anatomy
When two bones repeatedly rub together, it will usually cause the outer coating of a nerve in your foot to swell which is called a neuroma or a Morton's neuroma. If repeated trauma occurs in the area the nerve will scar. It is most commonly affected between the metatarsal heads of the third and fourth toe. If caught early conservative treatment can be successful however if the neuroma gets too large the only option is surgical removal.
symptoms
The pain from the neuroma may start gradually but may become a severe and persistent pain. It is described as a burning, cramping, or aching sensation but may cause tingling or numbness. It usually occurs after walking or standing on your feet for a long period of time and is commonly found in people who wear tight-fitting shoes. The pain is usually relieved by removing the shoe and massaging the affected area. When examined, the clnician may feel a "click" which is known as Mulder's sign. There may be tenderness in the interspace. The metatarsal bones will also be examined both clinically (and often with an xray). Tenderness at one of the metatarsal bones can suggest an overstress reaction (pre-stress fracture or stress fracture) in the bone.
Pronation of the foot can cause the metatarsal heads to rotate slightly and pinch the nerve running between the metatarsal heads. This chronic pinching can make the nerve sheath enlarge. As it enlarges it than becomes more swollen and increasingly troublesome. Tight shoes, shoes with little room for the forefoot, pointy toeboxes can all make this problem more painful. Walking barefoot may also be painful, since the foot may be functioning in an over-pronated position.
self treatment
Wear wide toe box shoes Don't lace the forefoot part of your shoe too tight Make sure your feet are in supportive shoes that do not squeeze your forefoot. Golden rule- Don't ignore the problem, it won't go away! The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family). The way you function is set and cannot be cured. What you can do however, is control lower limb biomechanics by altering foot position during the contact phase of gait (when the foot is in contact with the ground). This can only be done by wearing a good shoe (see our shoe guide) and with orthotics (foot beds). This is the cheapest and most cost effective way for any athlete to reduce the risks of injury from occurring and from helping to prevent re-injury. Overall costs for the average athlete will run into pennies per mile/hour of sport. Orthotics are designed to alter the biomechanics during the time the foot is on the ground. They are also used to provide increased shock absorbency working in harmony with the sport shoe worn.
If pain persists seek treatment as soon as possible. The earlier conservative treatment of this condition takes place the less likely surgical excision will be required.
returning to sporting activity
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true: You have full range of motion in the injured leg compared to the uninjured leg. You have full strength of the injured leg compared to the uninjured leg. You can jog straight ahead without pain or limping. You can sprint straight ahead without pain or limping. You can do 45-degree cuts, first at half-speed, then at full-speed. You can do 20-yard figures-of-eight, first at half-speed, then at full-speed. You can do 90-degree cuts, first at half-speed, then at full-speed. You can do 10-yard figures-of-eight, first at half-speed, then at full-speed. You can jump on both legs without pain and you can jump on the injured leg without pain.
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Remember virtually all mortons neuromas occur during the contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point. It is therefore vital to improve your biomechanics with orthotics designed for your chosen sport. 