Morton's neuroma, Queen Letizia's ailment: how much does it have to do with footwear and how to prevent it

In the last two years, Queen Letizia has considerably lowered the height of her heels. Since she was diagnosed in 2022 with Morton's neuroma and metatarsalgia (inflammation in the ball of the foot that makes it difficult for her to remain standing, static, for a long time), she has been leaving behind her famous

Letizios

(those

peeptoe

shoes with openings in the toes, platform and high heel that she wore so much in her early years as a princess) and also the stiletto pumps to switch to the sensible heel, the one that does not exceed three centimeters in height. And even, if the occasion allows it, the flat shoe. But the unprecedented image in the Royal Palace of Amsterdam, where she had to perform the hand-kissing sitting before the reception that William and Maxima of the Netherlands offered for the kings' state trip, shows that this pathology can be very painful.

“It is a stabbing and very intense pain in the metatarsal area. There may also be numbness and tingling in this area. Many times cramps appear between the third and fourth fingers,” explains Neus Moya Arasa, podiatrist and communicator, about the symptoms of this ailment. “Colloquially we call it 'sciatica of the foot' because it is an abrupt pain that forces you to stop. It is very common for those who suffer from it to have the almost instinctive need to take off their shoes and place their bare feet on the ground,” she adds. Letizia could not do this in the middle of the royal reception, hence the convenience of the stool they had arranged for her: the greeting to the 200 guests lasted 45 minutes.

As this specialist explains, Morton's neuroma consists of the thickening of the tissue around one of the nerves that are between the third and fourth metatarsals and points out that, although its causes can be very diverse (cavus foot, flat foot, toes in claws, bunions...), footwear is a very important external factor that can cause the appearance of neuroma and one of the explanations why this condition mainly affects women. "For two reasons: because they are narrow shoes that cause friction between the metatarsals due to lack of space and because of the heel, which shifts the forces forward." In women's footwear, these two characteristics are very common "and that is why they are more likely to suffer from Morton's neuroma," says podiatrist Neus Moya.

“There is a direct relationship between Morton's neuroma and tight, narrow shoes that excessively compress, especially the front part of the foot, as they exacerbate the pain,” agrees Dr. Gabriel J. Dávila Sánchez, General Director of the foot and ankle clinic in Madrid DM Clínica. “Excessively high-heeled shoes, with narrow and thin toes, are a clear example of this, and that is why women, who throughout their lives tend to wear this type of footwear more, or other much more stylized ones, are much more more predisposed to suffer from it.”

Women's shoes, in general, are designed with a much narrower last than what your feet need, confirms Jorge Escoto, podiatrist and member of the board of directors of the ICOPCV (Illustrious Official College of Podiatry of the Valencian Community): “That is Thus, the models are often narrower and very disrespectful to the feet” and recalls some classically feminized professions among which it is common, such as store staff or hostesses.

Juan Arnal, traumatologist and orthopedic surgeon with his own clinic in Madrid, encompasses the biomechanical causes of Morton's neuroma into two types: those that are not modifiable or intrinsic to the individual, and those that are modifiable or attributable to external factors, where the main one is narrow footwear. in the previous area.

Respectful footwear

In recent times, the wave of well-being has reached territories such as cosmetics, with the boom in skincare or facial care, and now it seems to have reached foot health. “We have noticed in consultation that in recent years interest in foot care has grown,” corroborates podiatrist Gabriel J. Dávila. According to data from researcher Research Radar, the global foot spa market is expected to reach $1 billion by 2026.

One of the manifestations of this trend for foot care is in the rise of minimalist footwear, which basically seeks to interfere as little as possible with the shape of the foot and its natural way of walking. The current comes from the world of

running

, where a few years ago it began to become fashionable to run with shoes with very thin soles.

This boom for respectful shoes (also called

barefoot

in English ) has reached street footwear and meets four characteristics:

- Zero Drop: Or what is the same, a completely flat sole, with very little or no difference in height between the front of the shoe and the back. This concept emerged with the rise of “

natural running”

and minimalism among runners.

