Did you ever see the episode of “Sex and the City” where Carrie gets fitted with custom made orthotics to ease the pain from Morton’s neuroma? OK…it never happened, but if Carrie was a real person, chances are it would have, as high heels – Carrie’s trademark fashion choice – are a common cause of this painful condition.
Morton’s neuroma is characterized by sharp, dull or throbbing pain in the web space between two toes, most commonly the third and fourth toes. Typically, the pain is temporarily relieved when walking barefoot, or by massaging the area. Morton’s neuroma can also feel like walking on a lump or on a wrinkled sock. Other symptoms may include: a burning pain that radiates into the toes; a tingling in affected toes; and numbness on the sides of the toes facing each other.
Morton’s neuroma results from repeated trauma or compression of the nerve just before it divides to go into each toe.  As high heels place a lot of pressure on the pad of the foot and are often very narrow, they frequently cause Morton’s neuroma. In fact, neuromas most often afflict fashion-minded women 40 to 60-years-old who wear high-heeled, narrow fitting footwear.  Overpronated feet, a condition where the arch side of the foot rolls inward, and feet that are overly flexible allowing the metatarsal bones – the long thin bones stretching from the toes – to move easily are also common causes of Morton’s neuroma.
Fortunately Morton’s neuroma can often be effectively treated with custom foot orthotics. Custom orthotics can control overpronation and improve foot posture. They are also designed to separate the metatarsal bones and lift the heads of the metatarsal bones thereby relieving pressure and trauma on the nerve and reducing the weight that is put on the painful area.
As a Canadian Certified Pedorthist I have treated many patients with Morton’s neuromas. I begin by providing a thorough assessment of the patient’s feet and the way they walk and then move on to designing and building custom foot orthotics to provide relief. I also counsel my patients on appropriate footwear that will enhance their comfort and maximize the effectiveness of the orthotics. If pedorthic treatment is not effective due to the severity of the neuroma or nerve damage, I recommend alternative treatment options including physiotherapy to reduce the symptoms through laser or ultrasound therapy or I refer them back to their physician to discuss injecting cortisone at the site, or a referral for surgery to reduce compression or to remove the neuroma entirely.
By Brad Gibbs, C. Ped (C), Cambridge, ON