What are some of the causes for a Mortons Neuroma?
Sharp, shooting and/or burning pain of the forefoot that occurs during weight bearing activities may be the result of a Morton’s Neuroma. This involves the enlargement of the intermetatarsal plantar nerve between the 3rd and 4th metatarsals and sometimes between the 2nd and 3rd metatarsals. As these bones irritate the nerve a lump known as a neuroma may form. There is also a viable theory the transverse metatarsal ligament may also irritate the nerve playing a role in the creation of a neuroma. Here are some common causes:
1) High heel footwear: the higher the heel of a shoe the more weight on the forefoot. This increased load may lead to a drop in the transverse metatarsal arch causing the metatarsals to come closer together with resultant irritation of the nerve.
2) Shoes with a tapered or pointed toe box: When the toe box comes to a point the forefoot needs to be compressed to allow the foot access to the shoe. This compression increases the pressure of the metatarsal bones on the intermetatarsal plantar nerve.
3) Sports with emphasis on forefoot weightbearing: Many sports and many forms of dance that place an emphasis on forefoot weightbearing increase the load on the transverse metatarsal arch. Overtime this may lead to subluxation of this arch with resultant neuroma formation.
4) Long 2nd metatarsal: This congenital condition pre-disposes to subluxation of the transverse metatarsal arch. With that comes a greater chance of developing a Morton’s Neuroma.
5) Hypermobile or hypomobile forefoot: Having to much are not enough movement in the forefoot in conjunction with the above mentioned causes can lead to neuroma formation. In order to determine the existence of excessive or restricted forefoot mobility requires a thorough biomechanical assessment by a podiatrist whom will use a combination of joint range of motion testing, treadmill gait analysis and pressure plate diagnostics.
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Posted by Luke Bortolussi: Bachelor of Applied Science (Podiatry)