- Flexible sole: Make it very easy to bend and rotate in all directions, ductile, malleable and not at all hard.

-Wide toe: This type of footwear allows the toes to be placed in their natural space, preventing them from being placed on top of each other or pressing against each other. This reduces the chance of bunions appearing.

- Smooth insole: Defenders of this type of shoe advocate an insole without any anatomical reinforcing element, to avoid a pronounced curve in the arch of the foot.

“One of the characteristics of respectful footwear is the absence of a heel and a wide toe. An anatomical toe in which it is respected that the first toe always remains straight and the rest of the fingers and metatarsals have space,” specifies podiatrist Neus Moya. “Only from these characteristics we can conclude that it has a prominent role in the prevention, not only of Morton's neuroma but also of metatarsalgia (pain in the metatarsals), bunions, claw toes…”

In the world of fashion it is known that when a trend reaches Zara it means that it has the possibility of becoming massive, or at least it is a good market test. So two pairs of shoes that meet her minimalist shoe requirements have not gone unnoticed on podiatrist Neus Moya's radar. Other brands such as the Spanish Camper or the Swedish Arket have launched minimalist footwear models and there are also others dedicated exclusively to this type of shoe, such as the German Groundies or Zaqq, or the Slovak Be Lenka.

toe separators

“Toe separators are useful for aligning and preventing deformity and especially friction due to narrow shoes that usually produce small painful calluses,” says Gabriel J. Dávila, who recommends them in cases of bunions that are just beginning or to relieve pressure. between the fingers when there is a lack of alignment between them.

“You have to see the separators for what they are. They are a great tool but it is not something miraculous that they work just by wearing them,” begins podiatrist Neus Moya. In her opinion, they are “one more tool” for changing foot habits: “What they do is align the toes with their metatarsals and force the foot to work aligned, so that the intrinsic and extrinsic musculature of the foot works in harmony.” correct way.” She points out that they are not designed to correct a deformity “because even with a lot of work the foot may not do so. But the focus of their use is not this, but rather returning functionality to the foot, and being used as a complement in a rehabilitation process of this foot." She recommends accompanying them with a change in habits, exercises and, above all, appropriate footwear. “There is no point in using the separators if we then wear narrow shoes all day.”

This podiatrist also points out that not everyone should use them and gives as examples patients with structured digital deviations in which separators could cause damage. “Instead, they opt for custom digital separators made by a podiatry professional,” she notes.

Rubber bands, balls and exercises

“If you continue wearing shoes with high heels, the pain will appear, it is not a question of strength. It is a matter of anatomy and biomechanics,” recalls podiatrist Jorge Escoto. He explains that when high heels are worn continuously, the muscles in the back of the leg shorten, so it would be advisable to perform rounds of exercises that help stretch the entire posterior and plantar compartment of the foot. “A very useful exercise is to put an elastic band on the tips of the fingers and on the metatarsals, pulling towards us, taking the ankle at 90 degrees. It is also advisable to self-massage the painful area or perform exercises by stepping on a tennis-type ball to relax the interdigital spaces. In this case, if in doubt or for the recommendation of certain specific exercises, you should consult the professional specialized in this field, who is the physiotherapist,” he points out.

Rubber bands are a useful tool for exercising the muscles of the feet, agrees Neus Arnal. “One of the exercises consists of placing your feet parallel with the separators on. Put the rubber band on the big toe of each foot. With the rubber bands on, tiptoe your feet and then vice versa, stand on your heels, raising your toes.” He also recommends another exercise: “With the same position as the previous one, separate your feet a little to redirect the big toe and place it in line and separate and bring the tips of the feet together.”

“We can use a tennis ball and pass it over the sole of the foot to work the entire plantar fascia,” adds the podiatrist, who also recommends placing the foot on a towel and folding it completely with the fingers, or applying stimuli to the foot, whether natural, such as walking on grass or stones, or artificial, such as sensory mats.

