By Dr Zeinah Keen
During the gait cycle, the foot plantar flexes and the toes dorsiflex during the push-off phase. The nerves between the 2nd and 3rd , and the 3rd and 4th metatarsals, can become compressed by the ligament between the bones. Additional compression can come from the metatarsal bones because of ill-fitting shoes or a depressed anterior arch (which was the case with me thanks to pregnancy!). The plantar digital nerves that join between the metatarsal heads can become irritated by this compression and form a local nerve swelling (neuroma). This occurs most commonly between the 3rd and 4th metatarsals. Each nerve transmits the sensitivity and pain from the lateral side of one toe and the medial side of the adjacent toe which can cause pain and numbness.
The pain is generally worse when weight bearing, at night and when compressed (no more high heels for a while).
- Most importantly you must see a podiatrist to fit you with a metatarsal dome to separate the joints in the forefoot and open the nerve pathways. This will relieve the pressure from the neuroma. The podiatrist can also do a thorough gait analysis to establish if you need orthotics on a long-term basis.
- Wear wide fitting shoes.
- Injection of local anaesthetic combined with cortisone under guided ultrasound.
- Surgery may be the only viable option if all else fails.
If you believe you may have a Mortons Neuroma, get a referral for an ultrasound via your GP. This can be used diagnostically and for the treatment too. Please contact Zeinah on 02 9452 2292 for information on local podiatrists who may be able to assist you.