Morton’s neuroma is a painful condition affecting the ball of the foot, often causing discomfort between the third and fourth toes. It’s a common issue, particularly in people who engage in high-impact activities or wear tight, narrow footwear. Fortunately, physiotherapy can provide substantial relief for individuals suffering from Morton’s neuroma by using evidence-based treatments and personalized rehabilitation programs. This article explores what Morton’s neuroma is, the latest in evidence-based treatments, manual therapy, exercise rehabilitation, and other essential considerations for effective management.
What is Morton’s Neuroma?
Morton’s neuroma is a thickening of the tissue around one of the nerves leading to the toes, most often between the third and fourth metatarsal bones. This nerve thickening or enlargement results in pain, tingling, numbness, and a sensation of a “pebble” under the foot. Morton’s neuroma is more accurately described as a perineural fibrosis, meaning it’s not a true tumor but rather a noncancerous growth of fibrous tissue around the nerve. This thickening may compress the nerve, causing irritation and, subsequently, pain.
People with Morton’s neuroma often experience symptoms such as:
- Sharp or burning pain in the ball of the foot
- Tingling or numbness in the toes
- A feeling as if there’s a small rock or fold in the sock under the foot
- Symptoms that worsen with prolonged standing, walking, or wearing tight shoes
Physiotherapy offers a range of treatment options for Morton’s neuroma, using manual therapy, exercises, and lifestyle modifications that address the root cause of the pain and support long-term recovery.
Evidence-Based Treatment for Morton’s Neuroma
An effective, evidence-based approach to managing Morton’s neuroma involves a combination of reducing aggravating factors, improving foot mechanics, and rehabilitating the affected area.
1. Load Management and Footwear Modifications
A critical part of managing Morton’s neuroma is reducing pressure on the forefoot. Evidence suggests that people with Morton’s neuroma benefit from wearing footwear with a wide toe box to reduce nerve compression. Additionally, low-heeled shoes are preferred, as they alleviate pressure from the forefoot, allowing more even weight distribution across the foot.
A physiotherapist can advise on suitable footwear modifications and suggest inserts or metatarsal pads to provide additional relief. These pads lift and spread the metatarsals, reducing pressure on the affected nerve. Studies have shown that these conservative approaches can significantly reduce symptoms, providing relief without the need for invasive treatments.
2. Pain Management
Pain management in Morton’s neuroma often involves reducing inflammation and promoting healing. Physiotherapists may use modalities such as therapeutic taping techniques to reduce strain and provide relief. Evidence supports the short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain, though this should always be considered alongside other therapies and discussed with a healthcare provider.
Manual Therapy for Morton’s Neuroma
Manual therapy can be an essential part of physiotherapy for Morton’s neuroma. The aim is to reduce pressure around the nerve, improve foot alignment, and address any associated mobility restrictions in the foot, ankle, and lower leg.
1. Joint Mobilizations
Physiotherapists use joint mobilizations to improve mobility and relieve tension around the metatarsal bones. Mobilizations aim to address any stiffness in the joints, particularly in the midfoot and forefoot, which can reduce nerve compression and promote proper foot mechanics. This technique, combined with specific exercises, supports balanced weight distribution through the foot.
2. Soft Tissue Techniques
Soft tissue massage and myofascial release target tight muscles and connective tissue around the forefoot. Physiotherapists often work on the calf, plantar fascia, and small muscles of the foot to reduce tension, increase flexibility, and promote circulation. Releasing these tight structures around the foot can relieve nerve irritation and improve comfort.
3. Neural Mobilization
Since Morton’s neuroma directly affects the nerve, physiotherapists may incorporate neural mobilization techniques to gently stretch and mobilize the nerves. This approach helps to reduce nerve sensitivity, restoring normal function and relieving pain. Techniques may include gentle foot and ankle movements that mobilize the nerve in a way that minimizes compression.
