Your feet absorb vast amounts of force, especially when running, which can lead to painful foot conditions.
If you have been experiencing a sharp and burning pain in the bottom of your foot that makes every stride almost unbearable, you might have Morton’s neuroma.
Injuries are every runner’s worst nightmare! If left untreated Morton’s neuroma can wreak havoc on your running schedule.
But don’t worry, there are several things you can do in combination with conservative treatments that can keep you running.
What Is Morton’s Neuroma?
Morton’s Neuroma affects the ball of the foot. It develops when the soft tissue around the interdigital nerve thickens, specifically between the third and fourth toes.
Morton’s neuroma vary in size from 4.9 mm and can grow to more than 15mm in size. The bones in the ball of the foot are closely packed together, leaving very little space for the nerves to run through.
So as the size of the neuroma gets bigger, the surrounding metatarsal bones begin to compress and irritate the nerve. This causes a sharp, burning pain in the ball of your foot that may radiate into your toes.
It’s important to note that the neuroma size doesn’t determine the level of discomfort or pain you may experience. Whether the neuroma is small or large, all it takes is a small amount of pressure on the nerve to cause significant pain.
Is Morton’s Neuroma Common in Runners?
Yes, Morton’s neuroma is common in runners. You’ll often find that it’s almost always listed as one of the most common foot conditions that affect runners.
The condition is thought to be caused by the repetitive stress and pressure placed on the nerves in the foot caused by the high-impact nature of running. Runners who train for marathons, long-distance runners, or runners who participate in ultras are at higher risk for developing this condition.
That said, Morton’s neuroma is more common in women runners than in men. This is only because women wear high heels and shoes where the heel height varies. Women’s shoes can have a heel height of 3 to 4 inches, while stilettos can reach up to 10 inches.
This can increase the risk of developing a neuroma before you even lace your running shoes.
What Causes Morton’s Neuroma?
While the exact cause of Morton’s neuroma isn’t known, several factors are believed to contribute to the development of the neuroma. Some of the most common causes of Morton’s Neuroma in runners include:
Running is high-impact and if you’re wearing tight shoes, have a narrow toe box, are worn, or that don’t provide adequate cushioning it will place significant stress on your feet.
Each time your foot hits the ground, your foot has to absorb more of the force, which places excessive pressure on the bones. This can lead to the nerve becoming compressed, putting you at a higher risk of developing Morton’s Neuroma.
The amount of pressure placed on your foot will vary depending on a few factors like:
- Body weight
- What surface you’re running on
- Your running speed
On average, the pressure placed on your foot when running is up to 3 to 4 times a person’s body weight with each step. For example, a person weighing 150 pounds can experience force of 450 to 600 pounds per step when running.
Unfortunately, in most cases, there’s little to no pain during the early stages of the injury. But over time, the repetitive demand places too much strain or force on the bones, ligaments, and muscles, leading to an overuse injury.
Poor foot mechanics can contribute to the development of Morton’s neuroma by putting extra pressure on the nerve. Foot mechanic factors that put you at a higher risk of developing this condition include:
- Flat feet
- High arches
- Excessive overpronation
- Inflexible ankle or stiff calves
- Hallux Rigidus
- Hypermobility of joints
- Poor distribution of weight and pressure on the foot
- Other forefoot conditions like bunions, hammertoes, and claw toes
- Poor running form
Other Potential Causes Outside of Running
Even if you take good care of your feet while running, what you do outside of your running training can also contribute to neuroma formation.
Wearing shoes that are too tight, narrow, or snug in the toe box places the ball of your foot under constant pressure. This can lead to the development of Morton’s neuroma.
Additionally, you risk developing a neuroma if you regularly wear high heels or shoes that shift your body weight onto your forefoot.
Participating in high-impact sports that have repetitive movements that can irritate the ball of your foot. These include activities like soccer, tennis, and basketball.
What Are the Symptoms of Morton’s Neuroma?
Unfortunately, you won’t see any noticeable signs of a Morton’s neuroma, like a lump on your foot, especially in the early stages.
The symptoms of Morton’s neuroma develop gradually. At first, you may only notice pain occasionally, either after a run or wearing shoes with a tight or narrow toe box. But your feet feel fine after some rest or even massaging the ball of your foot.
As the neuroma develops, the inflamed nerve changes and you’ll find that the symptoms become worse and persist for days or weeks. These symptoms include:
- It feels like your sock has bunched up or that there’s a small pebble under the ball of your foot
- Pain that can be a stabbing or burning pain between the toes
- Pain that radiates into the ball of your foot or that shoots into your toes
- Numbness and tingling in your foot
- Inflammation between the toes
- Swelling under the balls of the feet
- Pain that gets worse when you walk or stand
Conditions That Feel Like Morton’s Neuroma
There are few foot conditions where the pain or common symptoms overlap. This can make it difficult to diagnose Morton’s neuroma without a clinical examination.
The following conditions can present similar symptoms as Morton’s neuroma:
Metatarsalgia is the medical term describing inflammation, tenderness, and pain in the bottom of your feet. The pain is often felt near the base of the toes, beneath the metatarsal heads. It most commonly affects the base of your 2nd toe.
But it can also affect your 3rd and 4th toes, which can be mistaken for Morton’s Neuroma.
Metatarsal Stress Fractures
A stress fracture is when tiny cracks occur in the bone which most often caused through repetitive stress or force on the foot bones. The most common stress fracture for runners is a 5th metatarsal fracture.
