Mortons Neuroma

A neuroma is a benign growth of tissue on a nerve. The most common neuroma in the foot is an interdigital neuroma or a 'Morton's Neuroma' which most often forms between the 3rd and 4th toes, although this is not the only site for a neuroma.

The nerve becomes 'pinched' between the metatarsal heads and is swollen and painful.

There is often a 'clicking' effect which is known as Mulders Sign, but it isn't always present. The clicking is actually the nerve moving up and down between the two bones.

Patients complain of a burning or a sharp pain.  The pain can become intense, affecting every step. Sometimes pain travels forward into the toes and occasionally the affected toes become numb. The pain is often relieved temporarily when the foot is rested without footwear. The site of the pain is easily palpated and sometimes a small lump can be felt through the skin.

Mortons neuroma can be caused by the specific architecture of the foot.  For example, hammer toes may cause the metatarsal heads to take excessive pressure during the walking cycle and press against each other. A neuroma may be due to occupational factors, such as excessive kneeling which causes  an 'overpull' on the structures. It is also caused by tight footwear, especially high heels which have the same effect on mechanical structures as kneeling and hammer toes. Even flat shoes may cause the problem if the toe box squeezes the metarasal heads and causes friction.

The discomfort from Mortons Neuroma can be relieved by separating the metatarsals which can be achieved conservatively. The first line of treatment is to assess footwear and decide if one particular pair of shoes is causing the problem. If the neuroma is more established and relief cannot be obtained through a change in footwear alone, your podiatrist can help often through the use of orthotics.

A podiatrist will advise on the best orthotic for your foot, although these do require extra space in the footwear and a shoe with more room for your forefoot is still a requirement. Sometimes the problem is so painful that surgery may be required; but often, once the inflammation subsides, the problem is more easily managed.

If you think you may be suffering from Mortons Neuroma, seek professional help, today!

Shin Splints

"The pain starts when I begin running, but eases off after a while. My friend had some therapy for shin splints, maybe that's what I need?"

"I'm training for a marathon but haven't kept to the schedule. On  Sunday I ran for 20 miles through the city, to 'catch up'. I now have terrible pains in my shins - I'm worried I may have shin splints "

There really is no such syndrome as 'shin splints', although it is a commonly used terminology. As a diagnosis, it is almost as exact as using the term, 'foot pain'.  When people refer to 'shin splints' they are generally referring to pain in their 'shins', towards the inside of the leg. The pain spreads across quite a wide area of the lower leg and usually affects those people who are involved in intense exercise. It is in fact, self inflicted.

There are a number of specific disorders covered by this title, including  fractures, muscle strains or tears, nerve entrapment and artery entrapment.  Most commonly however, it refers to a condition entitled, Medial Tibial Stress Syndrome. (MTSS) . 

The pain experienced with MTSS is worse at the beginning of training and subsides during the session. As the condition progresses in time, the pain is present with less activity and it may even occur when resting. Running on hard surfaces makes it worse as does suddenly increasing the intensity or duration of training. It can develop into a stress fracture due to repeated trauma on the leg structures

It is more common in women, in whom it is 3x more likely to advance into a stress fracture. The cause is often associated with biomechanical abnormalities. 

To recap; pain in the lower leg is not a 'shin splint' but one of many different disorders.

So if you are suffering with this,

·         stop training,

·         rest the area,

·         use ice on the leg immediately after exercise and,

·         seek the advice of a podiatrist or biomechanist who will guide you through the recovery process.