Australian Walking Clinic

Forefoot pain

Neuroma: Joplinís and Mortonís

What is it?

A neuroma refers to the thickening or enlargement of nerve tissue, which is often caused by irritation or compression of the nerve. This compression causes swelling in the nerve and can lead to permanent nerve damage.

A Joplinís Neuroma is an entrapment of the nerve travelling along the bottom and inside area of the big toe.

A Mortonís Neuroma causes pain in the ball of the foot that shoots out to the 3rd and 4th toes. The 2nd and 3rd toes can also be affected. The pain is typically worse when standing and walking and relieved by rest. Discomfort may be felt as a burning pain, deep achy pain, constant burning, radiating pain, electrical pain, or numbness. Others may describe the sensation of feeling as though their sock is bunched up under the ball of their foot or feeling like they are walking on a lump or a ball.

What causes them?

A Joplinís Neuroma may be caused by abnormal pronation, or may be associated with a bunion formation.

The exact cause of a Mortonís neuroma isnít always known, although a number of problems can contribute to the formation of a neuroma.

High heels, particularly those over 5cm (2″), or shoes with constricting, pointed, or tight toe boxes can cause compression (for this reason, women tend to suffer from a Mortonís neuroma more often than men).

Conditions such as a high-arched or flat foot, bunions and hammer toes can lead to a neuroma being formed. These foot types can lead to instability around the toe joints, which can cause the beginnings of a neuroma.

Other causes include sporting activities, such as running or racquet sports, which can involve repetitive irritation to the ball of the foot.

How are they treated?

The treatment options for a Mortonís neuroma can differ according to how long youíve had the condition and its severity. Identifying the neuroma in its early stages will help to avoid surgery.

The most important action is correct diagnosis, usually requiring a diagnostic ultrasound to differentiate a neuroma from other conditions that can produce similar symptoms.

Early treatments will concentrate on trying to relieve and reduce pressure on the area around the neuroma. This may consist of:

  1. A simple change in the style of shoes you normally wear. Wide-toed shoes may be recommended.
  2. Padding to provide support for the arch of the foot may be advised to take pressure away from the nerve.
  3. Anti-inflammatory drugs (NSAIDs) and a course of steroid injections can help ease acute pain and inflammation.
  4. Orthotics will help the foot to function so that the pressure is in the correct structure at the proper timinds, relieve abnormal stress on the affected area.
  5. If the neuroma is small, cortisone injections or repeated injections of alcohol can also be beneficial.

In more severe cases, where early treatment options havenít worked, surgical options may be considered. Surgery to remove the inflamed and enlarged nerve often takes up to 30 minutes and can be performed on an outpatient basis. Recovery generally takes less than four weeks and surgery is successful in 80% of cases.

Metatarsalgia

What is it?

Metatarsalgia is a common overuse injury described as pain in the forefoot that is associated with increased stress over the metatarsal head region. Metatarsalgia is often referred to as a symptom, rather than as a specific disease.

What causes it?

Common causes of metatarsalgia include:

  • metatarsophalangeal synovitis
  • avascular necrosis
  • sesamoiditis
  • inflammatory arthritis
  • Mortonís neuroma
  • Prominent metatarsal heads
  • Hypermobile foot joints
  • Excessive pronation
  • Forefoot equinus

Each is diagnosed separately, often with the aid of X-rays and diagnostic ultrasound. Diagnosis is the key to ensuring the treatment matches the actual condition

How is it treated?

Once the cause of the metatarsalgia is known the appropriate treatment can be given. These may include:

  • Trialing Felt padding to offload high pressure areas, which when successful will be replaced with an insole of some type.
  • Orthotic devices to aid the foot to function correctly thus normalising the forces.
  • Short-term relief may be from the removal of callus or corns under the metatarsal area.
  • Footwear advice and footwear modifications
  • Splinting all movement to completely rest the tissues

WARNING : This information is for educational purposes only and is not intended to replace professional podiatric advice. Treatment will vary between individuals depending upon your diagnosis and presenting complaint. An accurate diagnosis can only be made following personal consultation with a Podiatrist.