Morton’s Neuroma Test – Everything You Should Know
Pain and disability in the forefoot is a common complaint of people. Although it can be a sign of more serious conditions, it is usually caused by the Morton’s neuroma. In medical terminology, neuroma is a benign tumor or benign proliferation of nervous tissue.
However, this term is not appropriate for this condition. Morton’s neuroma is actually not a tumor. It is a thickening and proliferation of the tissues that surround the nerve that goes to your toe, in medical terminology known as perineural fibrosis.
Even though it is not a tumor, it is an unpleasant condition which causes pain and disability in the forefoot and therefore limits everyday activities. Because it is a progressive condition, the symptoms will become worse over time.
That is why Morton’s neuroma should be diagnosed and treated as soon as possible. Thankfully, there are various simple tests that can help in recognizing this condition that even regular people can do.
What is Morton’s neuroma?
Morton’s neuroma, also known as Morton’s metatarsalgia or interdigital neuroma, is a painful condition which usually affects the third interdigital nerve between the third and fourth toes (third web space). It can also affect the second common nerve in the second web space, although less often.
The exact cause of this condition is still not known. However, current theory believes that repetitive mechanical and ischemic trauma and entrapment cause thickening of the nerve.
There are couple of anatomical and biomechanical explanations for the common affection of the third nerve. The nerve in the third web space is the largest digital nerve and therefore more susceptible to compression and irritation.
Secondly, the third web space and the accompanying nerves and tissues are more prone to injury because of the relatively fixed third metatarsal bone and more mobile fourth metatarsal bone. Thirdly, when people wear shoes with narrow toe box there is more compression on the nerve caused by the hyperextension of joints during weight-bearing activities.
Even though the exact cause is still not known, there are couple of factors that contribute to Morton’s neuroma like:
- Unfitting, tight shoes and high heels
This is one of the most important contributing factor in Morton’s neuroma. As I’ve previously mentioned, high heels and other shoes with narrow toe boxes increase compression on the nerve and other structures between the heads of metatarsal bones.
- Certain physical activities and sports
Weight-bearing physical activities and sports that involve repetitive action like walking, running, jogging can contribute to the development of Morton’s neuroma.
Sports that feature tight shoes like skiing or rock climbing can also be a contributing factor to this condition.
- Foot deformities
People with foot abnormalities like high-arched feet or flat feet have a higher risk for this condition.
- Certain injuries
Fractures and dislocation in this area can narrow the tunnel where the nerve passes and make compression more likely.
What are the symptoms of Morton’s neuroma?
The main characteristic of Morton’s neuroma is the pain in the forefoot. However, many people will have different experience of this pain.
Because the most common area for this condition is between the third and fourth metatarsal heads, most symptoms are usually located in the third and fourth toes and the space between them. However, it is possible for this condition to exist in other toes, but less often.
Initially, patients may only experience a tingling sensation in the interdigital space between the toes. This tingling, also known as paresthesia, can get worse over time. There can also be numbness in your toes.
As the time passes by and the condition progresses, this tingling sensation changes into sharp shooting or burning pain. This pain is usually located on the ball of the foot and radiates in either side of the toes. It can also radiate from the forefoot up the leg. Patients may also have feeling like there is a pebble in their shoes while walking.
The pain is aggravated when walking, wearing tight shoes and walking barefoot. Patients usually have some pain relief after they remove the shoes and massage the painful area. Usually there are no outward signs, like lump, because the thickening of the nerve is not that big.
How to treat Morton’s neuroma?
Treatment for Morton's neuroma depends on longevity and severity of the symptoms. Initial treatment of Morton’s neuroma is usually conservative, non-surgical and simple. The point of these methods is to relieve pain and prevent from recurring.
Conservative treatment includes the following methods:
- Rest, massage and ice
- Non-steroidal anti-inflammatory medications
These medications can be used to reduce the pain and inflammation.
- Changing your footwear
Wide, comfortable shoes with larger toe box, lower heels and soft sole will ease the pressure on the nerve. Also, avoid high heels and pointed shoes.
If you’re not sure what type of shoes you should buy, I’ve compiled a list of best shoes for Morton’s neuroma that you can check on this site.
Shoe inserts and pads can also help by lifting and separating the metatarsals and therefore reducing the pressure, irritation and inflammation.
- Corticosteroid injections
If the initial conservative treatment fails, corticosteroid injections with local anesthetic may help. These injections can be effective in many cases.
Several studies have shown that corticosteroid injections along with adequate shoes, non-steroidal anti-inflammatory medication and orthotics provide relief in over 80 percent people with Morton’s neuroma.
However, if conservative treatment did not help, you should consider surgical treatment. If you want to know more about Morton’s neuroma surgery, I’ve made another post about it.
Common varieties of Morton’s neuroma test
There are various tests that can help diagnose Morton’s neuroma. Couple of studies assessed the diagnostic accuracy of these tests. Evidence showed that some of the tests are more accurate and sensitive than others. Based on these studies, I present to you the most common and accurate tests for diagnosing Morton’s neuroma.
1. Lateral squeeze test or Mulder’s click test
This test is one of the most commonly used test for diagnosing Morton’s neuroma.
- Place the index finger on the upper surface of the foot in the space between the suspected area (usually between third and fourth metatarsal heads), while the thumb is placed on the bottom side of the foot.
- Squeeze the fingers together with a small amount of pressure.
- With the opposite hand, squeeze the forefoot and the metatarsal heads.
- The test is positive if the painful or palpable ‘’click’’ is felt. This sign is also known as ‘’Morton’s click’’.
2. Tinel’s sign
Gently tap the space between the third and fourth toe (and/or spaces between other toes). If this gentle tap causes pin or prick like sensation, tingling or numbness in the forefoot, the test is positive.
3. Gauthier’s test
Like the previously mentioned tests, this test is also performed by squeezing the metatarsals together.
- Squeeze the metatarsals with hand
- Move the second and third toes up and down for 30 seconds
- The test is positive if you feel tingling, numbness or pain in the affected area after you’ve done squeezing and moving your toes.
The squeeze of metatarsals along with movement of your toes actually replicates motions that are present in the weight-bearing physical activities such as walking or running.
4. Digital nerve stress test
The digital nerve stretch test is performed with the patient seated with the feet upon the examiner’s knees.
- Hold both ankles in full dorsiflexion
- Passively fully extended the lesser toes on either side of the suspected web space on both feet.
- The test is positive if the patient complains of discomfort in the web space of the affected foot.
Today’s studies show that this test is one of the most effective ways to diagnose Morton’s neuroma and should be used regularly in medical practice.
This test can also be done without doctor’s help.
- Have your foot flat on the ground and raise it as high as you can while your heel remains on the floor.
- The test is positive if the pain prevents the affected toes to fully extend.
5. Sullivan’s Sign
· The Sullivan’s sign is positive if your affected toes spread apart when weight-bearing or stand.
There are various foot conditions that have similar symptoms, making diagnosis much harder. This can be a big problem, especially for progressive conditions, where early treatment and diagnosis is a key to successful resolution. Most of these conditions are diagnosed late and surgical therapy is the only option that is left for these patients.
Thankfully, that is not the case with Morton’s neuroma. Thanks to specific and various symptoms that Morton’s neuroma causes, doctors were able to provide simple Morton’s neuroma tests that can recognize the condition fast and start with the treatment as soon as possible. Most of these tests are so simple that even regular people can do them.
I hope that with this text you’ve learned more about this common and painful condition, and that with just a few simple tests you can easily recognize it, start your therapy sooner and prevent further progression.