If what we are looking for is to relieve the pain after wearing heels, the podiatrist Gabriel J. Dávila proposes a very useful exercise: “Place an elastic band around the five fingers and with the leg stretched and in a sitting position, gently pull in the direction of our chest. . In this way we will relax the muculature of the back and also the inside of the foot.”

In any case, remembers traumatologist Juan Arnal, exercises should always focus on two things: gaining elasticity in the plantar fascia to better distribute pressure between the forefoot and rearfoot (stretching exercises for the arch of the calf and hamstrings) , and secondly, muscle-building and proprioception exercises for the foot and ankle, muscle-building of the closed kinetic chain (squats, lunges) and strengthening of the “core” through floor exercises to improve the footprint.

The heel that podiatrists recommend

“The ideal is not to wear heels,” says Neus Arnal. “The foot is made to walk without having to wear a heel. Sa knows that the rear height causes imbalances, increased braking forces and an increase in pressure on the ball of the foot,” she explains. "What we must keep in mind is that if we are adults, and we have worn conventional footwear all our lives (which have a heel to a greater or lesser extent), we must make a transition to drop 0 (flat shoes) because it is most likely that "We have a retraction of the posterior muscles that requires prior work."

For shoes for daily use, Jorge Escoto recommends a height “between 2 and 4 centimeters since less than 2 can also influence, depending on the foot, the appearance of other ailments such as plantar fasciitis.”

“The maximum acceptable height in a high-heeled shoe depends on several individual factors, but it is generally recommended not to exceed 5-7 centimeters and to use a wide heel,” advises Gabriel J. Dávila. “The most recommended sole height would be between 1 and 2 centimeters, and even more important, that it has a material that is flexible enough to allow bending and momentum during walking.”

But if we talk about high-heeled shoes, says orthopedic surgeon Juan Arnal, “It is best to reserve heels for weddings, baptisms and communions. Since in general terms they will not offer any benefit by changing the normal support of the foot” and he details how the height of the heel affects as we walk: the higher the heel, the more the pressures on the forefoot increase. With a heel of approximately 2 cm. and a half the pressure increases by 25%, if the heel is 5 cm. It is approximately 60% and if we are at 7 cm. it shoots to 80%.

Prevention and treatment

From the Navarra University Clinic they affirm that although it is not possible to prevent all instances of Morton's neuroma, adopting certain measures can reduce the risk of developing this condition. And they cite the following:

·

Wearing appropriate footwear:

Selecting shoes with a wide toe box, adequate support, and a low heel can decrease pressure on the nerves in the foot and prevent the development of Morton's neuroma.

·

Avoid high-impact activities

: Reducing participation in activities that involve repetitive impact on the front of the foot, such as running or dancing, can help prevent irritation of the interdigital nerve.

·

Maintain a healthy weight:

Excess weight can increase pressure on the feet and contribute to the development of Morton's neuroma. Maintain a healthy weight through a balanced diet.

·

Perform stretching and strengthening exercises:

Regularly practicing specific exercises to stretch and strengthen the muscles of the foot can improve foot function and reduce the risk of developing a Morton's neuroma.

In the Department of Orthopedic Surgery and Traumatology of the Clínica Universidad de Navarra they indicate a conservative treatment and another in the operating room for Morton's neuroma. The first involves a change of footwear to shoes with a wider toe box and adequate support to relieve pressure on the nerve and reduce pain, adopting orthopedic insoles that help redistribute pressure and provide adequate support to the structure of the foot, the taking non-steroidal anti-inflammatory medications such as ibuprofen and corticosteroid injections, which in some cases the doctor can prescribe to reduce inflammation and relieve pain.

When conservative treatments do not provide sufficient relief, the clinic explains, the doctor may recommend surgery to treat Morton's neuroma: a nerve decompression surgery (which involves cutting the ligaments and surrounding tissues that compress the nerve, with the objective of reducing pressure and relieving pain) or a removal of the neuroma in the most complicated cases.