It can be mistaken for Morton’s neuroma as you’ll experience pain, swelling, and tenderness that can radiate into the ball of the foot. You’ll also find walking or applying weight to the affected foot difficult.
That being said, if you experience sudden pain along the outside of your foot and there’s bruising, you will likely have a stress fracture.
Metatarsophalangeal Joint Synovitis
This foot condition affects the metatarsophalangeal—MTP—joints and are also known as the toe knuckles. When the soft tissue that lines the joint—synovium—becomes inflamed, you can experience a sharp pain in the ball of your foot.
This can also be mistaken for Morton’s neuroma. But to differentiate between the two conditions, look for redness and swelling around the joint that will also feel really warm. If you move that joint, you’ll experience pain.
There are over 150 small fluid-filled sacs known as bursae that cushion your joints throughout your body. You’ll find bursa in your forefoot, at the base of the fifth metatarsal, and one between your heel bone and Achilles tendon.
When the bursa in the forefoot becomes irritated and inflamed, this will cause the condition bursitis. It can be extremely difficult to tell the difference between Morton’s neuroma and bursitis as the symptoms are similar.
In some cases, you may have both conditions, and you’d need an MRI or an ultrasound of your foot to get a proper diagnosis.
Tarsal Tunnel Syndrome
Your posterior tibial nerve runs through a narrow passageway inside your ankle bone. When this never becomes compressed or trapped, it can cause symptoms similar to those of Morton’s Neuroma, including:
- Numbness and tingling in the foot
- A sensation similar to an electrical shock
- Weakness in the foot
- Muscle atrophy
How to Tell if It’s Morton’s Neuroma
There are a few self-assessment techniques that you can do at home that may help you determine if you have a neuroma.
Start by examining your foot on the top and the bottom for any signs of swelling, redness, or changes in skin color. Then gently feel underneath the ball of your foot to find areas that are tender to the touch or have a burning sensation.
Then hold your affected foot in both hands and gently squeeze the metatarsal bones together. The bones will compress on the nerve, and if it causes pain, you have a high chance of a neuroma.
It’s important to note that in many cases this test can be helpful in diagnosing if you have a neuroma. But it could provide a “false positive” as you may have bursitis or even a combination of both.
You should still see your doctor so that they can rule out other common conditions and discuss treatment options.
How to Treat Morton’s Neuroma
The good news is that Morton’s neuroma often responds well to conservative treatment methods, so you won’t have to give up running. But you may have to take a break from running and switch to low-impact activities to give your foot time to heal.
Check your footwear and make sure you wear shoes with wider toe boxes. This will help your toes to splay naturally, reducing the pressure on the nerve.
Consider using orthotics, shoe inserts, or metatarsal pads in all your shoes, including your running shoes. These devices can help keep your foot in a neutral position and redistribute pressure, relieving pain.
Use ice and massage your ball of foot for 10 to 20 minutes every few hours to reduce pain and swelling. You can also take an over-the-counter nonsteroidal anti-inflammatory medication.
Depending on the severity of your Morton’s neuroma your doctor may recommend either steroid injections, physical therapy, or cryotherapy.
Tips For Running With Morton’s Neuroma
Wear the Right Kind of Shoes
Make sure that your running shoes have a wide toe box, good arch support for your foot shape, and cushioning. The wide toe box will let your toes spread naturally and the arch support ensures that your weight is distributed evenly throughout the foot. We’ve got a recommended list of great shoes for morton’s neuroma.
While the cushioning absorbs the shock of impact, you should also consider using custom orthotics, over-the-counter insoles, or met pads to help redistribute pressure away from the neuroma.
Always Warm Up Before Running
Do light exercises and stretches before starting your run to loosen up tight muscles and your feet. This will help reduce the risk of pain or injury and relieve some of the pain associated with Morton’s neuroma.
Lower Your Mileage When It Flares Up
Pay attention to your body and how it feels. If you notice that the pain is becoming persistent again, reduce your run mileage, frequency, and intensity.
Before you head out for your next run, make sure that you’re pain-free and that you gradually return to your running routine. This can help prevent you from experiencing crippling pain halfway through your runs, and it can aid in your recovery times.
Cross-training is a great opportunity to ensure that you can keep your hard-earned fitness gains while resting your foot.
Consider swapping out an easy run or rest day for a low-intensity cross-training workout such as aqua jogging, Pilates, swimming, or rowing. This will let you work on correcting any muscle imbalances along the kinetic chain.
Try Running on Softer Surfaces
Switch up your running routes so that you’re not always running on asphalt or concrete. Try running on a track, through a local park on the grass, and some trails.
The softer surfaces will be more forgiving on your feet which can provide some much-needed relief for your feet. Fortunately, by running on softer surfaces, you’ll be providing a challenging workout for your muscles.
This can also help correct muscle imbalances while reducing the risk of overuse injuries.
Stretch and Massage Your Foot
Stretch and massage your foot after every run if the pain levels allow. Not only will this help reduce the tension in the foot. But it will help reduce pain associated with Morton’s neuroma and promote healing.
You can ice massage your foot for 10 to 20 minutes every four hours to reduce the swelling. Make sure you pay attention to any trigger points that you find. This will help to ease sore, tight muscles while you check your feet for any potential issues.
Incorporate the following stretched into your post-recovery routine to help reduce the pressure on the neuroma:
- The wall stretch
- Towel toe curls
- Big toe stretch
- Plantar fascia stretch