Morton's Neuroma is a painful condition that affects the ball of your foot, most commonly the area between your third and fourth toes. Despite the name, it is not a cancerous tumor. Instead, it is a benign thickening and inflammation of the tissue surrounding one of the digital nerves leading to your toes. This thickening is caused by chronic compression, irritation, or repetitive pressure on the nerve.
Morton's Neuroma
Functional Tests
Deep pincer pressure between 3rd and 4th metatarsal heads recreates pain; metatarsal squeeze test recreates pain.
December 2035-Present
PA and Tissue Inspe
Morton's toe; fallen metatarsal arch; callus build-up under 2nd-4th metatarsal heads; webbed tissue between 2nd and 3rd toes.
December 2035-Present
History and Mechanism
Chronic: Repetitive activity on ball of foot; poor arch support; shoes too narrow in toe box.
December 2035-Present
Achievements
Results that matter
Nominations
Perineurium: Connective tissue wrapping around bundles of nerve fibers.
Demographics
The incidence of Morton neuroma isn't tracked, but it is generally regarded as a common condition. Women are diagnosed with Morton neuroma about five times more frequently than are men.
Etiology: What Happens?
The bones in the long part of the foot are the metatarsals, numbered 1 to 5 from medial to lateral. Their distal heads form the “ball” of the foot.
The common digital nerves supply sensation and motor control for the distal foot. Their branches converge between the superior aspects of the metatarsal heads. At this location, they can be squeezed from all sides when pressure is translated across the bottom of the foot and toward the toes, as during the “toe-off” phase of walking.
Several issues can contribute to nerve irritation in the ball of the foot. The nerve is embedded in thick fascia, the perineurium, all the way down the leg. If that fascia is tight and restrictive, it inhibits the ability of the nerve to function well, and increases the risk of entrapment or stretching of the nerve. Additionally, muscle tightness in the hamstrings or plantarflexors can pull on or compress the medial and lateral plantar nerves that eventually become the common digital nerves. People who spend a lot of their day in heels put pressure at the metatarsal heads, just where the nerves are compressed under the intermetatarsal ligaments.
Signs and Symptoms
The irritation that occurs with Morton neuroma creates a characteristic electrical shooting pain that travels distally from the ball of the foot to the toes, usually between the third and fourth metatarsals (Figure 3.39). This happens mainly with walking or other weight bearing, rather than at rest.
Treatment
If Morton neuroma is identified early, it can be treated with a change in footwear, orthotics, and pads for the metatarsal heads. Careful stretching and massage therapy may also be a part of this strategy. More invasive options include steroid injections to reduce the bulk of the fibroma, or injections to kill the sensory neurons if the pain is intractable. Surgery may be conducted to remove the connective tissue mass, but the risk of complications is fairly high.
RESEARCH
One case report found that a client with Morton neuroma had less pain and more ability to exercise with massage.1 This is worthwhile in itself, but it is especially so because this client had not had success with other noninvasive therapies and was contemplating surgery.
OPTIONS
Work directly on the foot to create space between the affected metatarsals is helpful as long as symptoms are not made worse. This can be coupled with massage and stretching to the whole posterior aspect of the leg, where the source of the common digital nerves can be freed from fascial restrictions.
BENEFITS
Massage therapy appears to offer some benefits to clients with Morton neuroma, as is evedenced by the natural response to rub our tender feet when we are in pain. As long as symptoms are not exacerbated, most types of massage are safe, and some could be helpful in reducing the irritation both at the compression site in the foot and along the length of the sciatic nerve where the affected branches begin.
RISKS
Squeezing the metatarsal heads may elicit symptoms. Avoid this maneuver and most other types of massage are safe and appropriate for clients with Morton neuroma.
Timeline
Massage Therapy Implication
1. Davis F. Therapeutic massage provides pain relief to a client with Morton's neuroma: a case repot. International Journal of Therapeutic Massage and Bodywork 2012;5(2):12-19.
Therapeutic Massage Provides Pain Relief to a Client with Morton’s Neuroma: A Case Report - PMC