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Monthly Archives: July 2015

Morton’s Neuroma

What is Morton’s Neuroma?

Morton’s neuroma is a thickening of nerve tissue that occurs between the third and fourth toes. The thickening of the nerve that defines a neuroma is the result of compression and irritation of the nerve, which leads to enlargement of the nerve therefore leading to permanent nerve damage.

Causes of Morton’s Neuroma:

The exact cause of Morton’s neuroma is not known. However it is thought to develop as a result of long-standing stress and irritation of the nerve. An example of what is thought to cause Morton’s neuroma is wearing high-heeled shoes that cause the toes to be forced into the toe box. Activities such as running, where there is irritation to the ball of the foot is also another potential cause.

Inflammation in joints of the foot next to one of the digital nerves can sometimes also cause irritation of the nerve which then leads to symptoms of Morton’s neuroma. People with certain foot deformities such as bunions, hammertoes or flat feet, are at a higher risk for developing a neuroma.



Some symptoms of Morton’s neuroma include:

  • Pain (some complain that the pain starts in ball of foot and shoot into the affected toes)
  • Tingling
  • Burning
  • Numbness
  • A feeling of something inside the ball of the foot

Symptoms may become worse when high-heeled shoes are worn. The pain is lessened when the foot is rested with no shoes on and you massage the area. The symptoms can vary between individuals, some may have regular and persistent pain and others may experience pain for a certain amount of time and then not again for a while.


Who gets Morton’s neuroma?

Morton’s neuroma generally affects people aged between 40 and 50, however it can occur at any age. The majority of people who have Morton’s neuroma are women, however some men can also get it. It is more common in women who wear high-heeled shoes regularly or men who are required to wear tight footwear. It can also be common in ballet dancers.

How is Morton’s neuroma diagnosed?

Our podiatrist will examine your foot and gather the history of your symptoms. Our podiatrist can also sometimes feel the neuroma or the thickening area of your foot. It is best to see one of our podiatrists when symptoms are first beginning.


Treatment of Morton’s neuroma:

Non-surgical treatments of Morton’s neuroma include:

  • Padding – to lessen the pressure on the nerve
  • Orthotic Devices – custom made to your foot by the podiatrist
  • Activity modifications
  • Shoe modifications – Wear shoes with a wide toe box
  • Medications such as anti-inflammatory drugs may be recommended
  • Injection therapy – treatments may include injections of a local anaesthetics
  • Cryotherapy

If these non-surgical treatments do not work, surgery is sometimes needed.


Prevention of Morton’s neuroma:

To prevent Morton’s neuroma, ensure that your shoes are well fitted, low-heeled and have a wide toe area.

Pes Cavus (Highly Arched Foot)

What is Pes Cavus?

Pes Cavus is a condition in which the arch of the foot is very high, causing an excessive amount of weight to be placed on the ball and heel of the foot when standing and walking. The deformity can occur in the forefoot, the midfoot, the hindfoot or a combination of these sites. Pes Cavus can lead to a variety of signs and symptoms, such as pain and instability, can be on one foot or both and can occur at any age.



Pes Cavus is generally caused by a neurologic disorder or other medical condition such as cerebral palsy, Charcot-Marie-Tooth disease, spina bifida, polio, muscular dystrophy, or stroke that can cause muscle imbalances. The arch of the foot could also be due to structural abnormality that is inherited.

The underlying cause of cavus foot largely determines its future course. If the high arch is due to a neurological disorder or other medical condition, such as the ones mentioned above, the problem is likely to progressively worsen. In contrast, causes of cavus foot that do not result from neurological disorders, usually do not change in appearance.



The arch of a cavus foot will appear high even when standing. The presentation for patient with pes cavus will be highly variable, depending largely on the extent of the deformity. Patient can experience lateral foot pain from increased weight-bearing on the lateral foot. One or more of the following symptoms may also be present in people with pes cavus:

  • Hammertoes (bent toes) or claw toes (toes clenched like a fist)
  • Calluses on the ball, side, or heel of the foot
  • Pain when standing or walking
  • An unstable foot due to the heel tilting inward

Some people with pes cavus may also experience foot drop which is a weakness of the muscles in the foot and ankle that results in dragging the foot when taking a step.



A review of the patient’s family history is required for diagnosis of Pes Cavus. The podiatrist will examine the foot, looking for high arches and possible calluses, hammertoes and claw toes. The foot is then tested for muscle strength and the patient’s walking pattern and coordination will be observed. Sometimes x-rays may be required to further assess the condition.



Treatment of pes cavus may include one or more of the following options:

  • Orthotics – custom orthotic devices that fit into the shoe can be beneficial because they will provide stability and cushioning of the foot
  • Shoe modifications – High-topped shoes support the ankle, and shoes with heels a little wider on the bottom add stability
  • Bracing – a brace may be suggested to help keep the ankle and foot stable.

If non-surgical treatment fails to relieve pain and improve stability, surgery may be needed.