I’ve recently been asked by an athlete I coach about a pain they have developing in their fore-foot when cycling. Based on their description it sounded like Morton’s Neuroma (sometimes called Morton’s Interdigital Neuroma or Plantar Interdigital Neuroma).
I gave them some initial advice and then started researching through some of my old notes and key text books.
- Pruitt, Andy; Matheny, Fred; (2006) Andy Pruitt’s Complete Medical Guide for Cyclists Velo Press
- Brukner, Peter; Khan, Karim (2019) Clinic Sports Medicine 5th Edition McGraw Hill
- Anderson, Marcia; Hall, Susan; Martin, Malissa; (2021) Foundations of Athletic Training: Prevention, Assessment & Management Lippincott Williams & Wilkins
Firstly, what is Morton’s Neuroma?
It is a compression of the plantar digital nerves as they are compressed between the metatarsal heads and transverse intermetatarsal ligament, often in the second and third metatarsal spaces.
During the initial stages it may feel like there is a stone in the shoe but as it progresses it develops in severity. It often becomes an issue for someone when it gets to the point where there is tingling or burning sensation, particularly when standing or when pressure is applied.
Pain will reduce as when activity is stopped or when the shoe is removed.
What causes Morton’s Neuroma?
There are a number of things that put the foot in a position where the nerve gets compressed. Tight fitting shoes (due to the compressive forces on the nerve), as well as a pronated foot can lead to abnormal pressure on the plantar, digital nerves as they are compressed between the metatarsal heads. Instability in the forefoot is also known as a cause of this painful condition, especially where there is excessive movement between the metatarsals.
Morton’s Neuroma is a common source of foot pain, particularly with middle aged women (but not exclusively).
Management of Morton’s Neuroma
Ceasing the activity with the onset of pain and removal of footwear will help in the short term.
Particularly with cycling, redistributing the weight of your foot on the pedal to avoid putting pressure on the concentrated section of nerves of the balls of the foot will help prevent future issues. So does utilising orthotics or shoe inserts with a metatarsal bump will spread the bones of the forefoot taking pressure off the nerves.
A metatarsal bump is a small domed area in the foot bed just behind the ball of the foot. As an alternative the addition of a metatarsal arch button can also help minimise discomfort and pain, relieving the symptoms. You stick these small foam buttons to the insole just behind the ball of the foot. You can often find these buttons in the footcare section of a pharmacy or make your own from dense foam.
The key thing to do is to ensure that your foot isn’t compacted into tight fitting shoes and that it has space to expand into as it swells during exercise. The inclusion of a metatarsal arch button can also help alleviate issues.
Further assistance
If you are suffering from a Morton’s Neuroma or similar seek advice of your physiotherapist or general practitioner.
Coach Ray has a number of relevant qualifications including both a Post Graduate Diploma in Sports Medicine and a Post Graduate Diploma in Rehabilitation both from the University of Otago’s Medical School.