Put simply – Morton’s neuroma is a swollen (inflamed) nerve in the ball of the foot, commonly between the base of the second and third toes. Patients experience numbness and pain in the affected area, which is relieved by removing footwear and/or massaging the foot. A neuroma is a tumor that arises in nerve cells, a benign growth of nerve tissue that can develop in various parts of the body. In Morton’s neuroma the tissue around one of the nerves leading to the toes thickens, causing a sharp, burning pain in the ball of the foot. A sharp severe pain, often described as a red hot needle may come on suddenly while walking. There may also be numbness, burning and stinging in the toes. Although it is labeled a neuroma, many say it is not a true tumor, but rather a perineural fibroma (fibrous tissue formation around nerve tissue).
In many cases, a neuroma may develop as a result of excessive loading on the front of the foot. Sometimes, a patient?s anatomic alignment in the forefoot contributes to the overload. There may be some cases where the neuroma develops spontaneously, for no obvious reason. However, once the nerve is irritated, pressure from walking, and from the adjacent bony prominences (metatarsal heads), as well as from the intermetatarsal ligament that binds the heads together, all may contribute to persistent pain. Repetitive pressure on the nerve causes localized injury with resulting scarring and fibrosis of the nerve. This leads to symptoms in the distribution of the nerve.
If you have a Morton’s neuroma, you will probably have one or more of these symptoms. Tingling, burning, or numbness. A feeling that something is inside the ball of the foot, or your sock is bunched up. Pain that is relieved by removing your shoes. A Morton’s Neuroma often develops gradually. At first the symptoms may occur only occasionally, when wearing narrower shoes or performing certain activities. The symptoms may go away temporarily by 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.
Metatarsal bones will be examined clinically, and often an x-ray will be taken to assess the particular case and ensure against other conditions, including fracture. When the foot is examined by a doctor, he may feel a characteristic ?click,? referred to as Mulder?s sign, and the interspaces between toe bones will often be tender. The doctor may put pressure on these areas to localize the site of pain and test for other conditions, including calluses or stress fractures. Range of motion tests will also be applied to rule out arthritis or joint inflammations. X-rays may be required to ensure there are no stress fractures or arthritis within the joints that join the toes to the foot. Tenderness in one or more metatarsal bones may imply a pre-stress fracture or stress-fracture. An ultrasound scan may be used to confirm diagnosis of Morton?s Neuroma, as x-ray will not detect the condition, (but can confirm that the bones are uninjured).
Non Surgical Treatment
Treatments may include rehabilitation measures to reduce nerve Irritation. Switching to low-heeled, wide-toed shoes with good arch support. Wearing padding in the shoes and/or between the toes. Wearing shoe inserts to correct a mechanical abnormality of the foot. Having ultrasound, electrical stimulation, whirlpool, and massage done on the foot. The foot may be injected with corticosteroids mixed with a local anesthetic in order to reduce pain. Relief may be only temporary, however, if the mechanical irritation is not also corrected. Injections with other types of medications such as alcohol, phenol, or vitamin B12 are sometimes used.
Surgery is occasionally required when the conservative treatment is not able to relieve your symptoms, particularly if you have had pain for more than 6 months. 80% of patients who require surgery report good results, with 71% of people becoming pain-free.
Ensuring that shoes are well fitted, low-heeled and with a wide toe area may help to prevent Morton’s neuroma.