Background &Etiology

The foot is responsible for supporting the weight of the body, while enabling us to walk, run, and move smoothly with speed and precision. There are five major nerves of the lower leg that affect the foot. These nerves provide both sensation and motor control to the foot. These nerves can thicken, causing pain, numbness, and tingling in the toes. The nerve that is affected is the digital nerve that leads to the toes.

Morton’s Neuroma

This condition is a thickening of the nerve tissue between the toes. Typically this condition occurs between the third and fourth toes of the foot (counting outward from the big toe). Although more rare, this condition can also occur between the second and third toes. The nerves that generally serve this part of the foot include the posterior tibial nerve, the deep peroneal nerve, and the sural nerve.

Morton’s Neuroma is more common in women than men, and may be caused by the type of tight shoes that women tend to wear (high heels). Other common causes of Morton’s Neuroma include:

  • Abnormal positioning of the toes
  • Flat Feet
  • Conditions that affect the alignment of the toes like bunions or hammer toe
  • High foot arches
  • Tight shoes and high heels
  • Tingling in the space between the third and fourth toes
  • Toe cramps
  • Sharp, shooing pain in the ball of the foot and toes
  • A burning sensation in the toes
  • Pain that gets worse when wearing shoes or putting pressure on the area
  • Pain the increases over time

The first line of treatment for Morton’s Neuroma will focus on identifying the underlying cause of the nerve injury. Padding or taping of the toes, in addition to shoe inserts and changes in footwear may help relieve the symptoms of Morton’s Neuroma. In some case surgery may be necessary to remove the thickened tissue to help relieve pain and improve the function of the foot. Numbness of the toes following surgery is likely permanent, but not painful.

Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Morton’s Neuroma include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage, manual stretching and joint mobilization by a physical therapist to regain mobility and range of motion of the foot and nerves.
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the foot and effected muscle.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity, and improve movement technique and mechanics (for example, running, jumping, kicking, or stepping) in daily use of the involved lower extremity. This may also involve use of pads, taping and modification of footwear.
  • Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the foot and nerves.
  • Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

Procedures that your physician may recommend and perform in addition to physical therapy may include:

  • REST and ICE
  • Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
  • Corticosteroid Injections
  • Surgery to correct underlying pathology or the cause of the nerve condition
  • Orthotic devices or special shoes
  • Cryogenic Neuroblation is the use of cold to interfere with nerve conduction. This is generally not permanent.
  • Decompression surgery is when the surgeon releases or cuts surrounding tissue to take pressure off of the nerve.
  • Nerve removal is the procedure of last resort, because the surgeon will remove both the nerve and neuroma.

Prognosis

Most people recover full function following a course of conservative care that includes physical therapy, anti-inflammatory medication, rest, injections and foot wear modifications. It is important that once the pain is reduced, and motion and strength are restored, the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of Morton’s Neuroma.

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Real People, Real Testimonials.

“Since receiving treatment here, I can see and feel positive results in the areas treated. The atmosphere is most pleasant and relaxing which I feel also aids in recover.”

Deirdra

I have been a customer at Twin Boro in the Hadley Center Mall, South Plainfield off and on for over a year, in the care of Brianna Patane. I am writing to commend the staff there on their friendly and helpful customer service and professional and personal approach to physical therapy. In particular I want to let you know what an asset to Twin Boro Brianna is. She is an outstanding physical therapist who provides a great exercise program to use both onsite and at home, and also utilizes deep massage to increase blood flow to the injured area, which also helps make the injured area feel better. Her friendly and professional approach to PT made my experience there more enjoyable then I ever thought PT could be, and the results and improvement to my injury were noticeable at once and were long-lasting. Not only are her PT skills top notch, but her enjoyment of working with people made it a joy to have her as my physical therapist. She is the best! Having a 41-year career myself, I know employees like Brianna do not come along every day, and my suggestion is that Twin Boro do whatever is necessary to keep this valuable employee on your staff. She is a tremendous physical therapist.

Lisa W.

"I went to the Westwood Office for therapy on my foot...I found everyone from office to therapists to be pleasant, attentive, knowledgeable, and the facility is run like a well-oiled machine! I especially want to thank Mark for my foot feeling better than it has in 7 years! I will definitely recommend Twin Boro Westwood to any one of my friends! Thanks again to all the staff!"

Kimberly M.

"Although getting released from physical therapy is a great thing, today was bitter sweet. How often do you get to rehab with your twin daughters at a place that makes you feel important, special and at home? Twin Boro Physical Therapy in Middletown has been our home away from home for the past three months. We always looked forward to our sessions because they helped us gain back the life we had before. From the phone calls with Stephanie scheduling appointments (all three of us simultaneously) to our awesome therapists: Andrew, Chris, Sydney, Brad, Justin & Anthony, to our PT assistants: Ryan, Gerard, Julian and the girls, we can't thank you enough! We couldn't even walk on two feet when we arrived. Today, we successfully completed "Boot Camp' running, hopping and jumping! We appreciate all that you have done. We will truly miss you all, but you have taught us well. We are forever grateful."

Denise M.

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