What is Morton’s Neuroma?

Intermetatarsal Morton’s Neuroma of the foot is a common problem that results in swelling and inflammation of the nerves, located between the 2nd and 3rd, or 3rd and 4th metatarsals. 

This condition can present gradually, or rapidly when associated with trauma. Once the pain begins, it will progress. The pain is related to the amount of time you spend walking and standing.

The condition begins as an annoyance, but over time it becomes a constant, disabling pain. The intense and disabling nature of the pain associated with Morton’s Neuroma demands attention. Even the most stoic of patients consult a physician.

Unfortunately, the treatment of this disabling condition eludes most physicians and surgeons and forces the patient to gradually eliminate their activity. Morton’s Neuroma is progressive and will continue to get worse as long as you remain active on your feet without proper treatment.

Do Theta Orthotics work for Morton’s neuroma?

How to successfully treat Morton's Neuromas with orhtotics.

Only successful way to treat Morton’s Neuroma

Thirty-five years ago I developed a neuroma. Knowing the devastating outcome long term, of this painful condition of the inter-metatarsal nerves, I was intent on finding help, to avoid inevitable neuroma surgery. 

It took me 4-5 years but I identified the design properties of any support/orthotic responsible for the desired changes in our gait. 

Not only did I learn how to improve the benefits of custom orthotics, but I quantified the design. I learned that every time I increased the angular correction by 5 degrees that I doubled the benefits of the device. 

I learned that if I got the correction high enough I could STOP the progressive pain associated with Morton’s Neuroma. The increased correction provided does work for Morton’s Neuroma.

Over the last 35 years, I have treated over 14 thousand neuroma patients without surgery. I have treated patients in the early stages and the advanced stages with this improved angular design.

I have treated patients who have tried every treatment available, including multiple failed surgeries. 

Once I learned how to improve the way orthotics work significantly, it put me out of business as a neuroma surgeon. Orthotics do treat the cause of Morton’s neuroma, and when they control foot function enough to stop the progressive nerve pain. 

Do not consent to surgery, do not accept the pain, and do not eliminate activities that are important for a healthy lifestyle. 

Call 801-651-3067, stop your pain, avoid surgery, resume a healthy lifestyle.

What Causes Morton’s Neuroma?

The cause of the inflammation is constant grinding on the nerve as you walk. This results in a progressive enlargement and swelling of the nerve. The breakdown of the arch, known as pronation, produces instability of the metatarsals, and a movement that grinds the inter-metatarsal nerves between the bones. 

Over time, the inflammation and swelling around the nerve gradually increases, and collagen is deposited, creating scar tissue around the nerve fibers.

Because the 2nd and 3rd intermetatarsal nerves are traumatized every time we stand, walk and run, the real cause of neuromas persists, even when adequate surgical resection is accomplished. The progression of this condition, over time, results in other gait-related medical conditions.

Symptoms of Morton’s Neuroma

Pain Morton's Neuroma

Stop the Pain: Morton’s Neuroma

In the early stages of Morton’s Neuroma, the symptoms are numbness or a wadded up sock feeling in the ball of your foot. 

At this point, the condition is more of an annoyance than it is a real problem. This annoyance phase proceeds for years before it changes to a burning pain. Eventually, the burning becomes more frequent and more intense.

This forces the patient to minimize weight-bearing activities. Rest, elevation, medication, and physical therapy can all be helpful. 

The burning and shooting pain comes and goes at this stage, but over time, when the condition advances and becomes constant, these treatments have minimal benefit. Most patients begin wearing wider bigger shoes, women give up on heels, and athletes consider giving up on their favorite sports. 

In the end stages, generally after years of symptoms, the patient reports constant disabling pain with every step.

Stages of Morton’s Neuroma Symptoms

Early

  • Patients reports more of an annoyance and not so much of a pain. 
  • The patients describe the feeling as a bunched up sock under the 2nd and 3rd metatarsals. 
  • They generally describe numbness or a buzzing sensation between the metatarsals associated with specific weight-bearing activity.

Middle

  • Symptoms are no longer an annoyance but rather sharp intermittent pain associated with excessive activity on their feet. 
  • In this stage patients description sharp shooting electrical or burning pain. 
  • The pain is generally intermittent in the middle stages of the condition. 
  • Patients report that after they spend too much time on their feet does the pain begin.
  • Patients begin to seek medical help and decrease regular activities.

