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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"The therapists and staff at the Twin Boro in North Brunswick truly place their patients first. My six month experience at this office was outstanding. Coming to Twinboro, I was unsure of my diagnosis, but with the help and dedication of my therapist Ivana, answers were found and exercises were set in place to treat my symptoms. Ivana made coming to therapy an enjoyable experience with her attention to detail, compassion, and sociability. It was evident through the environment Ivana created for that she listens to her patients and makes decisions with the best interest of the patient in mind. If you need to attend physical therapy and are in the area, Twin Boro in North Brunswick is the right choice!"

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The Bridgewater Location is excellent! Every single staff person is on point. From day one when I called to schedule my first appointment and throughout my treatment staff were helpful, professional, and overall a caring and compassionate team. Their professionalism and caring was evident not only in my treatment, also in the treatment of other patients. Being in a room with multiple treatment stations you cannot help but notice the care received by other patients. My ankle is 100% better and if I ever need PT again I would not hesitate to return. I was always a part of the therapy process, if I had questions they were answered. If I wanted to improve my ankle health at home I was provided clear instructions for exercises. Staff were skilled and knowledgeable. I highly recommend this location to family and friends.

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"Twin Boro Piscataway/South Plainfield is great! I was treated for occipital neuralgia and posture issues. Aside from performing wonderful treatment, everybody there is super friendly and accommodating (you will always be greeted with a smile) and also very focused and helpful! Bri is a knowledgable and experienced physical therapist who is not only a great PT, but also one of the friendliest people you will ever meet. Her pacing with my various exercises was perfect, as she pushed me, but not to any point that was uncomfortable for me. I enjoyed the variety of exercises and treatments, from heat and stim to exercises with weights and stretch bands. I thoroughly enjoyed going in 3 times a week to be treated by Bri. It is clear that she cares about and wants the best for her patients, with her passion and expertise for physical therapy! My posture has gotten much better and the headaches and pain I used to experience have completely disappeared after 3 months at Twin Boro. 5/5 I would recommend Twin Boro Piscataway/South Plainfield to anyone seeking physical therapy."

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