Morton’s neuroma, a painful condition affecting the ball of the foot, particularly between the third and fourth metatarsal bones, is a common condition treated by acupuncturists, as well as podiatrists and orthopedists. Characterized by inflammation of the common digital plantar nerve leading to the toes, this condition can cause sharp, burning pain, tingling, or numbness.
The pain pattern is similar to capsulitis of the foot, in which inflammation of the capsular ligaments typically results from activities that excessively bend the toes, such as gardening or sprinting.
Morton’s neuroma is more prevalent in women than men, likely due to the frequent use of tight-fitting shoes, and it typically occurs between the ages of 40 and 60. While the exact etiology remains unclear,1 complementing standard care with acupuncture, supplements, and diet / lifestyle modifications can significantly enhance patient outcomes. Let’s explore standard care options, acupuncture points, and supplements that can be integrated into the treatment of Morton’s neuroma.
Standard of Care: Surgery, Orthotics, and Beyond
In conventional medicine, Morton’s neuroma is typically treated with conservative methods before considering surgical intervention.2 These methods include avoiding tight “toe box” shoes, using forefoot gel cushions, and taking NSAIDs or corticosteroid injections.
Orthotics are often the first-line treatment, designed to provide support and alter foot biomechanics to relieve pressure on the affected nerve. Custom orthotics can be particularly effective in gently lifting the center of the ball of the foot, allowing the metatarsal bones to spread apart and reducing pressure on the irritated nerve.
When conservative treatments fail, surgical options may be considered. Surgery can involve decompression, which entails cutting nearby structures to relieve pressure; or neurectomy, in which the affected nerve is removed. This procedure can be approached either from the plantar or dorsal side.3
While surgery can be effective, it carries risks such as infection, scarring, and the recurrence of symptoms. Additionally, recovery from surgery is not immediate; although literature suggests a recovery period of 2-4 weeks, it often realistically takes 3-4 months to fully recover and return to full mobility.
Physical Examination
Visual inspection: Check the foot for any visible deformities, swelling or changes in the skin reflecting inflammation. Usually, Morton’s neuroma doesn’t present with noticeable external signs.
Palpation: Press the area between the metatarsal heads (especially between the third and fourth toes) – that pressure may reproduce symptoms.
Squeeze test: Take one hand and press down on the top of the foot to keep the bones from arching while compressing the foot (medially and laterally). A positive sign is pain, tingling or numbness.
Mulder’s sign: While doing the squeeze test, if a clicking sound or sensation occurs, that can indicate the presence of a neuroma.
Range-of-motion testing: Assess the ROM in the foot and toes to ensure the pain isn’t related to joint issues such as osteoarthritis.
Gait analysis: Observe the patient’s gait to see if the pain affects their walking pattern.
Imaging: Both MRI and ultrasound examinations may confirm a diagnosis, but there are high false-negative values.
Suggested Acupoints
Acupuncture can reduce pain and inflammation, improve circulation, and enhance nerve function. Below are some acupuncture points that have been found effective in treating Morton’s neuroma:
Supplementing Nerve Health: Integrative Nutritional Support
Begin with a discussion of an anti-inflammatory diet with your patient and then talk about additional support. Several supplements have been shown to support nerve health and reduce pain, making them valuable in the treatment of Morton’s neuroma.
Alpha-Lipoic Acid: This potent antioxidant has been studied for its ability to reduce nerve pain and inflammation. It works by neutralizing free radicals and improving the function of mitochondria, which are crucial for nerve health.
Omega-3 Fatty Acids: Found in fish oil, flax seeds, primrose oil, krill oil, etc., these essential fatty acids have anti-inflammatory properties that can help reduce nerve pain and improve overall nerve function. Omega-3s are particularly beneficial in reducing the inflammation that contributes to Morton’s neuroma.
Benfotiamine: A fat-soluble form of vitamin B1 (thiamine), benfotiamine has been shown to improve nerve function and reduce pain in conditions like diabetic neuropathy. Its ability to prevent cellular damage makes it a promising supplement for those with nerve pain.4
Vitamin B12: Essential for nerve health, vitamin B12 deficiency is linked to neuropathic pain. Supplementation can improve nerve function and reduce pain, particularly in individuals with low B12 levels. Injections are the best method to improve B12 levels, but it’s a hassle for the patient and can be expensive as well.
I recommend sublingual methylcobalamin (the cheapo cyanocobalamin type of B12 is more commonly found in drugstore vitamins and has poor bioavailability), starting a “loading dose” of about 1,000 mcg two to three times per day for a week and then tapering down. If your scope of practice permits, order a B12 test to assess their level; low levels are common among those who have a plant-based diet or are vegetarians or vegans.
Magnesium: I tend to recommend transdermal magnesium5 to avoid bowel distress (diarrhea/loose stool) from an oral route, using a magnesium chloride spray to apply 300 mg to 400 mg directly to the affected foot. You can also recommend soaking their foot in Epsom salts (magnesium sulfate). Both are very effective.
Clinical Guidelines and Integrative Approaches
According to the latest clinical guidelines from podiatric and orthopedic associations, conservative treatments like orthotics and corticosteroid injections are recommended as first-line treatments for Morton’s neuroma. Surgery is generally reserved for patients who do not respond to these interventions, and acupuncture approaches (not surprisingly) are absent from these guidelines.
Offering an integrative approach to your patients, combining “standard” treatments with acupuncture, orthotics, and supplements to address both the symptoms and the underlying causes of Morton’s neuroma, not only alleviates pain, but also supports overall nerve health and function, potentially preventing the recurrence of symptoms.
References
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
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