Morton's Neuroma in Sports

(Interdigital Plantar Neuroma)

Morton's neuroma is a condition of the nervous system that results in pain or loss of feeling in the toes. The disease is caused by the bones of the foot squeezing the nerve that runs between two toes (interdigital nerve). The third and fourth toes are most likely to be affected by this disease.

SYMPTOMS

  • Tingling, numbness, burning, or electric shocks in the front of the foot, often involving the third and fourth toes, although it may involve any other pair of toes.

  • Pain and tenderness in the front of the foot, that gets worse when walking.

  • Pain that gets worse when pressure is applied to the foot (wearing shoes).

  • Severe pain in the front of the foot, when standing on the front of the foot (on tiptoes), such as with running, jumping, pivoting, or dancing.

CAUSES

Morton's neuroma is caused by swelling of the nerve between two toes. This swelling causes the nerve to be pinched between the bones of the foot.

RISK INCREASES WITH:

  • Recurring foot or ankle injuries.

  • Poor fitting or worn shoes, with minimal padding and shock absorbers.

  • Loose ligaments of the foot, causing thickening of the nerve.

  • Poor foot strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Foot and ankle flexibility.

  • Muscle strength and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded shoes.

  • Wear arch supports (orthotics), when needed.

PROGNOSIS

If treated properly, Morton's neuroma can usually be cured with non-surgical treatment. For certain cases, surgery may be needed.

RELATED COMPLICATIONS

  • Permanent numbness and pain in the foot.

  • Inability to participate in athletics, because of pain.

TREATMENT

Treatment first involves stopping any activities that make the symptoms worse. The use of ice and medicine will help reduce pain and inflammation. Wearing shoes with a wide toe box, and an orthotic arch support or metatarsal bar, may also reduce pain. Your caregiver may give you a corticosteroid injection, to further reduce inflammation. If non-surgical treatment is unsuccessful, surgery may be needed. Surgery to fix Morton's neuroma is often performed as an outpatient procedure, meaning you can go home the same day as the surgery. The procedure involves removing the source of pressure on the nerve. If it is necessary to remove the nerve, you can expect persistent numbness.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers are usually prescribed only after surgery. Use only as directed and only as much as you need.

  • Corticosteroid injections are used in extreme cases, to reduce inflammation. These injections should be done only if necessary, because they may be given only a limited number of times.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • After surgery you develop increasing pain, swelling, redness, increased warmth, bleeding, drainage of fluids, or fever.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)