A Podiatrist's Guide To Morton’s Neuroma & Shoes.
What is Morton’s Neuroma?
Morton's neuroma, also known as intermetatarsal neuroma, is a condition that involves thickening of the tissue around one of the nerves that travels in between your metatarsals (long bones in your feet), into the toes. The thickening is due to irritation or compression of the nerve, which can cause a burning pain in the ball of the foot and may radiate to the toes. It most commonly occurs between the third and fourth toes.
What causes Morton's Neuroma?
Friction and compression between the metatarsal bones causes thickening of the tissue around the nerve. This can be due to ill-fitting, tight and restrictive footwear or a combination of footwear and an individual's biomechanics (the way we move) leading to repetitive compression and/or friction over time. Individuals with bunions have an increased chance of developing a neuroma.
Symptoms include:
- Burning pain, or hotspot, in the ball of the foot that can radiate to the toes.
- Sharp, shooting pain in the ball of the foot.
- Pins and needles or numbness in the ball of the foot.
- Feeling of walking on a stone or pebble.
- Localised tenderness.
- Pain in narrow footwear.
- Pain in high heels.
Treatment of Morton’s Neuroma:
Footwear changes: Switching to shoes with a wider toe box, adequate depth and avoiding high heels can alleviate pressure on the nerve. See below for advice on what to look for in footwear.
Orthotics: Insoles or inserts, referred to as orthotics, can aid to reduce pressure in the forefoot and reduce compressive loads. These can be prefabricated insoles that are off the shelf, or custom devices prescribed by your podiatrist or relevant health practitioner. They can be fashioned from dense or light foams, plastics, cork and other materials.
Metatarsal domes: Metatarsal domes placed in the shoe or on your orthotic device can help to splay the metatarsals, creating space around the irritated nerve allowing it to settle and reducing pressure beneath the ball of the foot.
Injections: Corticosteroid injections can provide temporary relief by reducing inflammation around the nerve.
Surgical Intervention: In severe cases where conservative treatment has failed.
Key features to look for in shoes for Morton’s Neuroma:
A neuroma can be present with no discomfort when appropriate footwear is worn.
Width & Depth In The Forefoot
To ensure that compression is reduced, allowing for space between your metatarsal bones. The thin footbed found in our Fit Kit can be utilised for all Bared shoes with a removable footbed to create more space around your forefoot.
Good Fixation
Laces, straps or buckles that secure your foot into the shoe are essential to reduce clawing of the toes which may aggravate symptoms. It’s for good reason we don't make slides!
Metatarsal Dome
Shoes with a cushioned insole that include a metatarsal dome have been shown to assist in relieving symptoms. A metatarsal dome is a key feature of our footbed, strategically placed to sit behind the ball of your foot to support your transverse arch.
Removable Insole
A removable insole with arch support is ideal to both support the foot and allow for modifications by your podiatrist or healthcare provider to further offload your neuroma. If you have custom orthotics, a shoe with a removable insole is important to account for extra width and depth to accommodate. Most of our fully-enclosed shoes have a removable footbed to allow for a customised fit or use of your personal orthotic.
Cushioned Midsole
Provides cushioning and shock absorption, particularly helpful for those that feel like there is a pebble under their forefoot. You’ll find extra cushioning beneath the footbed in all Bared shoes.
Low Heel Height
If wearing a dress shoe is a must, stick to a lower heel height to reduce pressure and load in the forefoot. If you're experiencing bad symptoms, stick with flats!
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