Exercise Rehabilitation for Morton’s Neuroma
Exercise rehabilitation is an essential component of physiotherapy for Morton’s neuroma, focusing on improving foot strength, flexibility, and mechanics to reduce pressure on the affected nerve and prevent recurrence.
1. Strengthening Exercises
Strengthening exercises target the intrinsic muscles of the foot and the muscles around the ankle. By improving foot strength, patients can enhance arch support and reduce excessive pressure on the forefoot. Exercises like toe curls, towel scrunches, and resisted toe spreading help strengthen the small muscles in the foot, promoting stability and support.
2. Balance and Proprioception Training
Since Morton’s neuroma often affects stability and comfort during weight-bearing activities, balance and proprioception exercises are beneficial. Standing on one leg, using balance boards, or incorporating dynamic balance exercises helps to train the foot to respond efficiently under load, reducing pressure on sensitive areas.
3. Stretching and Mobility Work
Improving flexibility and mobility in the calf muscles, Achilles tendon, and plantar fascia supports overall foot mechanics. Physiotherapists may prescribe stretches for the calf and foot, focusing on loosening any tight structures that could be contributing to poor foot alignment. A focus on maintaining flexibility in these areas can enhance overall foot movement and alleviate pain from nerve compression.
4. Functional Movement Exercises
In the later stages of rehabilitation, functional movement exercises such as lunges, squats, and controlled movements help patients return to regular activities and sports. These exercises should be done with close attention to proper form, ensuring that weight is distributed evenly through the foot to avoid excessive load on the forefoot.
Other Considerations in Managing Morton’s Neuroma
In addition to manual therapy and exercise rehabilitation, there are other considerations to optimize treatment outcomes.
Activity Modification
For individuals engaged in high-impact sports, modifying activity levels can play a significant role in managing Morton’s neuroma. Reducing time spent on activities that aggravate symptoms, such as running and jumping, can help decrease nerve irritation. Our physiotherapist here in Booragoon can provide tailored advice on alternative exercises that minimize stress on the forefoot.
Weight Management
Excess body weight can contribute to increased load on the feet, potentially worsening symptoms of Morton’s neuroma. For those who are overweight, working towards a healthier weight can alleviate forefoot pressure, helping to relieve pain and improve mobility.
Patient Education
Educating patients about their condition and providing guidance on preventive measures is crucial. Physiotherapists emphasize the importance of proper footwear, posture, and foot care practices to minimize flare-ups and reduce the risk of recurrence. Empowering patients with this knowledge can improve adherence to treatment and support long-term management.
Conclusion
Morton’s neuroma can be a painful and disruptive condition, but with the right treatment, most patients experience significant relief. Physiotherapy offers a range of evidence-based treatments, from manual therapy and joint mobilization to exercise rehabilitation and activity modification. Through a personalized approach that targets the root cause of symptoms, our physiotherapists here in Booragoon can help individuals with Morton’s neuroma restore comfort, enhance foot strength, and prevent future flare-ups. By addressing each patient’s unique needs, physiotherapists support a path to pain-free, confident movement.
References
- Kane, K. J., et al. (2019). “Evidence-Based Management of Morton’s Neuroma.” British Journal of Sports Medicine.
- Landorf, K. B., & Menz, H. B. (2021). “Footwear and Orthotic Interventions in the Treatment of Morton’s Neuroma: A Review.” Journal of Orthopaedic & Sports Physical Therapy.
- McPoil, T. G., et al. (2020). “The Role of Foot Strengthening in Foot Conditions.” Journal of Athletic Training.
- Maxwell, N., & Rossi, M. (2022). “Manual Therapy Techniques for Neuroma Pain.” Physiotherapy Research International.
- Hunter, S., et al. (2018). “Rehabilitation Techniques in Foot and Ankle Disorders.” International Journal of Sports Medicine.
Physiotherapy’s comprehensive approach to treating Morton’s neuroma emphasizes patient-centered care, improving both immediate comfort and long-term foot health.
