Mortons Neuroma is a common painful condition involving compression of nerves between the long bones of the forefoot just before they enter the toes. Commonly this involves the 3rd and 4th toes, however may affect the 2nd and 3rd toes. Repeated trauma or compression of these nerves causes the nerves to swell and thicken causing a Morton's neuroma to develop.
Pronation of the foot can cause the metatarsal heads to rotate slightly and pinch the nerve running between the metatarsal heads. This chronic pinching can make the nerve sheath enlarge. As it enlarges it than becomes more squeezed and increasingly troublesome. Tight shoes, shoes with little room for the forefoot, pointy toeboxes can all make this problem more painful. Walking barefoot may also be painful, since the foot may be functioning in an over-pronated position.
People with Morton's neuroma usually complain of pain that can start in the ball of the foot and shoot into the affected toes. However, some people just have toe pain. There may also be burning and tingling of the toes. The symptoms are usually felt up the sides of the space between two toes. For example, if the nerve between the third and fourth long bones (metatarsals) of the right foot is affected, the symptoms will usually be felt up the right-hand side of the fourth toe and up the left-hand side of the third toe. Some people describe the pain that they feel as being like walking on a stone or a marble. Symptoms can be made worse if you wear high-heeled shoes. The pain is relieved by taking your shoe off, resting your foot and massaging the area. You may also experience some numbness between the affected toes. Your affected toes may also appear to be spread apart, which doctors refer to as the 'V sign'. The symptoms can vary and may come and go over a number of years. For example, some people may experience two attacks of pain in a week and then nothing for a year. Others may have regular and persistent (chronic) pain.
The clinical symptoms should quickly lead your doctor to suspect a neuroma. When examined, the doctor may feel a "click" which is known as Mulder's sign. There may be tenderness in the interspace. The metatarsal bones will also be examined both clinically (and often with an xray). Tenderness at one of the metatarsal bones can suggest an overstress reaction (pre-stress fracture or stress fracture) in the bone. An ultrasound scan can confirm the diagnosis and is a less expensive and at this time, at least as sensitive a test as an MRI. An x-ray does not show neuromas, but can be useful to "rule out" other causes of the pain.
Non Surgical Treatment
Treatment for Morton?s Neuroma usually begins conservatively, with a change in lifestyle choices. People suffering from the condition may find pain relief by reducing activity levels, changing footwear, using orthopedic supports, reducing weight. Medications are also available to help relieve the pain of Morton?s Neuroma. Over-the-counter medications are sometimes very helpful in reducing pain and inflammation. Your health care provider can also provide you with anesthetic or corticosteroid injections. These help to numb the area affected by the neuroma, and reduce inflammation.
Should the problem have progressed beyond the point where these measures are sufficient, the podiatric professional may recommend surgery. This procedure involves excision of the involved nerve mass. This will relieve the pain. Many patients report permanent numbness in the spot formerly affected by the neuroma, but prefer it to the pain. Most surgeries are successful; unfortunately, there are cases where the patient suffers another neuroma, sometimes in or near the same spot as before. A podiatric professional can explain the statistics of recurrence in various cases. If you suspect a neuroma, don?t wait for it to get better on its own. The earlier the diagnosis, the higher the likelihood that it can be treated with conservative measures. Don?t think that foot pain of any kind is inevitable, either, even if it runs in your family.