Are there Morton’s neuroma exercises that I can do?

Morton’s neuroma treatment can be difficult because it is not a true neuroma. It is an enlargement of the nerve caused by irritation and repetitive stress. There are Morton’s neuroma exercises but these are usually combined with other treatments and changes in shoe wear. As a practicing physical therapist, I do find this to be a challenging condition. However, it is treatable, especially if caught early. Read on to learn more about this condition. Let’s start with anatomy!

The foot

The foot is divided into 3 sections which are the hindfoot, midfoot, and forefoot. The hindfoot is the heel area of the foot and is made up of the calcaneous and talus. The midfoot is the area off of the hindfoot. The bones in this area are the cuboid, navicular, medial cuneiform, intermediate cuneiform, and lateral cuneiform bones. The forefoot is last half of the foot including the toes. It consists of the 5 metatarsal and 14 phalangeal bones. The metatarsals are long bones that connect to the midfoot and the phalanges are the bones of the toes. The metatarsals ends are connected to each other by a ligament called the transverse metatarsal ligament.

Web spaces are the spaces between the metatarsals. There are 4 web spaces.

1^st web space
- Between the big toe and the second toe
2^nd web space
- Between the second toe and the third toe
3^rd web space
- Between the third toe and the fourth toe
4^th web space
- Between the fourth toe and the fifth toe

Nerves give sensation to all areas of the body. The nerves that innervate the toes are called the medial and lateral plantar nerves. The nerves are located along the bottom of the foot and branch out to form common digital plantar nerves as they reach the web spaces and the toes. The common digital plantar nerves pass under the transverse metatarsal ligament as they travel to the toes.

“U.Br.Columbia – Drawing Superficial dissection of the sole of the foot – English labels” by A.G.L. (Nan) Cheney, UBC and K.S. Morton, UBC, license: CC BY-NC-SA. Source: website Clinical Anatomy, http://www.clinicalanatomy.ca

What is a Morton’s neuroma?

Morton’s neuroma is a compression or entrapment of the common digital plantar nerve as it passes underneath the transverse metatarsal ligament. This is a degenerative condition caused by pressure or repetitive irritation to the nerve. This causes fibrosis and thickening of the nerve. It is more common in the third web space because it is narrower than the others. Morton’s neuroma is more common in women. It’s onset is gradual and usually presents between the ages of 45-50.

What causes Morton’s neuroma?

There are several different ways to cause pressure or irritation to the nerve. These include:

Wearing shoes that are too narrow
Wearing high heeled shoes
Playing high impact sports
Trauma or accident involving the forefoot
Abnormal biomechanics of the foot and ankle when walking

What are the symptoms of Morton’s neuroma?

There are several symptoms associated with Morton’s neuroma. These include:

Pain in the bottom of the forefoot when weight bearing (walking, running, or standing) after a short time
- The type of pain varies – It could be shooting pain, stabbing pain, or like walking on a pebble.
May also have burning, tingling, and numbness
Symptoms usually begin with a tingling sensation in the ball of the foot – This is called Mulder’s sign.
Wearing tight, narrow shoes exacerbate symptoms
Pain decreases with rest

Who should I see?

Orthopedic physician – An orthopedist who specializes in feet would be needed for treatment. Anti-inflammatory medication or an injection might be needed to decrease the inflammation. Imaging can be used to rule out other pathologies and visualize the thickened nerve. Conservative treatment, which includes changes in footwear and possible injections, are the initial course of treatment. Surgery is an option if all conservative measures fail. However surgery has about a 30% failure rate.
Physical therapy – Conservative treatment is the first approach in treating Morton’s neuroma. This includes physical therapy. Your PT can assess abnormal joint mobility and the biomechanics of your walking and running. Your PT will also assess form during sport to help with any abnormalities that might be causing injury. Some PT’s or an orthotist can measure your foot for custom made orthotics. Orthotics are needed to put your foot in the proper position while standing, walking, or running. Your PT will also assess your gait, shoe wear, training schedule, and technique to prevent the problem from happening again.

What can I do at home?

Relative rest – Resting the area to decrease further pain and swelling from occurring is one of the best ways to treat Morton’s neuroma. Basically stay away from the activities that are causing pain until the pain and inflammation have subsided. This gives the area time to rest and heal. If you keep doing what is causing the inflammation, it is not going to get better. Swimming would be a good alternative activity that does not put much stress through the ankle and foot.
Ice – Ice can help decrease the pain and swelling at the foot. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or preventing you from participating in an activity. Ice immediately after activity.
Shoe wear – Changing up your shoes is one of the best ways to decrease pressure on the nerve. Wearing a shoe with a wide toe box, soft sole, and low heel can decrease the compression on the nerve when standing and walking.
Metatarsal foot pad – A metatarsal foot pad can be placed on the insoles of your shoes to decrease the pressure put through ball of the foot.

Stretching – Stretching the calf muscles and plantar fascia can help improve the motion at the ankle. This includes stretching the gastrocnemius and the soleus. See the videos below.

Strengthening the ankle and foot – Strengthening the muscles of the ankle and feet are very important important. This will help with normal gait and decreasing stress on the nerves of the feet. Below are videos showing general strengthening of the ankle and also how to strengthen the deep posterior compartment which will strengthen the foot. Using resistance bands can increase strength and difficulty of the exercises.

Strengthening the hip and knee – It is important to strengthen the muscles around the knee, and hip. All of these muscles work together to stabilize the ankle while squatting, running, cutting, and jumping. Using loop resistance bands , resistance bands, and ankle weights can increase strength and difficulty of the exercises. See the videos below.

Balance – Working on balance is important in strengthening the foot and ankle but also improving proprioception. Improving proprioception will help improve the overall stability of the ankle. See the video below.

In review

The foot is divided into 3 sections which are the hindfoot, midfoot, and forefoot.
The forefoot is last half of the foot including the toes.
- It consists of the 5 metatarsal and 14 phalangeal bones.
Morton’s neuroma is a compression or entrapment of the common digital plantar nerve as it passes underneath the transverse metatarsal ligament.
Morton’s neuroma can be caused by wearing shoes that are too tight or wearing high heeled shoes.
Symptoms include pain in the forefoot that occurs with standing, walking, or running.
Conservative treatment including a gait analysis, changes in shoe wear, and injections is the first approach.
Surgery is an option if conservative treatment does not work.
There are things that you can do
- Relative rest
- Ice
- Shoe wear
- Metatarsal foot pad
- Stretching
- Strengthening
- Balance