Late

  • As Morton’s Neuroma progresses the pain is present during most all weight-bearing activities.
  • In the late stage, it is common to have multiple neuromas in both feet. 
  • The pain is electrical and burning in nature, aggravated by any weight-bearing activity.
  • Some symptoms can remain even when the patient is non-weight bearing. 
  • The only way patients learn to stop the pain in the final stage of Morton’s Neuroma is to curtail virtually all weight-bearing activities

How Doctors Diagnose Morton’s Neuroma?

For years, the diagnosis of Morton’s neuroma was based on clinical findings. Although x-rays are taken to rule out fractures, they do not show Morton’s Neuroma. 

The fact is that only well-advanced Morton’s Neuromas will show up on an MRI and you require some experience and skill to identify them when they become as big as the end of your small finger.

The classic “click” or Mulders sign that is felt when the 2nd, 3rd, and 4th metatarsals are compressed was diagnostic. When performed, the patient would express extreme displeasure, pull their foot away, and tell the physician not to do that again. 

This confirmed that you had a Morton’s Neuroma. Currently, most insurance programs require an MRI to pre-authorize surgery.

Orthotics for Morton’s Neuroma

How is Morton’s Neuroma Treated?

  1. Steroid Injections

Cortisone injections into the Morton’s Neuroma are the first line of treatment recommended by physicians. A significant reduction in pain is temporarily observed immediately following the injection. 

Although a relatively safe treatment, rare reactions are observed, possibly more related to the anesthetic used in combination. Generally every time the injection is given it becomes less effective and the duration of benefits is decreased. 

Because cortisone injections mask the inflammation and pain, they are rarely if ever, a permanent option in the treatment of Morton’s Neuroma.

  1. Medication

Anti-Inflammatory medication can be helpful in the early stages of this progressive condition but falls way short of the help required as it advances over time. Prednisone dose packs can provide noticeable relief in moderate to advanced cases. 

Inflammation is created with every step we take, so greater amounts of medication are required with diminished benefits. Oral narcotics won’t control the pain when this condition is in the advanced stages. The common side effects of pain meds often only complicate the problem.

  1. Physical therapy

Because many physical therapy modalities will help reduce inflammation they can be a helpful treatment option for Morton’s Neuroma. 

Because PT does not treat the cause of the inflammation, that occurs as we walk, frequent treatments are necessary with diminishing results. Time and cost restraints are associated with this treatment option that will provide minimal and temporary benefits.

  1. Orthotics

Most physicians understand that walking activity somehow aggravates the Morton’s Neuroma condition. They know that orthotics can change the way we walk and are used to treat other conditions believed to be caused or aggravated by the way we walk. 

Only about half of the foot specialists recommend orthotics as a treatment option for Morton’s Neuroma. Your specialist knows that the orthotics they prescribe are generally an out-of-pocket expense to the patient, and that they are not a good treatment option for Morton’s Neuroma anyway, because they don’t work. 

If they do help for a while, relief is minimal and temporary. Many doctors recommend orthotics even though they rarely work long term, because the alternative is surgery, and they want to exhaust all conservative options first.

  1. Alcohol Injections

Over the last 25 years, foot specialists have desperately searched for another effective alternative before surgery. A series of injections containing a toxic chemical that can kill nerve tissue was thought to be less invasive than surgery yet kill the nerve and stop the pain. 

This treatment is an unpredictable attempt to ablate the intermetatarsal nerve, and stop the pain. There is minimal to no guarantee that after as many as 10 painful injections, any or all of the nerve will be ablated. What is also not clear is how much damage to the good tissue is done by this toxic chemical. 

From both my personal experience using this treatment and consultation with many patients who have experienced this treatment, I fail to see any long term value. I do see the definite potential for toxic tissue reactions associated with the application of this treatment. It is difficult for me to treat a Morton’s Neuroma patient once they have had a series of failed OH injections.

  1. Surgery (Ablative Procedures)

Surgical excision is the most definitive ablative treatment option for Morton’s Neuroma. Radio-frequency ablation and Cryroablative procedures are newer alternatives to surgical excision. Pros and cons for all ablative procedures are debatable. 

Short and long term benefits of all ablative procedures are not well documented. What is certain is that if the ablative procedure used by your surgeon WORKS PERFECTLY, overall and long term it will fail.

Are there conservative, OTC treatments I can try for Morton’s Neuroma?

metatarsal pad for morton's neuromaAnti-inflammatory and pain medications are the first DIY treatments patients try and are helpful short-term in the early stages of the condition. More commonly, patients self-treat by first eliminating shoes with a heel. Later, they purchase bigger and wider shoes, with an enlarged toe box to minimize the compression on the inflamed neuroma.

At some point, most all Morton’s Neuroma patients try a metatarsal arch pad. 50 percent who try it find the pad causes pain. The other 50 percent report it provided the only help they got. Either way, the metatarsal arch pad is not enough.

