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Plantar Digital Neuroma (Morton's Neuroma)

University Department of Podiatry

What is a Plantar Digital Neuroma (Morton’s Neuroma)?

Morton’s neuroma can be a painful condition that affects the nerves that runs between your toes in the ball of the foot. People between the ages of 35 and 60 are more prone to developing this condition but it can happen at any age, affecting women more than men.

It develops because of irritation and thickening in the nerves that supply your toes, triggering pain and numbness. Treatment for Morton’s neuroma usually begins with self-care.

Morton’s neuroma is a thickening of one of the plantar digital nerves in your foot. The plantar digital nerves run between the long bones (metatarsals) in your feet and provide sensation in your toes. The nerves most commonly involved are the ones that supply the 3rd and 4th toes but any of the plantar digital nerves can be affected. These nerves can

 experience a significant amount of stress and pressure which could result in damage and thickening to happen. Unfortunately, as the nerve thickens, the pressure around the nerve can increase resulting in pain and numbness in your forefoot and toes.

Illustration of plantar foot showing location of plantar digital neuroma

What are the signs and symptoms of a Plantar Digital Neuroma (Morton’s Neuroma)?

The pain usually starts in the ball of the foot and can spread into your toes. Burning, tingling or numbness between the affected toes may also be felt. Some people describe the pain like they are walking on a pebble or have a lump on their foot. Symptoms will be aggravated when wearing tight fitting footwear. Removing your shoes and massaging the area can often help relieve the pain.

You may experience any or all of the following:

 

  • Sensation of walking on a `pebble’ or `lump’
  • A sharp, stabbing, burning or tingling sensation affecting the ball of the foot and into the toes
  • Pain more commonly affecting the 3rd and 4th toes, can affect all other toes
  • Pain on walking, aggravated when putting on or wearing ill- fitting footwear
  • Relieved by removing footwear and massaging foot

What causes a Plantar Digital Neuroma (Morton’s Neuroma)? 

The exact cause of Morton’s neuroma is not known. It is thought to develop due to increased stress and irritation on one of the plantar digital nerves. This increased stress may cause the nerve to be compressed, rubbed, or stretched. Ill-fitting footwear is a well- known cause in aggravating your symptoms.

You may have contributing factors related to a Plantar Digital Neuroma (Morton’s Neuroma):

 

  • Illfitting footwear that is too narrow or has a thin sole i.e. high heeled shoe
  • Being overweight
  • Foot deformities such as hallux valgus (bunion), hammer toes
  • Inflammatory conditions i.e. rheumatoid arthritis, psoriatic arthritis etc.
  • Previous foot trauma i.e. metatarsal fracture, nerve injury
  • Weakness in the muscles within your foot or leg
  • Tightness in the muscles up the backs of your legs may cause you to load more through your forefoot
  • Wearing unsupportive footwear such as shoes or sandals which have a low heel
  • Spending long periods standing, walking or running, especially with a sudden increase in these activities. What causes a neuroma?

What can help with a Plantar Digital Neuroma (Morton’s Neuroma)?

Unfortunately, there is no quick or easy fix and your symptoms will not improve overnight. We would advise you follow the advice below for Morton’s neuroma in the first instance. The advice is aimed at reducing the pressure and inflammation from around the affected nerve. The main focus is on footwear and decreasing any tightness in the calf muscles. Tight calf muscles can increase the pressures through your fore foot. Your pain should improve but may take time to get better.

Making changes to your lifestyle as well as reducing aggravating activities is key to helping your recovery. Only you can do this.

Shoes

With Morton’s neuroma it is important to make sure that your footwear fits you well and are not too tight across the fore foot. Narrow footwear will increase compression on the nerves. Shoes with a deep and wide toe box are preferable.

Avoid high-heeled, narrow or pointed-toe shoes as these could further increase the pressure on the nerves. Footwear that have thin, hard soles should also be avoided as these will not provide enough cushioning or shock absorption that can also increase the pressure on your nerves. Shoes with laces or adjustable straps are best.

Illustration of tight shoes

Padding

Some people find benefit from wearing a metatarsal pad on the bottom of their foot or on an insole to help reduce the pressure on the nerve. A metatarsal pad is a soft pad which sits just behind the ball of your foot rather than directly underneath it. It is important to place the metatarsal pad in the correct position, ideally 5mm behind the metatarsal heads as shown in the diagram. These pads help to reduce the pressure on the nerve and can be bought from the local pharmacy or online.

Illustration of padding to help with a plantar digital neuroma

Pain Activity Ladder

By following the pain activity ladder you can identify activities that you would consider severely painful, moderately painful and mildly irritating and act to change your habits.

