The injury
Area affected: Feet underneath the metatarsals
recovery period: Anything from 4-6weeks to 6-8 months
What is Morton’s neuroma?
Morton’s neuroma is the irritation and then thickening of tissue around the nerves between the metatarsals.
The neuroma usually begins between the middle two toes.
The symptoms that can indicate a neuroma are:
- Numbness in the feet or toes
- A sensation of constantly walking on a pebble
- A sensation of burning throughout the forefoot
What causes Morton’s neuroma?
Footwear
Poor daily footwear is one of the biggest causes, especially for women. Formal footwear – the kind of shoes you might wear to the office – are notoriously not ‘foot’ shaped.
Many heeled shoes place increase pressure through the front of the foot while also being far too narrow. This narrowing and forefoot pressure over time can compress the nerves in the foot, which can enable a neuroma to form.
Because of its repetitive nature, running can also be a factor in causing a neuroma, and this can be exacerbated by poor footwear.
Running shoes can be too soft or too firm for your feet, both of which can cause the numbing and irritate the nerves. That’s why it’s so important to find the right running shoes for you.
repetitive strain
Another running-related cause can be linked to low cadence (foot turnover). When we spend more time on each foot we increase the stress on the foot and its structures.
Other exercise forms such as HIIT classes, boxing and skipping can also be blamed because of the repetitive jumping nature of the activity.
Previous injuries
Previous foot conditions can be another cause of neuroma. For instance, those who have bunions are very likely to develop neuromas. This is because the restricted/painful big joint causes an imbalance in pressures in the foot.
High arches and tight calves
High arches and hammer toes also fall into this category, as both of these can mean you land very heavily on the forefoot when you run, again loading up the nerve endings there.
Lastly, persistent calf tightness can cause a neuroma. If the calf is tight, the transition from heel to forefoot will constantly be quicker as the muscles are shorter. Therefore, more time is spent of the forefoot and that increased time can lead to increased stress on the nerves.
How to treat Morton’s neuroma
As you might imagine, correct diagnosis is key to rule anything else out. This can be via GP or physio and is most commonly confirmed using an ultrasound, although an X-ray might also be requested to rule out bone stress.
To fully remove a neuroma, you’ll need surgery, but there are other options to relieve pain before getting to that stage.
Reducing symptoms and pain
In terms of reducing the pain symptoms and treating a neuroma, insoles have been found to give great relief. The aim of an insole is to aid with pressure distribution and increase comfort.
Many off-the-shelf options have a built-in metatarsal dome: this is a round pebble-shaped protrusion in the insole that sits just behind the metatarsal heads offering relief to the compression of the nerves. It can take some getting used to, but can be extremely effective.
Another option is to speak to a podiatrist and source a customized insole for a bespoke fit to your feet.
No runner will like this, but another way to offload your running pain is to reduce your training and running load. Consider doing a few more cross training sessions on the bike or in the pool perhaps.
rehab and exercise
Meanwhile, have a good look at your running shoes, as you might find that changing them up could bring relief: have a gait analysis and see if your footwear is making the issue worse.
If it’s your calves that are the cause, make an appointment to see a physio or osteopath to address the underlying cause and to prevent your calves causing the issue. Bear in mind that, as well as tightness, the opposite issue – hypermobility – can also be the ultimate cause, although this is true in only a small percentage of cases.
If you are hyper mobile, you’ll need to work on specific strength exercises to help your foot to press away from the ground quicker.
For those in acute pain, one option is to speak to your GP about steroid injections, which can offer significant relief.
The only downside is that the relief is only temporary for most, so do look at the treatments above alongside going down this route to find a solution that fits your lifestyle and future goals.
Speak to a professional
Ultimately, while a neuroma can be a debilitating injury, it is still possible to train and run with one. Investigate all your options with a physio, podiatrist and doctor to see how you can best overcome the issue.
Reducing the time on your feet will make a difference and reduce the stress to the area.
As with all running niggles and injuries, trust the process, take the rest and the advice, and you’ll be back quicker if you address the problem sooner than later.
Preventing Morton’s neuroma in the future
Working on your dexterity can help prevent future issues
- Can you separate your toes? Can you squeeze them together?
- Can you move just your big toe in isolation? Can you move you little toes in isolation?
- Can you play the toe piano? Starting from your big toe, lift each toe up from the ground until all five are up. Then place all five down again in order.
