Do you experience tingling or numbness in your toes? Pain in the ball of your foot that causes a shooting, burning or stabbing sensation? These symptoms can be caused by a few things but one condition is known as a Morton’s Neuroma.
This is something that I have unfortunately had to deal within both feet for years. I first noticed symptoms back in 2008 whilst training for The Edinburgh Moonwalk. I felt like I had a stone in my left shoe, and after walking around 7 miles I developed a burning/ shooting sensation through my 2nd and 3rd toes. However, once I took my shoes off the pain almost immediately disappeared.
So, what is a Neuroma?
Typically, a neuroma is caused when there is compression of a nerve in the foot. Most commonly it is the 3rd and 4th toes that are affected the most. There are a few factors that can lead to it developing.
1) Foot mechanics and deformities such as bunions, hammertoes, flat feet, and hypermobility can all contribute to a neuroma developing.
2) Footwear which is narrow at the toe box or high heels can put extra pressure on the forefoot. This causes an increase in compression and irritation of the nerve.
3) Repetitive stress such as running, jumping or some court sports can lead to excessive stress on the forefoot.
4) An injury such as an ankle sprain or other type of trauma to the area can increase the chances of a neuroma developing.
In my case I have never worn high shoes on a regular basis and do not have any obvious foot deformities. However my style of gait and my increase in activities over the years has led to my neuromas getting progressively worse.
Will I need surgery?
We consider surgery as a last case option as there are several conservative treatments that can help.
The first thing that has to be looked at when treating a Neuroma is footwear. In some cases, simply changing your footwear to something that has more support, a wider and deeper toe box is enough to get relief from Neuroma pain. Wearing a better fitting shoe is also important if padding or orthotics are going to be required for long term treatment. For myself I started trying wider fitting trainers which helped slightly but was not enough to alleviate my symptoms completely, but they were essential for when I eventually had to get fitted with orthotics.
If a change in footwear has not helped then the first treatment option would be to apply a specific padding directly to the foot or to place it into your shoe. I found semi compressed dome pads applied to my feet really helped and I used this method for years. As my running and walking distance increased, I then found the padding to be less effective as it eventually flattens. If the padding is effective at relieving the symptoms then orthotic devices can be used long term. These are a great option as they can be removed and swapped between different shoes. I opted for orthotics as they were more durable long term. My insoles were effective for around 3 years but then the discomfort started occurring after 2-3 miles as the neuromas were well established and I had increased my activities dramatically by this point. However, my discomfort was no where near as bad as it would have been without wearing the orthotics.
Even with orthotics you can still experience some pain or discomfort. Oral anti-inflammatory drugs can help ease symptoms, especially if you are still active and this is when the pain or discomfort is at its worst. I very rarely had to use pain relief after activities but on several occasions whilst taking part in events I had to take anti-inflammatory drugs.
One last option before opting for surgery is to have a steroid injection which can reduce the swelling of the nerve. I tried steroid injections 3 times over the period of 11 years. The first two injections worked well and I had a significant reduction in pain in both feet for over a year. Unfortunately the third set of injections only helped to reduced the pain slightly and within a couple of months the pain returned at its worst.
If you have exhausted all options and the neuroma is affecting your daily life and activities then the best course of action would be to have the neuroma surgically removed. Every surgeon is different at how they carry out the procedure, but it is normally carried out as a day surgery. You will normally have to rest with your foot raised for 5-7 days with minimal weightbearing, then after 2-3 weeks you can return to gradually introducing your daily activities ie; short walks, driving etc
I recently had surgery to remove the neuroma on my right foot. The surgery was conducted under a general anaesthetic. They also administered an ankle block for pain control after surgery. I took a full week’s rest and got about the house with a post operative shoe that the hospital issued.
After this week I used a recovery air cast boot to get around if I was taken out in the car.
My surgery was successful, and I was able to return to driving after two weeks and start running again after 3 weeks which I have been successfully increasing over the past 5 months with no post operative complications.
