles on the floor.
   • Use your toes to pick up the marbles and place them in a bowl.
   • Repeat 10-15 times.
3. Heel Raises:
   • Stand with your feet hip-width apart.
   • Slowly rise onto your toes, lifting your heels off the ground.
   • Hold for a few seconds, then lower your heels back down.
   • Repeat 10-15 times.

Manual Therapy Techniques

Manual therapy can help alleviate pain and improve the flexibility of the tissues around the affected area. Some common techniques include:

1. Joint Mobilizations:
   • Gentle movements to improve the mobility of the joints in the foot.
   • These techniques can help reduce stiffness and improve the range of motion.
2. Soft Tissue Mobilizations:
   • Techniques to release tight muscles and improve tissue flexibility.
   • This can help reduce pain and improve overall foot function.
3. Myofascial Release:
   • Applying gentle pressure to the fascia (connective tissue) to release tightness and improve mobility.
   • This technique can help reduce pain and improve tissue flexibility.

Gait Analysis and Correction

Assessing your walking pattern can help identify any abnormalities that may be contributing to your symptoms. A physiotherapist may perform a gait analysis to evaluate your walking pattern and provide corrective exercises and advice to improve your gait. This can help reduce stress on the foot and alleviate symptoms.

Education and Self-Management

Educating patients about their condition and how to manage it effectively is a key component of physiotherapy. A physiotherapist can provide you with strategies for managing symptoms at home, such as:

1. Proper Footwear Choices:
   • Choosing shoes with a wide toe box, low heels, and good arch support.
   • Avoiding high heels and tight shoes that can compress the toes.
2. Home Exercises:
   • Performing regular stretching and strengthening exercises to improve foot flexibility and strength.
3. Self-Massage Techniques:
   • Using self-massage techniques to relieve muscle tension and improve blood flow to the affected area.
4. Activity Modification:
   • Adjusting your activities to reduce stress on the foot, such as avoiding high-impact activities and choosing low-impact exercises like swimming or cycling.

When to See a Physiotherapist

If you are experiencing symptoms of Morton’s Neuroma, it is important to seek treatment from a physiotherapist. Early intervention can help prevent the condition from worsening and improve your chances of a successful recovery. You should consider seeing a physiotherapist if you have:

• Persistent pain in the ball of your foot
• Tingling or numbness in your toes
• Pain that worsens with activity or wearing tight shoes
• Difficulty walking or performing daily activities

A physiotherapist can develop a personalized treatment plan to relieve pain, improve foot function, and prevent the condition from worsening.