Also known as Morton's Interdigital Neuroma, Morton's Metatarsalgia, Morton's Neuralgia, Plantar Neuroma, Intermetatarsal Neuroma) What is a Morton's neuroma? Morton's neuroma is a condition characterized by localized swelling of the nerve and soft tissue located between two of the long bones of the foot (metatarsals - figure 1), which can result in pain, pins and needles, or numbness in the forefoot or toes.
Experts are not sure what exactly causes Morton's neuroma. It seems to develop as a result of irritation, pressure or injury to one of the digital nerves that lead to the toes, which triggers a body response, resulting in thickened nerve tissue (neuroma). Feet conditions/situations that can cause the bones to rub against a nerve include high-heeled shoes, especially those over 2 inches (5cm), or a pointed or tight toe box which squash the toes together. This is probably why the condition is much more common in females than in males. High-arched foot, people whose feet have high arches are much more likely to suffer from Morton's neuroma than others. Flat feet, the arch of the foot collapses. The entire sole of the foot comes into complete or near-complete contact with the ground. A bunion, a localized painful swelling at the base of the big toe, which enlarges the joint. Hammer toe, a deformity of the proximal interphalangeal joint of the second, third, or fourth toe causing it to be permanently bent. Some high-impact sporting activities including running, karate, and court sports. Any sport that places undue pressure on the feet. Injuries, an injury or other type of trauma to the foot may lead to a neuroma.
Neuroma pain is classically described as a burning pain in the forefoot. It can also be felt as an aching or shooting pain in the forefoot. Patients with this problem frequently say they feel like they want to take off their shoes and rub their foot. This pain may occur in the middle of a run or at the end of a long run. If your shoes are quite tight or the neuroma is very large, the pain may be present even when walking. Occasionally a sensation of numbness is felt in addition to the pain or even before the pain appears.
You might first seek advice from your family doctor about your foot pain. He or she may refer you to a doctor or surgeon who specializes in foot disorders. Before your appointment, you may want to write a list of answers to the following questions. When did your symptoms begin? Did your symptoms begin gradually or suddenly? What type of footwear do you wear for work? Do you participate in sports? If so, what types in particular? What medications and supplements do you take regularly? Your doctor may ask some of the following questions. Is the pain worse in certain pairs of shoes? Does any type of activity ease the pain or worsen it? Are you having pain in any other part of your body?
Non Surgical Treatment
Orthotics and corticosteroid injections are widely used conservative treatments for Morton?s neuroma. In addition to traditional orthotic arch supports, a small foam or fabric pad may be positioned under the space between the two affected metatarsals, immediately behind the bone ends. This pad helps to splay the metatarsal bones and create more space for the nerve so as to relieve pressure and irritation. It may however also elicit mild uncomfortable sensations of its own, such as the feeling of having an awkward object under one's foot. Corticosteroid injections can relieve inflammation in some patients and help to end the symptoms. For some patients, however, the inflammation and pain recur after some weeks or months, and corticosteroids can only be used a limited number of times because they cause progressive degeneration of ligamentous and tendinous tissues.
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.