Many patients end up wearing support sandals, like Vionics, Fit Flops, or Birkenstocks. The support they provide limits a small amount of pronation, and the sandal design decreases compression.

DIY Approaches to Treating Morton’s Neuroma Pain

  1. Cushioned surface

In the early stages of Morton’s Neuroma, patients find that a softer walking surface helps to control the nerve pain. Patients find that if they avoid hard surfaces they can mitigate the symptoms. 

Use of cushioned insoles and standing mats will decrease symptoms at the beginning of this progressive condition. As this condition becomes more advanced, even the softest and most cushioned walking surfaces will provide minimal help with Morton’s Neuroma pain.

  1. Decrease Compression

When Morton’s Neuroma pain is in the earlier stages, patients will tell me that if they could avoid the compression of a shoe full time, they would have no problem whatsoever. They report that if they could go barefoot, or wear flip-flops and open sandals full time, it would be sufficient to stop most of the nerve pain. 

Most physicians and shoe salesmen know to recommend bigger wider shoes to decrease the compression. Patients purchase shoes two full sizes bigger than the shoe size they wore when their feet quit growing. As this medical condition advances, even full-time use of completely non-compressive shoe gear fails to stop the pain aggravated by weight-bearing activity.

  1. Arch Support

As this condition progresses and pain is more frequent, it becomes apparent that arch support plays a critical role in the prevention of painful nerve symptoms. Patients make a change in shoe gear at some point during the progression of this disabling condition, to include those with built-in longitudinal support. Most patients try metatarsal arch supports and half of them find them helpful, the other half find them problematic. 

Over time most patients gravitate toward a variety of shoes and inserts that provide longitudinal and metatarsal arch supports. By the time they call me, most patients are wearing a variety of support sandals including, Birkenstocks, Orthoheels, Vionics, or both custom and over the counter orthotics used in a stable running shoe. 

Some patients are quick to tell me that although full-time use of these non-compressive and supportive shoes did stop the pain for a while, they “quit working” and the pain returned. Many patients tell me they continue to wear them full time as they are not working well enough.

  1. Decrease activity

Most patients control or diminish the symptoms of this condition by avoiding weight-bearing activities. One of the first things to change for women is a decrease in heel height and compressive shoes. After that, one weight-bearing activity after another is eliminated, to minimize Morton’s Neuroma pain.

When Should I Seek Treatment?

The point at which you consult a doctor for Morton’s Neuroma pain is a personal choice dependent upon your level of comfort in seeking help. Unfortunately, when caught early, the diagnosis is more difficult and less obvious. 

Other conditions like stress fractures, arthritis, plantar plate tears, capsulitis, tendonitis, and Morton’s Neuroma are all grouped into a common diagnosis called metatarsalgia.

It doesn’t matter if you catch this condition early or late, if you remain active the condition will worsen over time and fail to respond to both conservative and invasive techniques. 

To complicate the issue further, some doctors do not like to make the diagnosis of Morton’s Neuroma. Both the physician and the insurance companies see red flags when making a Morton’s Neuroma diagnosis.

Frequently Asked Questions

Why can Theta Orthotics stop pain from Morton’s Neuroma and other arch supports and orthotics can not?

All orthotics attempt to supinate or hold a foot in a supinated position during function. Other orthotics and arch supports do not supinate the foot enough to stop the progression of Morton’s Neuroma and healing can not take place.

Theta Orthotics use a progressive treatment to stop the pain whether your neuroma is in one or both feet. Whether you have tried conservative treatments or if you have had failed surgery. Theta Orthotics can stop the pain when every other treatment for Morton’s Neuroma has failed.

Call get the help you need. 801-651-3067

Can foot trauma cause Morton’s Neuroma?

A significant number of patients get their first real symptoms of an acute Morton’s Neuroma following some form of trauma to the foot. Trauma that involved a laceration of that same web space, heavy objects dropped on the top of the foot, impact from a fall, or the most common bedroom fractures (5th toe).

The trauma creates swelling that spreads throughout the ball of the foot. This swelling compresses the beginnings of an asymptomatic neuroma and can awaken it in full glory quickly.

Most patients believe the trauma caused the neuroma, but if that were the case, it would heal up as the trauma healed. The trauma did not cause the neuroma, but it precipitated it. It pushed it over the edge and it was obvious and progress in spite of proper treatment.

Can you get more than one Morton’s Neuroma?

If you ask many foot specialists they will tell you no. Frequently, when they are preparing a patient for surgery, they will forget to mention that the patient will grow more neuromas. They forget to say that a percentage of neuromas will re-grow, or enlarge as a Stump Neuroma.

