Mortons Neuroma
What is Mortons Neuroma?
A neuroma is an abnormal thickening of nerve tissue that can occur in various body parts. One common type of neuroma in the foot is called Morton's, which usually develops between the third and fourth toes at the ball of the foot, where the metatarsal bones are located. Although neuromas can also form in other foot parts, this is the most common location.
The thickening of the nerve that characterizes a neuroma is caused by compression and irritation of the nerve. This pressure leads to the enlargement of the nerve, which produces the symptoms associated with Morton's neuroma and can eventually result in permanent nerve damage.
Cause of Mortons Neuroma
Morton's neuroma frequently arises due to ill-fitting shoes, particularly those with high heels or a tight fit, which compress or irritate the nerves in the feet. As a result of this pressure, the affected nerve thickens and gradually causes increasing discomfort.
In addition to footwear issues, foot or gait abnormalities can lead to Morton's neuroma, as they can create instability and further pressure on the foot's nerves.
Morton's neuroma is commonly associated with certain foot conditions such as flat feet, high arches, bunions, and hammer toes. Furthermore, it can be exacerbated by certain activities that increase pressure on the ball of the foot, including repetitive sports like running or racquet sports and sports that require tight shoes such as skiing or ballet. In some cases, a neuroma can result from foot injuries.
Mortons Neuroma Symptoms
Morton's neuroma may not present visible signs on the foot since it is not a tumor, and there is no noticeable lump. At the onset of the condition, you may experience mild pain that gradually worsens. Taking off your shoes and massaging your foot can help alleviate the discomfort.
As Morton's neuroma progresses, the symptoms become more pronounced, including a sharp, stinging, or burning pain between the toes while walking or standing. Swelling may also occur between the toes, and you may experience a tingling or numbness in your foot. It may feel as if there is a small rock or bunched-up sock under the ball of your foot. Additionally, pain can worsen when wearing high-heeled shoes or standing on the balls of your feet.
How is Mortons Neuroma diagnosed?
To diagnose Morton's neuroma, a foot and ankle surgeon will comprehensively evaluate your symptoms and examine your foot. The doctor may manipulate your foot during the physical examination to replicate your symptoms. Additionally, other tests or imaging studies may be required.
It is advisable to seek the attention of a foot and ankle surgeon at the initial onset of symptoms. Early detection of Morton's neuroma can significantly reduce the need for more invasive treatments and even help you avoid surgery.
What are Morton's neuroma treatments?
Nonsurgical Treatment
The initial treatment of Morton's neuroma typically involves one or more of the following options:
- Shoe modifications: Wearing wide shoes with a soft sole and a lower heel, and avoiding high heels and tight, narrow shoes, can help spread out the bones and reduce pressure on the nerve, allowing it time to heal.
- Orthoses: Custom shoe inserts and metatarsal pads/bars can be added to your shoes to relieve irritation by changing the location of forces on the forefoot and separating the bones, which reduces the pressure on the neuroma.
- Injection: One or more corticosteroid injections can help reduce nerve swelling and inflammation, providing relief. This injection can be done at the orthopedic clinic, or you may be referred to an ultrasound specialist who will inject under your guidance. Another type of injection is nerve ablation, which involves injecting a medication that permanently stops the nerve from sending pain signals.
- Alternative therapies: Alternative treatments such as extracorporeal shockwave therapy, radiofrequency ablation, and non-steroid injections may be suggested, but their effectiveness is inconclusive.
Research has demonstrated that combining shoe wear modifications, orthoses, anti-inflammatory medications (such as ibuprofen or naproxen), and corticosteroid injections can relieve many individuals.
Surgery Treatment
If nonsurgical treatment fails to improve your symptoms or they recur, your surgeon may suggest surgery. The surgery can either remove the diseased part of the nerve or release the tissue around it. Surgery is considered the most effective treatment for Morton's neuroma, with 80 to 95% success rates reported in many studies.
Your orthopedic surgeon can discuss various surgical techniques available for treating Morton's neuromas, all of which have shown similar results. To access the nerve, the surgeon may make an incision on either the top or bottom of your foot over the web space. Once the nerve is accessed, the surgeon may remove the swollen portion or release surrounding tissues to relieve pressure. The choice of surgical approach will depend on multiple factors, and it's important to discuss the specific details of the procedure with your surgeon.
