Morton’s neuroma is a common source of forefoot pain, particularly among runners, which involves a thickening of the tissue surrounding a nerve in the ball of the foot. This condition most frequently occurs between the third and fourth toes, causing a sharp, burning pain or the sensation of stepping on a pebble or bunched-up sock while running. While the diagnosis can be discouraging, continuing to run is often possible with a comprehensive strategy of immediate adjustments, professional medical interventions, and changes to training habits.
Immediate Adjustments for Runners
Runners can achieve immediate relief by focusing on footwear modifications that reduce compression on the forefoot. The most impactful change is ensuring that all running shoes have a wide toe box, which allows the toes to spread naturally upon impact and prevents the metatarsal bones from squeezing the irritated nerve. Avoiding narrow or pointed shoes outside of running is also important to prevent nerve irritation from worsening.
Over-the-counter metatarsal pads or cushions are another practical tool for temporary symptom management. These pads work by slightly lifting the metatarsal bones, which helps to separate them and offload pressure from the nerve that runs between them. The correct placement of the pad is just behind the ball of the foot, not directly underneath the painful neuroma itself. Runners can also utilize specific lacing techniques, such as gap lacing, which skips the eyelets directly over the painful area of the forefoot to reduce pressure across the top of the foot.
Non-Surgical Medical Interventions
For persistent pain, professional medical treatments are available to reduce inflammation and nerve irritation. Corticosteroid injections deliver a powerful anti-inflammatory medication directly around the affected nerve, which can reduce swelling and provide significant pain relief that may last several weeks or months. This temporary relief can create a pain-free window to implement long-term adjustments like physical therapy or orthotics.
Another targeted injection approach is alcohol sclerosing injections, which involve injecting a concentrated alcohol solution into the neuroma. This treatment aims to chemically destroy the nerve tissue to stop it from transmitting pain signals. Multiple injections are often required, and the goal is to shrink or eliminate the neuroma over time.
Custom orthotic devices manage the biomechanical factors contributing to the condition, especially in runners whose feet exhibit excessive motion or instability. These devices are designed to precisely support the arch and often incorporate a metatarsal dome placed to relieve pressure on the nerve. Custom orthotics are molded to the individual foot, providing specific control necessary to tolerate the repetitive impact of running. Physical therapy is frequently part of a comprehensive plan, focusing on strengthening the intrinsic foot muscles, improving overall foot flexibility, and addressing any gait issues that overload the forefoot.
Running Technique and Training Adjustments
To manage Morton’s neuroma long-term, runners must modify their training load and running mechanics to minimize forefoot stress. Reducing running mileage or frequency temporarily allows the irritated nerve time to recover and prevents chronic compression. Immediately reduce activity if symptoms intensify during a run.
Gait modification can significantly alter the load distribution across the foot during running. Forefoot strikers should shift their landing pattern toward a midfoot or slight heel strike, reducing pressure on the metatarsal heads. Analyzing running form, perhaps with the help of a physical therapist, can identify mechanical flaws that contribute to nerve compression.
Incorporating cross-training activities is an effective way to maintain cardiovascular fitness without high impact. Swimming, cycling, and elliptical training are low-impact alternatives that allow the foot to rest while preserving endurance. Choosing softer running surfaces, such as grass or dirt trails, over hard asphalt helps absorb shock and reduce the force transmitted through the forefoot.