What To Do When You Have A Pain Between Fourth And Fifth Toes?

Whether you are a new or seasoned runner, experiencing a pain between the fourth and fifth toes may not seem too serious. The good news is you are the right-the pain is definitely not life-threatening.
However, what you may not realize is how the initially irritating pain can greatly affect your running in the future. So what is causing the pain you are experiencing? How can it be treated? Can I continue running with the condition? We'll answer all these questions in this article. 

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1. Understanding the Condition

The pain that is usually felt between the fourth and fifth toes is referred to medically as a Morton’s Neuroma. It is caused by nerve tissue growing to form a benign lump between the toes. This thickening of the tissue is often caused by constant squeezing of the common plantar digital nerve for extended periods of time. (1)

  • This nerve provides the sensation to the web space between the toes.

The thickening of the nerve forms a lump that causes a pain, tingling, and numbness between the toes and in the ball of the foot. The sensation is often described by sufferers as similar to having a stone in your shoe. (2)

  • If you find yourself constantly stopping, removing your shoes and rubbing the area for relief, this is one symptom of the condition. 

2. General Symptoms

To help you determine whether your pain is caused by Morton’s Neuroma, examine yourself for these symptoms: (3)

  • Burning pain at the ball of the foot that seems to travel to the toes. The pain gets worse when you walk
  • A numbness in the toes
  • The sensation that you have something stuck in your shoe like a stone
  • ​No physical signs of a lump
  • ​Swelling between the toes
  • ​Cramping of the toes or a clicking feeling when walking
  • ​The feeling of a bulge between the toes
  • ​Urge to massage your foot constantly
  • ​Feeling that your toes are asleep
  • ​Tingling feeling at the ball of the foot

3. Contributing Factors

  • According to statistics, Morton’s Neuroma is more common in women than in men by 8-10 times. Athletes are also prone to the condition.

Two of the reasons why this is the case is because women tend to wear pointed, narrow shoes which compress the foot and increase pressure. (4)

High heeled shoes are titled which puts pressure on the nerve between the toes and makes it prone to more stress. When it comes to athletes, Morton’s Neuroma can be triggered for the following reasons: (5)

  • According to statistics, Morton’s Neuroma is more common in women than in men by 8-10 times. Athletes are also prone to the condition.
  • Athletic footwear such as skiing boots often has a tight fit and narrow toe box which can cause the compressing of the nerve.
  • Other athletic activities including running and jogging put pressure on the connective tissue causing the nerve to thicken.

In addition to women and athletes being at higher risk, deformities of the feet including flat feet, bunions and hammer toes can cause the ligament to press the nerve.  It has also been found that running with improper form can trigger the condition since you are putting extra pressure on the foot.

4. Diagnosis of Morton’s Neuroma

Lateral squeeze test

Since Morton’s Neuroma has no visible signs, diagnosis needs to be made by a qualified physician. A useful test is called the lateral squeeze test.
This
Morton’s Neuroma test is performed with the index and thumb finger on the painful space in between the toes. The forefoot is compressed with the other hand by squeezing together metatarsal heads.

  • If there is a painful or ‘click’ felt, the test is positive. (6)

Imaging tests

Imaging tests are also useful for diagnosing the condition.

  • X-rays are used to make sure that the pain is not caused by another condition such as a stress fracture which has similar symptoms.
  • Ultrasounds may also be used to reveal soft tissue abnormalities including a neuroma.
  • ​Lastly, MRI (Magnetic resonance imaging) can give a visual image of the soft tissue.

5. Treatment of Neuroma

As the condition progresses, walking will become more and more difficult so running is out of the question at this stage. Treatment of Morton’s is classified into two-conservative treatment and operative treatment. 

Conservative treatment

One of the first things you should do is wear wide, comfortable shoes with wide toe boxes. When selecting shoes for running make sure that they are low-heeled. These are the best running shoes for Morton’s Neuroma. Also, consider adding a metatarsal pad or a custom orthotic. These pads are a great way to relieve pressure.

Non-steroidal anti-inflammatory medications can be purchased without prescription to help control the inflammation. They can also help with the pain. Medications include aspirin, ibuprofen and the like. Although these will not permanently treat the condition, they may make walking more bearable.

Physical thereby including massage, and electrical stimulation is also used although the efficacy has not been confirmed.

Intermetatarsal corticosteroid and local anesthetic injection is another conservative treatment method. This provides short-term relief but no long-term benefits can be expected.

Operative Treatment

Operative treatment has been said to be the only way to permanently get rid of Morton’s Neuroma. Surgical methods include interdigital nerve excision, isolated intermetatarsal ligament division, metatarsal shortening osteotomy and isolated interdigital nerve excision.

During surgery, the patient is usually given regional anesthesia with sedation and a thigh or ankle tourniquet is used to limit the bleeding. 

Although surgery can remove the neuroma, the complications that occur afterward make it a difficult treatment option. For example, keloid formation from wound healing may result. A recurrent neuroma is another possible complication. 

6. Easy Prevention Methods

Morton’s Neuroma can be easily prevented if you follow these steps:

  • Always make sure your running shoes have a wide toe box and fit properly
  • Opt for shoes with padding at the ball of the foot
  • Avoid shoes with a heel more than 2 inches
  • ​Do not wear tight shoes for extended periods of time
  • ​Stretch your toes regularly before any physical activity

7. Conclusion

Experiencing pain between fourth and fifth toes may have long-term effects on your running routine. Despite this, with early diagnosis, you will be able to prevent the condition from getting worse.  The moment you feel a numb sensation in your feet, consult a physician to confirm the diagnosis.

If you have flat feet, wear high heels regularly, or engage in a sport that requires tight shoes, you are at higher risk of developing a neuroma.

When deciding which treatment method to follow, keep in mind the pros and cons of both conservative and surgical treatment methods. Conservative methods may make the condition bearable but they cannot cure it. Surgical methods, on the other hand, have the potential to completely remove the lump but complications may occur.

Prevention is the best cure when it comes to Morton’s Neuroma. Always opt for wide toe boxes, limit the time you wear high heeled shoes and use padded shoes. 

How did you like this article? Have you experienced any of the symptoms of Morton's Neuroma? What are you doing about it? We'd love to hear your thoughts in the comments below. Also, remember to share this information with friends and family.