The pain scale, most often used in healthcare, measures pain from 0-10 (zero being no pain and 10 representing the worst pain you could imagine).

If you can identify the level of pain you are experiencing, you will find out if you are in the green, amber or red zone. The best way to move down to the green zone is by pacing and spacing your activity.

When you are completing your rehabilitation exercises it is often best to work within the green (and sometimes amber zones depending on what you deem is an acceptable level of pain) both during the exercises and within 48 hours of completing your exercises. If you find yourself in the red zone you are likely pushing yourself too hard and may flare up the pain.

Ankle, Foot and Toe Exercise

The following exercises will help to improve your pain over a period of time. Remember to follow the advice from the pain activity ladder section above.

 

Further information about Plantar Digital Neuroma (Morton's Neuroma)

image of a wasp, an acronym for weight, activity, shoes and partnership

W.A.S.P. is an acronym employed by our podiatrists to remind you of your current situation regarding your foot pain. It stands for Weight, Activity, Shoes and Partnership.

This is based on some of these areas of your lifestyle that go relatively unnoticed, in your life, until one day this comes sharply in to view then it stings you, resulting in your foot pain and now you pay attention, seeking help.

Weight reduction

People who tend to have increased weight can have more prolonged pain and poorer tissue healing due to increased levels of inflammation in the body. Reducing your weight can generally help improve and pain and the healing process.

Shoes

Shoes that have flexible soles generally offer the foot less support and can increase the stress in soft tissues in your feet. If you have shoelaces make sure they are tied appropriately. Avoid wearing hard, flat or unsupportive shoes.

Activity modification

Pacing is the term used for breaking down an activity or task. This can be done by taking regular breaks and prioritising daily activities can help. This can also help prevent ‘over-stimulating’ the pain system, so it is important to plan rests and set achievable goals.

Partnership

Your partnership with our MSK podiatrists, is based on the aims from NHS Scotland’s Realistic Medicine strategy, for you using healthcare services to feel empowered to discuss your treatment fully with our clinicians, including the possibility a suggested treatment might come with side effects – or even negative outcomes.

Additional information

Acute Injury Management

POLICE is an acronym (Protection, Optimal Loading, Ice, Compression and Elevation) that is used as a management strategy for many injuries and conditions for the first 24 to 72 hours.

  • Protection and relative rest are advised immediately after injury for the first 24 to 72 hours.
  • Optimal Loading refers to having a balanced rehabilitation program which encourages early and gradual activity to improve recovery. How you progress will vary from person to person depending on the injury. It is about finding the injured areas happy place and increasing slowly and gradually.
  • Ice may be used for reducing pain and swelling. There are safety points to follow when you use ice:
    • Don't ice over a numb area or open wound. If the skin is numb you won't notice if you're developing an ice burn and ice on an open wound can increase the risk of infection.
    • Be wary of ice burns – don't apply ice directly to the skin, wrap an ice pack in a clean, damp tea towel before applying. Avoid prolonged exposure to ice, 10-20 minutes is usually adequate.
    • Apply crushed ice/frozen peas wrapped in a damp towel for 10-20 minutes, 2-3 times per day for the first 5-7 days post injury/ flare up of pain.
    • Stop applying ice if there are any negative effects such as increase in pain or swelling or skin soreness.
  • Compression and Elevation are helpful for reducing inflammation. This can be done by keeping your joint raised on a pillow and compressed by wrapping a bandage around it.
    Do not make the bandage too tight and do not wear tubi-grip or any compression bandage in bed at night.
  • Heat: After 2-3 days, you may find that heat is more relaxing.

You could use a heat pad or a hot water bottle with an insulated cover on it. Make sure this is not too hot and is not directly touching your skin.

You should do this for 10 to 15 minutes, 3 to 4 times a day.

What do I do if my symptoms flare up?

Flare ups of pain are common. Some people have recurrent flare ups of pain so it is important to know how best to manage these flare ups. In most cases a pain flare-up will settle within 6 weeks.

Top Tips

  • You will likely find it helpful to rest a bit more but it is still important to keep active. This will help to avoid becoming stiff and your muscles becoming weak.
  • If you aim to get a balance between rest and activity it should help your pain to settle down. You may be sore at first, however, start slowly and gradually increase the amount you do.
  • Reduce movements or tasks that aggravate your symptoms. This can help especially in the early days.
  • Adopting positions or movements that reduce your pain can be useful.

Pain Relief

Analgesia

  • Analgesia also known as pain relief can be an important part in helping you manage your symptoms and allow you to stay active.
  • Taking suitable pain relief regularly allows you to move more normally and continue your usual activities without causing any damage. It is unlikely that medication alone will resolve your pain totally. For this reason we are using the term pain relief (A 30-50% reduction in pain would be deemed to be a good success).

