Working with Mortons Neuroma
Overview
A morton's neuroma (or an "inter-digital" neuroma) is found between the toes of the foot, most commonly the third and fourth toes. It can also occur between the metatarsal bones (the long bones in the forefoot). It is basically an entrapped nerve, which becomes inflamed due to constant irritation from the surrounding bony structures.
Causes
It's not always clear what causes Morton's neuroma, but several things seem to aggravate it. These include other foot-related problems and wearing restrictive footwear. It's thought that Morton's neuroma may be caused by the toe bones (metatarsal bones) pressing against the nerve when the gap between the bones is narrow. This causes the nerve and surrounding tissue to thicken.
Symptoms
Normally, there are no outward signs, such as a lump, because this is not really a tumor. Burning pain in the ball of the foot that may radiate into the toes. The pain generally intensifies with activity or wearing shoes. Night pain is rare. There may also be numbness in the toes, or an unpleasant feeling in the toes. Runners may feel pain as they push off from the starting block. High-heeled shoes, which put the foot in a similar position to the push-off, can also aggravate the condition. Tight, narrow shoes also aggravate this condition by compressing the toe bones and pinching the nerve.
Diagnosis
The exact cause of Mortons neuroma can often vary between patients. An accurate diagnosis must be carefully made by the podiatrist through thorough history taking and direct questioning to ensure all possible causes are addressed. The podiatrist will also gather further information about the cause through a hands on assessment where they will try to reproduce your symptoms. A biomechanical and gait analysis will also be performed to assess whether poor foot alignment and function has contributed to your neuroma.
Non Surgical Treatment
You may be able to treat this problem at home. Avoid wearing tight, pointy, or high-heeled shoes. Choose well-fitted shoes with plenty of room for your toes. Put ice or a cold pack on the area for 10 to 15 minutes at a time. Put a thin cloth between the ice and your skin. Take anti-inflammatory medicines to reduce pain and swelling. These include ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve). Rest your feet when you can. Reduce activities that put pressure on the toes, such as racquet sports or running. Try massaging your foot to relax the muscles around the nerve. If these steps do not relieve your symptoms, your doctor may have you use special pads or devices that spread the toes to keep them from squeezing the nerve. In some cases, a doctor may give a steroid shot to reduce swelling and pain. If these treatments do not help, your doctor may suggest surgery.
Surgical Treatment
If these non-surgical measures do not work, surgery is sometimes needed. Surgery normally involves a small incision (cut) being made on either the top, or the sole, of the foot between the affected toes. Usually, the surgeon will then either create more space around the affected nerve (known as nerve decompression) or will cut out (resect) the affected nerve. If the nerve is resected, there will be some permanent numbness of the skin between the affected toes. This does not usually cause any problems. You will usually have to wear a special shoe for a short time after surgery until the wound has healed and normal footwear can be used again. Surgery is usually successful. However, as with any surgical operation, there is a risk of complications. For example, after this operation a small number of people can develop a wound infection. Another complication may be long-term thickening of the skin (callus formation) on the sole of the foot (known as plantar keratosis). This may require treatment by a specialist in care of the feet (chiropody).
A morton's neuroma (or an "inter-digital" neuroma) is found between the toes of the foot, most commonly the third and fourth toes. It can also occur between the metatarsal bones (the long bones in the forefoot). It is basically an entrapped nerve, which becomes inflamed due to constant irritation from the surrounding bony structures.Causes
It's not always clear what causes Morton's neuroma, but several things seem to aggravate it. These include other foot-related problems and wearing restrictive footwear. It's thought that Morton's neuroma may be caused by the toe bones (metatarsal bones) pressing against the nerve when the gap between the bones is narrow. This causes the nerve and surrounding tissue to thicken.
Symptoms
Normally, there are no outward signs, such as a lump, because this is not really a tumor. Burning pain in the ball of the foot that may radiate into the toes. The pain generally intensifies with activity or wearing shoes. Night pain is rare. There may also be numbness in the toes, or an unpleasant feeling in the toes. Runners may feel pain as they push off from the starting block. High-heeled shoes, which put the foot in a similar position to the push-off, can also aggravate the condition. Tight, narrow shoes also aggravate this condition by compressing the toe bones and pinching the nerve.
Diagnosis
The exact cause of Mortons neuroma can often vary between patients. An accurate diagnosis must be carefully made by the podiatrist through thorough history taking and direct questioning to ensure all possible causes are addressed. The podiatrist will also gather further information about the cause through a hands on assessment where they will try to reproduce your symptoms. A biomechanical and gait analysis will also be performed to assess whether poor foot alignment and function has contributed to your neuroma.
Non Surgical Treatment
You may be able to treat this problem at home. Avoid wearing tight, pointy, or high-heeled shoes. Choose well-fitted shoes with plenty of room for your toes. Put ice or a cold pack on the area for 10 to 15 minutes at a time. Put a thin cloth between the ice and your skin. Take anti-inflammatory medicines to reduce pain and swelling. These include ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve). Rest your feet when you can. Reduce activities that put pressure on the toes, such as racquet sports or running. Try massaging your foot to relax the muscles around the nerve. If these steps do not relieve your symptoms, your doctor may have you use special pads or devices that spread the toes to keep them from squeezing the nerve. In some cases, a doctor may give a steroid shot to reduce swelling and pain. If these treatments do not help, your doctor may suggest surgery.
Surgical Treatment
If these non-surgical measures do not work, surgery is sometimes needed. Surgery normally involves a small incision (cut) being made on either the top, or the sole, of the foot between the affected toes. Usually, the surgeon will then either create more space around the affected nerve (known as nerve decompression) or will cut out (resect) the affected nerve. If the nerve is resected, there will be some permanent numbness of the skin between the affected toes. This does not usually cause any problems. You will usually have to wear a special shoe for a short time after surgery until the wound has healed and normal footwear can be used again. Surgery is usually successful. However, as with any surgical operation, there is a risk of complications. For example, after this operation a small number of people can develop a wound infection. Another complication may be long-term thickening of the skin (callus formation) on the sole of the foot (known as plantar keratosis). This may require treatment by a specialist in care of the feet (chiropody).
