Transcription
Hello everyone, this is Paul from Ortho Eval Pal. Today, I want to talk about the difference between metatarsalgia and Morton's neuroma. Now, I've done several videos on this in the past, and I still get a lot of questions, really with more specifics on what the difference is between the two of them, how to treat it. So today, I thought I would tear them apart a little bit and talk about them individually and what you should feel when you have that.
Let's start off with Morton's neuroma. When you take a look at the top of the foot, there are shafts of bones that go up like this, and in between those bony shafts are nerves. These are called interdigital nerves, and Morton's neuroma occurs most often between the third and the fourth shaft. As you can see, I drew a little bump, and that's basically what happens: you develop this lump on top of that nerve, and it takes up space between the shafts of those bones. That can become very, very painful in this area. You can get it in other areas, but this is the most common.
What people will feel with this is a numbing or tingling type sensation in the third and fourth toes, especially when you squeeze that area. Why do people get this? A lot of it is due to too much pressure in the forefoot part of the foot, sometimes because of a tight calf or because they're wearing high heels and distributing a lot of pressure into this area. Wearing shoes that are too tight can compress that region, or wearing a shoe that's too wide can allow the feet to splay and then cause too much movement here, and therefore the neuroma grows.
One of the ways to identify it is that you squeeze the foot this way, and you'll feel a little click or hear a little click in there. It almost sounds like a nail clicking, and that can be a sign of a Morton's neuroma. It can be very, very uncomfortable and very difficult to treat, but I do treat it like metatarsalgia.
So how is metatarsalgia different? Metatarsalgia is pain on the joint from the shaft to the toe bone, and it's painful on that joint, most commonly on the second and third. It can happen on any of them, but it's most common between two and three, and it's right on the joint; it's not between the shafts. These people will have pain when bringing the toe back like this and with pushing in the joint. Some people will be tender on the top of the joint also, so you can put your fingers right above and below and have pain in that region.
Again, patients will commonly complain of this feeling like there's something in their shoe, that the sock is bunched up in the forefoot part of the shoe or in the ball of the foot. They'll feel like there's a stick in the shoe or in the sock, and that gives you this irritating pressure. One of the problems is that as we get older and/or we get a lot of tightness in the calf muscle, this arch that is supposed to be like this in the foot ends up becoming inverted. Then we start putting too much pressure in these little joints right here; they become very inflamed, very irritated, and sometimes swollen in the joint, causing a lot of pain.
So, I'm a big advocate of stretching the calf out often, wearing an orthotic, and making sure that you don't spend a lot of time on really hard surfaces like linoleum or ceramic tile floors because that will cause a lot of irritation. Having a nice cushioned shoe or a slipper can help absorb a little bit of shock. I do an orthotic, and I like to take some pressure off of this spot by putting a piece just behind those metatarsals.
That's kind of how I differentiate between the two of them: one is more of a joint problem, and the other one is a nerve problem. If you have any questions about Morton's neuroma and/or metatarsalgia, just leave a message in the comment section of this video, and I'll make sure that I get back to you. If you have any other questions or want to get any more information regarding online coaching or anything else that we do with Ortho Eval Pal, make sure that you check out the links in the show notes. And make sure you give us a thumbs up if you liked this video. Thanks!