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Neuroma Pain

Morton's Neuroma can be very painful.  It often starts with an intermittent burning feeling between the third and fourth toes after being on your feet for a long time. If not treated, the neuroma can easily develop into a chronic stabbing pain that radiates up the foot and even into the leg.  The third and fourth toes may feel tingly or numb.  Morton's Neuroma typically becomes worse with standing and walking. Although Morton's Neuroma typically occurs between the third and fourth toe, nerve irritation and pain may occur between other toes.   
 

Common Causes   •   •   •   •   •   •   •   •   •   •   •   •   •

Nerves connected to the toes are located between the metatarsal heads.   The nerve between the third and fourth metatarsal is particularly prone to becoming trapped between the metatarsal bones leading to swelling of the nerve, scar tissue build up and pain.

Morton's Neuroma pain is often blamed on wearing too narrow shoes, but is more often caused by bad foot mechanics.  Hyperpronation causes the foot to twist inside the shoe, and even in a wide shoe, the metatarsal heads may pack against the lateral (outer) side of the shoe upper. With every step, the metatarsal heads crash together like the cars in a stopping freight train.

People running barefoot seem prone to experience neuroma pain also in spite of there being no shoes to restrict foot motion. This may be due to the organization of the bones of the feet. The medial and lateral columns of the foot divides between the third and fourth toes. The medial column (metatarsals 1,2 and 3) is attached indirectly to the ankle bone and the lateral column (metatarsals 4 and 5) is connected indirectly to the heel bone. People who supinate seem to be subject to excessive motion between the medial and lateral columns, so the trapped nerve becomes irritated.

Pain starts when the trapped nerve starts swelling and protecting itself by forming scar tissue.  Morton's Neuroma can be a negative spiral - more swelling and scar tissue creates more pressure and more swelling etc. until you just can't stand it any more. 

 

The most common spot for Morton's neuroma is between the 3rd and 4th metatarsal.
 

How to eliminate the pain

Preventing the foot from cramming into the outside of the shoe will help alleviate Morton's Neuroma pain.  Wearing shoes with appropriate width for the foot will help, but eliminating the twisting motion of the foot inside the shoe may be the quickest way to stop continuously aggravating the nerve tissue.  This is most easily done by preventing hyperpronation.

Stopping supination may also help aleviate neuroma pain. Because supination (ankles leaning out and a tendency to walk on the outside of your feet) is a typical compensation for hyperpronation, reducing hyperpronation helps both scenarios.

If you have had chronic neuroma pain for multiple years, there may be so much scar tissue and nerve damage that a mechanical change may not immediately aleviate the pain. Realizing that everyone is different, it may be worth it for you to try changing your foot mechamnics and monitor if your pain is starting to abate. If it does not, surgical intervention or alchohol injections to kill the nerve may be a more effective alternative.

Steroid injections usually aleviate pain for 2-3 months. In stubborn cases, combining injections with insoles changing the foot mechanics may be a good experiment before proceeding with surgery. Surgery is not always a sure fix as some people end up with phantom nerve pain.

Removing the inflamed nerve does nothing to change the foot mechanics that caused the formation of scar tissue in the first place.  Following surgery, your foot may heal quicker if you prevent hyperpronation.