Paracetamol

  • Paracetamol is a good general pain management medication. It is used to help manage lots of different types of pain.
  • Sometimes people believe they need something ‘stronger’ than paracetamol when in fact, taking a regular dose rather than a one-off dose is more effective.
  • Spreading the doses of the paracetamol evenly out over a day will help you control your pain. Visit NHS Inform for more detailed information on paracetamol.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

  • NSAIDs are medications that can reduce swelling around joints and nerve endings to give pain relief. They are particularly useful
    in treating inflammatory type pain. Two commonly prescribed NSAIDs are ibuprofen and naproxen.
  • Although NSAIDs can be very useful they are not suitable for everyone. Visit NHS inform for further information related to NSAIDs.

There are other forms of pain relievers available. If you feel your current pain relievers are not helping your pain or you are
experiencing any side effects from your medication, please seek advice from your GP or pharmacist.

For general information on medication visit NHS Inform.

Staying in work and returning to work

We know that staying in work or returning to work as soon as possible is good for your mental and physical health.

If you have problems with activities at work, it may be helpful to ask for a workstation/workplace assessment or talk with your manager or Occupational Health Department. This can help with alterations or provision of equipment or altering your working day or tasks.

There are organisations which can support you at work or help you return to work. You can visit Knowledge Scotland for further information.

Weight Management

Weight Reduction – People who are overweight tend to have more prolonged pain and poorer tissue healing due to increased levels of inflammation in the body. Reducing your weight can generally help improve the healing process.

A good indicator of whether you need to lose weight is your body mass index (BMI), which you can calculate with the NHS BMI calculator.

If your BMI states you are overweight or obese it is likely that losing weight will reduce your symptoms. Carrying extra fat also increases your risk of heart disease, stroke, type 2 diabetes, and some cancers. Reducing your portion sizes and eating a balanced diet can be helpful in reducing weight. NHS informs provides a free online 12-week weight management programme to get you started right away.

If you need a little more help and feel that you would benefit from working with others in group sessions NHS Lanarkshire’s Weigh to Go programme, groups in North and South Lanarkshire, will help you become more active, eat well and lead a healthier lifestyle.

Smoking

Smoking can affect how your body recovers from musculoskeletal problems. If you smoke then the good news is that by stopping smoking it can improve your health in many different ways. Giving up smoking is not something you have to do on your own. You’re twice as likely to stop smoking successfully if you get the right support from the NHS. There is a free NHS stop smoking service available in Lanarkshire to help you succeed.

Chronic Pain

Some people will have pain which persists beyond the expected time frame for their condition. For further information on this and how best to manage it please visit our Chronic Pain webpage.

Pain Association Scotland is a national charity that delivers professionally led self-management pain education in the community.

Active Health Programme

South Lanarkshire

Active Health is a programme for residents of South Lanarkshire living with long term conditions. Residents are referred via Acute, Physio & specialist nurses to a 10-week programme and then signposted onto a wide variety of mainstream physical activity, sport & outdoor opportunities.

South Lanarkshire Leisure and Culture have many active community opportunities as well as specialised referral programmes. Full details of the 20 leisure centres can be found on the SLL website. Contact details across South Lanarkshire or call 01698 476262 to find out the number of your local leisure centre.

Please contact your health professional to discuss this referral or contact SLLC on 01698 476262.

Contact details

North Lanarkshire

North Lanarkshire Leisure’s Active Health Programme in partnership with NHS Lanarkshire provides a range of supported programmes to help individuals realise the benefits of becoming more physically active whilst also assisting those who are recovering from minor or even more serious illness.

The Active Health Programme has both a General Programme where individuals can access the mainstream health and fitness programmes running within NL Leisure Venues including swimming, jogging, golf and more!

A Specialised Health Class Programme which requires a referral from a health professional, this option is available to individuals who require additional specialised support in taking part in physical activity and classes include Strength and Balance, Cardio I, Cardio II, Back Care and Macmillan Move More classes.

A health and social care professional can make a referral by using the Active Health referral form found at the bottom of the page in the link below.

Contact Details - Health & Wellbeing Information

Mental Wellbeing

It is very important to look after your own mental wellbeing. This can have an influence on your recovery or management of your Musculoskeletal problem. Visit our mental wellbeing page for more information.

If the advice on our website hasn't helped or improved your foot issue, you can self-refer and book an appointment.

Please complete our e-referral form and email this form to podiatry.hub@lanarkshire.scot.nhs.uk

The Podiatry Hub is open from Monday to Friday from 8am to 6pm.

Call the hub on 01698 753753

Podiatry hub telephone details 01698 753753
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