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.
