Morton?s neuroma is inflammation, thickening, or enlargement of the nerve between the bones of the toes (metatarsal bones). The condition is also called intermetatarsal neuroma. The thickening is usually found between bones of the third and fourth toes of the foot, but sometimes it may develop between the second and third toes. It occurs when the medial plantar nerve near the bones of those toes becomes compressed or irritated, possibly because the metatarsal bones press against the nerve in the narrow gap between the toes. If left untreated, Morton?s neuroma can cause a sharp, burning, or shooting pain that often gets worse over time. The pain becomes worse when a person walks or stands on the ball of the foot. Sometimes the pain reaches the toes next to the neuroma and a sensation of tingling or numbness is felt.
A Morton's Neuroma is not a true neuroma, which is a tumor that is generally benign. Rather, it is an enlargement of the nerve where it goes between the metatarsal bones of the foot. Because the nerve no longer fits between the gap, the pressure causes pain and sometimes numbness. This enlargement of the nerve is often an inflammation due to irritation. If the forefoot becomes compressed due to shoes that are too narrow, the nerve becomes damaged and inflamed. This inflammation means the nerve no longer fits in the space between the bones, creating further irritation and more inflammation. If this vicious circle can be broken, the problem may be resolved. However, in some situations the nerve can have fibrous tissues formed around it, which may require the destruction of the nerve or surgical removal.
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.
An MRI scan (magnetic resonance imaging) is used to ensure that the compression is not caused by a tumor in the foot. An MRI also determines the size of the neuroma and whether the syndrome should be treated conservatively or aggressively. If surgery is indicated, the podiatrist can determine how much of the nerve must be resected. This is important, because different surgical techniques can be used, depending on the size and the position of the neuroma. Because MRIs are expensive, some insurance companies are reluctant to pay for them. If the podiatrist believes an MRI is necessary, he or she can persuade the insurance company to pay for it by presenting data to support the recommendation.
Non Surgical Treatment
Most patients' symptoms subside when they change footwear to a wide soft shoe with a metatarsal support inside to relieve the pressure on the involved area. If this treatment fails, a cortisone injection into the nerve is occasionally helpful.
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.
How can Morton?s neuroma be prevented? Do not wear tight shoes or high-heeled shoes for prolonged periods. Do wear shoes with a wide toe box so that your toes are not squeezed or cramped. Do wear athletic footwear with enough padding to cushion the balls of the feet when exercising or participating in sports.