What Causes Mortons Neuroma
Morton’s neuroma is an inflammation of the nerves in the foot that go to the toes. Although the name includes the word ?neuroma,? it is not really a tumor. It can affect any of the toes in the foot. However, it most often affects the nerves that run between the third and fourth, or second and third toes.
A Morton’s neuroma commonly occurs due to repetitive weight bearing activity (such as walking or running) particularly when combined with tight fitting shoes or excessive pronation of the feet (i.e. “flat-feet”). The condition is also more common in patients with an unstable forefoot allowing excessive movement between the metatarsal bones. A Morton’s neuroma can also occur due to certain foot deformities, trauma to the foot, or the presence of a ganglion or inflamed bursa in the region which may place compressive forces on the nerve.
Typically, there’s no outward sign of this condition, such as a lump. Instead, you may experience the following symptoms. A feeling as if you’re standing on a pebble in your shoe. A burning pain in the ball of your foot that may radiate into your toes. Tingling or numbness in your toes. It’s best not to ignore any foot pain that lasts longer than a few days. See your doctor if you experience a burning pain in the ball of your foot that’s not improving, despite changing your footwear and modifying activities that may cause stress to your foot.
The physician will make the diagnosis of Morton’s neuroma based upon the patient’s symptoms as described above in an interview, or history, and a physical examination. The physical examination will reveal exceptional tenderness in the involved interspace when the nerve area is pressed on the bottom of the foot. As the interspace is palpated, and pressure is applied from the top to the bottom of the foot, a click can sometimes be felt which reproduces the patient’s pain. This is known as a Mulder’s sign. Because of inconsistent results, imaging studies such as MRI or ultrasound scanning are not useful diagnostic tools for Morton’s neuroma. Thus the physician must rely exclusively on the patient’s history and physical examination in order to make a diagnosis.
Non Surgical Treatment
Depending on your overall health, symptoms and severity of the neuroma, the condition may be treated conservatively and/or with surgery. Non-surgical methods for neuroma are aimed at decreasing and/or eliminating symptoms (pain). Wear proper supportive shoes. Use an arch support. Wear shoes with a wide toe box. Modify your activities. Lose weight. Wear shoes with cushion. Prescribe an oral anti-inflammatory medication. Anti-inflammatory medication is useful to significantly reduce pain and inflammation. A physical therapist may perform ultrasound and other techniques to reduce inflammation. You will also be instructed how to stretch your foot and leg properly. Padding and/or cushioning of the ball of the foot is an effective method of preventing physical irritation with shoes. A custom foot orthotic is a doctor prescribed arch support that is made directly from a casting (mold) of your feet, and theoretically should provide superior support compared to shoe insert that you would purchase from a pharmacy. A cortisone injection is a powerful anti-inflammatory medication that is used to rapidly reduce the pain associated with an inflamed nerve. The pain relief that you may experience from the injection(s) is often temporary. Typically injection(s) are administered once every 2 months for a total of 3 injections or until the pain is resolved. A sclerosing alcohol injection is placed around the involved nerve to weaken its capacity to report pain. In other words, the alcohol injection will ?deaden? the affected nerve. The pain relief that you may experience from the injection(s) can be permanent. Typically injection(s) are administered once every week for a few weeks until the pain is resolved.
Surgical treatment has provided relief in some cases while poor results and surgical complications have resulted in other cases. It is believed that ligament weakness, as opposed to the pinching of nerves in the foot, may be to blame for recurrent pain in these situations. For reasons which are not fully understood, the incidence of Morton?s Neuroma is 8 to 10 times greater in women than in men.