They rarely tell the patient that it is common to get a neuroma in two web spaces in each foot. The fact is, when the cause of the problem is not addressed, you will just grow more neuromas. When every step you take damages the nerve, even perfect surgery fails, as you will grow more neuromas.

Contrary to the opinion of many physicians and surgeons, multiple Neuromas in both feet are common. This is why Theta research centers on a surgical alternative.

Can neuromas grow back after surgery?

Can Neuromas can grow back? Yes. Can you grow more neuromas? Yes In both feet? YES.

After treating more than 14,000 neuroma patients, many of whom have experienced multiple surgeries in an attempt to relieve their pain, I’ve noticed that re-growth, stump neuromas, and new neuromas in the adjacent interspace or other foot are common.

Fifty percent of my patients tell me they have the condition in just one foot, the other fifty percent tell me it started in one foot but is now in both feet. You can grow more neuromas, and neuromas can grow back following surgery.

Unfortunately, surgical excision, even when performed correctly, fails to resolve the underlying cause of the neuroma. The constant damage to the nerves, unresolved by surgery and generated with every step you take, will create a similar condition in another or same area.

Often the remaining portion of the nerve, now surrounded by scar tissue is subjected to the same forces that caused the original neuroma. The result is what is referred to as a stump neuroma. This condition is generally far more symptomatic than the original neuroma.

Additionally, and more common than a stump neuroma, is the production of another neuroma in an adjacent interspace or the other foot. Patients report symptoms of another neuroma on their first postoperative visit. The swelling, tight bandages, and stress placed on the non-surgical foot causes neuroma symptoms in other areas by the first postoperative visit.

Our Morton’s Neuroma Success Stories

Most Morton’s Neuroma sufferers who call are looking for a non-invasive treatment that will help them avoid surgery. Hear what these patients have to say about how Theta Orthotics offered the non-surgical solution they needed to put an end to their Morton’s Neuroma pain:

I am 74 and have been using Theta-Orthotics for 10 years.

I was experiencing terrible pain off and on for five years due to Morton’s neuroma. I saw two podiatrists. One gave me a shot. The other one fitted me for expensive custom orthotics. I still felt like my feet were walking on hot coals. I considered surgery, but was informed that sometimes this only results in a different nerve becoming inflamed. I came upon Theta-Orthotics via an Internet search and figured, “what do I have to lose.”

Because the Theta Orthotics provide a great deal of arch uplift, you need to gradually work up to your ideal strength. This took me about 3-4 months. But I began to notice substantial improvement even with my “break-in” prescription.

After about six months, all of my neuroma pain went away, and I have been using my Theta Orthotics ever since – in my street shoes, my golf shoes, my tennis shoes, you name it. By restoring my arch to its original configuration, I went from wearing 12 EEEE shoes back to my original size of 10 ½ EE.

You’d think other companies or podiatrists would be copying Dr. Jarrett’s approach, but I haven’t seen any orthotics like his. If you are experiencing Morton’s neuroma his orthotics are a godsend.

Ed Shineman

Dear Dr Jarrett.

I want to share my testimonial. My podiatrist had been giving me steroid injections for the neuromas in both my feet. The pain kept getting worse. He said, he could only administer a limited number of injections. I would eventually need surgery. But that was before I found your website and purchased your orthotic inserts. They have been life changing, when I wear them I have no pain. It has been 3 yrs now and I have not had surgery. Dr. Jarret, I can’t thank you enough for developing these inserts.

Gina Anderson

Hi I bought orthotics a few years ago. I have Morton’s Neuroma tried the foot Dr. had 6 cortisone shots did nothing I saw an ad for orthotics had them made immediately when I put them in my shoes the pain was gone. Best thing I ever ordered. Thank you Theta orthotics.

Linda

Hello,

I wanted to give you an update on my progress. I recently moved up to the 27-5, and adjusting to it very well.

I’ve not had any more pain due to Morton’s Neuroma.

I love my insoles and I’m very pleased with the success I’ve had! I’ve given your website info to my doctor.

If I could make a suggestion, I wish I could wear flip flops/ sandals again. Maybe you could design and produce some? Just some food for thought.

Thank you!

Angela

I had been feeling numbness in my toes that turned into pain when hiking, and was diagnosed with a neuroma. After trying other orthotics and treatments that just didn’t work, I discovered Theta Orthotics. After several months of faithfully wearing the Theta Orthotic inserts, I am able to hike again. Last month I hiked the 192 mile Coast to Coast trail in Northern England, pain free. I couldn’t be happier with the results.

Kim Patton