Overview

interdigital neuromaMorton’s neuroma is a swollen, inflamed nerve in the foot.Morton’s neuroma causes a “burning” sharp pain on the bottom of the foot. Treatments for Morton’s neuroma include resting the foot, better-fitting shoes, anti-inflammation medications, ice packs, and operation. A neuroma is growth (benign tumor) that arises in nerve cells. A Morton’s neuroma is a swollen, inflamed nerve located between the bones at the ball of the foot. The most common location of a Morton’s neuroma is in either the second or the third spacing from the base of the big toe.

Causes

Occupational hazards. Individuals whose jobs place undue stress on their forefeet (with or without wearing improper footwear) are among those who complain of neuromas. Podiatric physicians report that individuals who work on ladders, or who perform activities on their knees (such as doing landscaping, carpeting, flooring, or other work on the ground) are at risk for this problem, too, since these activities cause stress to the nerve near the ball of the foot. Those who engage in high-impact activities that bring repetitive trauma to the foot (running, aerobics, etc.) have a better than average chance of developing a neuroma at the site of a previous injury. To put it more simply, if you have sustained a previous injury to your foot (a sprain, stress fracture, etc.), that area of your foot will be more prone to neuroma development than an area that has not been injured. However, sports injuries aren?t automatically a ticket to neuromas. Trauma caused by other forms of injury to the foot (dropping heavy objects, for example) can also cause a neuroma to develop at the site of the previous injury. Much though we hate to say it, sometimes neuromas just develop and nobody knows why. The patient doesn?t have a previous injury, is wearing properly fitted shoes, and doesn?t stress his/her feet with any specific activity but the neuroma develops anyway. It is important to remember that some of the factors listed above can work alone, or in combination with each other, to contribute to the formation of neuroma.

Symptoms

If you have a Morton?s neuroma, you may have one or more of these symptoms where the nerve damage is occurring, Tingling, burning, or numbness, pain, a feeling that something is inside the ball of the foot or a feeling that there?s something in the shoe or a sock is bunched up. The progression of a Morton?s neuroma often follows the following pattern. The symptoms begin gradually. At first they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities. The symptoms may go away temporarily by removing the shoe, massaging the foot, or by avoiding aggravating shoes or activities. Over time the symptoms progressively worsen and may persist for several days or weeks. The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.

Diagnosis

In some cases your doctor will be able to feel the Morton’s as a swelling in the middle of your foot. However they may also suggest an X-ray or a blood test – this is normally to rule our other causes of the pain such as arthritis. The most accurate way to diagnose Morton?s itself is with magnetic resonance imaging (MRI) or ultrasound.

Non Surgical Treatment

Treatment for Morton’s neuroma may depend on several factors, including the severity of symptoms and how long they have been present. The earlier on the condition is diagnosed, the less likely surgery is required. Doctors will usually recommend self-help measures first. These may include resting the foot, massaging the foot and affected toes. Using an ice pack on the affected area (skin should not be directly exposed to ice, the ice should be in a container or wrapped in something) Changing footwear, wearing wide-toed shoes, or flat (non high-heeled) shoes. Trying arch supports (orthotic devices). A type of padding that supports the arch of the foot, removing pressure from the nerve. The doctor may recommend a custom-made, individually designed shoe-insert, molded to fit the contours of the patient’s foot. There are several OTC (over the counter, non-prescription) metatarsal pads or bars available which can be placed over the neuroma. Taking over-the-counter, non-prescription painkilling medications. Modifying activities, avoiding activities which put repetitive pressure on the neuroma until the condition improves. Bodyweight management,if the patient is obese the doctor may advise him/her to lose weight. A significant number of obese patients with foot problems, such as flat feet, who successfully lose weight experience considerable improvement of symptoms.

Surgical Treatment

Surgery for neuroma most often involves removing affected nerve in the ball of the foot. An incision is made on the top of the foot and the nerve is carefully removed. Surgeon must remove the nerve far enough back so that the nerve doesn?t continue to become impinged at the ball of the foot. Alternatitvely, another type of surgery involves releasing a tight ligament that encases the nerve. Recovery after Morton?s neuroma (neurectomy) surgery is generally quick. Typically patients are walking on the operated foot in a post-surgical shoe for 2 – 4 weeks, depending on healing. Return to shoes is 2-6 weeks after the surgery. Factors that may prolong healing are age, smoking, poor nutritional status, and some medical problems.

Prevention

How can Morton?s neuroma be prevented? Do not wear tight shoes or high-heeled shoes for prolonged periods. Do wear shoes with a wide toe box so that your toes are not squeezed or cramped. Do wear athletic footwear with enough padding to cushion the balls of the feet when exercising or participating in sports.

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